Advanced Critical Care Practitioners (ACCPs) are part of the multidisciplinary team within the Adult Critical Care Unit (ACCU). ACCPs are clinical professionals responsible for delivering high-level clinical care throughout a patient’s critical care admission.

The ACCPs in RLH work as part of the junior medical rota and their clinical duties include:

– assessment of critically ill patients, including taking a history and clinical examination

– review of critically ill patients in the intensive care unit and deteriorating patients throughout the hospital, intervening to prevent patients from deteriorating further, and working under the supervision of the intensive care consultant to formulate a clinical plan

– performing diagnostic, therapeutic and emergency invasive and non-invasive procedures such as ultrasound, invasive lines placement and airway management

– prescribing medications, intra-venous fluids and blood products (according to current legislation)

– teaching, education and supervision of junior colleagues and peers (i.e. doctors, nurses, physiotherapists and other allied healthcare practitioners)

– communication, engagement and liaison of patients, relatives, specialist teams and other members of the multi-professional team (e.g. physiotherapist, speech and language therapist, dietician)

The role spans traditional professional boundaries between medicine, nursing and the allied healthcare professions. The role of ACCP is available, by competitive application, to nurses, physiotherapists, paramedics or other related health care professionals who are already experienced in the delivery of critical care.

ACCPs are accredited with the Faculty of Intensive Care Medicine and must complete a 2-years training programme which includes i) clinical training in line with the Curriculum of the Faculty of Intensive Care Medicine and ii) an academic pathway leading to a Masters degree focused on Critical Care Medicine including an advanced assessment and independent prescribing course with an accredited Higher Education Institution. ACCP education within hospitals is overseen by a named lead medical Consultant and the University Educational Lead who are responsible for the delivery of the academic and clinical components of training. Whilst working, the ACCPs each retain medical supervision from a named consultant in Intensive Care Medicine. The Department of Health National Education and Competence Framework for ACCPs by the Faculty of Intensive Care Medicine can be found at the following link:

Meet the ACCPs:

Brigitta Fazzini

BSc(Hons), PgDiP DTN, MSc (Crit Care and Adv Clin Practice), NMP(V300), FHEA

Brigitta is an Advanced Critical Care Practitioner in the Adult Critical Care Unit (ACCU) at the Royal London Hospital and an honorary research fellow at Barts Health with Queen Mary University of London (QMUL).

She originally graduated in Italy with a BSc(Hons) in Adult Nursing, and she moved to London in 2014 working within ACCU ever since. During these years she has developed and consolidated 10 years of experience in intensive care and critical care outreach alongside a solid academic pathway including a MSc in Critical Care MSc and a second MSc in Advanced Clinical Practice. Interested in humanitarian healthcare and global health, she holds the Professional Diploma in Tropical Medicine. She is accredited for Focus Ultrasound in Intensive Care (FUSIC) with the Intensive Care Society (ICS) and she mentors and supervises ICM/Anaesthetic doctors, physio and nurses on FUSIC heart and lungs. Alongside her clinical commitment, she undertakes research and quality improvement work with the Critical Care and Perioperative Medicine Research Group (CCPMG) and she teaches on the Critical Care MSc at QMUL. She is the Deputy Chair of the UK Intensive Care Society (ICS) Professional Advisory Group for Advanced Practitioners in Critical Care advising the ICS governing council on national policy, guidelines, position statements and education for ACP/ACCPs in critical care.

Alex Nobrega

BSc(Hons), MSc (Crit Care), NMP(V300)

Alex is an Advanced Critical Care Practitioner in the Adult Critical Care Unit (ACCU) at the Royal London Hospital.  Originally graduate in Portugal with a BSc (Hons) in General Nursing, moving to the UK in 2013 to work in a respiratory and general medicine ward at Great Yarmouth Hospital. Developed an interest for critical care nursing moving to the adult intensive care unit at Guys and St Thomas Hospital in 2014. Having completed his nursing critical care training, he adventured into advance practice as a Nurse Practitioner in Cardiac Surgery developing skills as an autonomous practitioner and non-medical prescriber.

A return to the general critical care unit with the COVID Pandemic re-ignited his true passion for critical care moving to the Royal London Hospital to start his training as an advanced critical care practitioner in 2021. He has completed a MSc in Critical Care.  He supports teaching on the Critical Care MSc at QMUL and he is actively involved in simulation training within the ACCU. He is currently completing the FUSIC Heart and Lung portfolio.