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Barts Health NHS TRUST

Recruitment Material

For the Posts of

Clinical Fellows in the

Adult Critical Care Unit (ACCU)

Part 1: Job Description

Part 2: The Critical Care Unit

Person Specification

Job Reference Number: 259-MED824447RLH

Critical Care Fellow 10/2012 1

 BARTS HEALTH NHS TRUST
CLINICAL FELLOWS IN CRITICAL CARE

THE ROYAL LONDON HOSPITAL

JOB DESCRIPTION

SUMMARY:

These posts are for Clinical Fellows in the ACCU, the new 44 bedded Adult Critical
Care Unit at The Royal London Hospital. The Critical Care unit has 44 beds, of which
22 are dedicated level 2 beds accepting both surgical and medical patients and 22 are
level 3 beds accepting a range of trauma, neuro and medical patients. The unit is
staffed by a team of 17 Consultant Intensivists and 30 trainees from a variety of
specialties and interests (Intensive Care medicine, Anaesthesia, Acute Medicine,
Respiratory medicine, Surgery, Research Fellows). There are opportunities to gain
experience in all aspects of critical care, and particularly in the following :

NEUROCRITICAL CARE:

Patients with trauma or neurotrauma make up over 35% of admissions to the ACCU.
These patients often present with a complex range of injuries which provide many
challenges to care. We admit many patients with isolated neurotrauma, or with head
and torso injuries, requiring neurocritical care. We utilise many forms of
neuromonitoring including ICP monitoring, NIRS and EEG. We also have a portable
CT scanner, kept on the unit, specifically for traumatic brain injured patients.

CRITICAL CARE ECHOCARDIOGRAPHY:

Multiple international studies have documented the utility of a limited or focused echo
study in the management of acutely unwell patients within the critical care area.
Focused Intensive Care Echocardiography was introduced in 2013, as a joint
collaboration between the Intensive Care Society and the British Society of
Echocardiography. Its aim is to provide training in basic level echocardiography for
doctors working in general intensive care units. It is designed to provide a level of
competence which would allow rapid cardiovascular assessment in critically unwell
patients.
FICE accreditation requires a logbook of 50 echo studies, with direct supervision of
the initial 10 cases. In the ACCU at the Royal London Hospital, we have four
Consultants who are accredited FICE mentors.

TRAUMA CRITICAL CARE :

From Roadside to Rehab

The ACCU at the Royal London Hospital gives the post holder the opportunity to be

Critical Care Fellow 10/2012 2

involved in Britain’s busiest trauma ICU. The trauma case mix is varied and there is
an active M+M and quality improvement programme. There would be an opportunity
to develop critical care skills relating to care of the trauma patient on the ITU, as well
as undertake audit and research into this area.
Educational: Attending trauma meetings, including weekly trauma radiology meetings
and monthly trauma M&M and peer review meetings. Attending the ICU follow up
clinic to review the post discharge course of Trauma patients Attending the monthly
HEMS longitudinal audit meeting

CRITICAL CARE NEPHROLOGY :

The ACCU has close links with the large renal and transplant unit based at the RLH.
The unit provide critical care support to the dedicated renal HDU, which Drs Prowle
and Kirwan also intermittently cover in addition to their ACCU commitments. There
are a number of research and service improvement projects, both planned and
running, in topics such as CRRT and citrate regional anticoagulation, AKI detection
and management and AKI during and after critical illness and major surgery. We have
a strong track record of generating poster presentations at international meetings as
well as journal publications for more substantial projects.

CRITICAL CARE EDUCATION :

The ACCU has a well established, active program that spans the full breath of
interprofessional, undergraduate and postgraduate medical education and through this
we present an exciting opportunity for a trainee to grow as an educator and develop a
rounded and competitive postgraduate educational portfolio. Members of our team
deliver clinical and class-room based small group teaching, lectures, high fidelity and
insitu simulation; organise courses and act as examiners within critical care and more
widely throughout the hospital and medical school. Ongoing and proposed projects
include : interprofessional insitu simulation on the ACCU, creation of novel learning
resources, clinical skills teaching, a new ‘in-house’ basic critical care course and
educational environment tracking.

JOB DESCRIPTION

Duties of the post

The duties are not definitive and may be changed in accordance with the needs of the
service.
1. Admitting emergency patients to the ACCU.
2. Involvement in day-to-day inpatient management under the direction of the
Consultants and other senior trainees.
3. Liaising with medical / surgical teams about patient’s admission, progress and
discharge.
4. Liaising with nursing staff, physiotherapists and other clinical staff about patient
status.
5. Caring for patients on the ACCU. This includes prescribing and supervising

Critical Care Fellow 10/2012 3

 treatment, instituting invasive monitoring and gathering and interpreting results.
6. Explaining the patient’s condition and progress clearly to patients and relatives.
7. Maintaining accurate medical records, including data for audit purposes.
8. Providing and receiving pertinent handover at the start and at the end of shift.
9. Participation in educational activities including formal teaching sessions, X-ray
meetings, journal clubs and case presentations.
10. Development of his/her own interests, including active participation in clinical
audit.
11. On- call will be a full-shift which is consistent with 1A banding under the New
Deal on junior doctors hours.
12. Reviewing patients referred to the critical care service from other wards and from
the A and E Dept.

General Duties of the Post

1. To contribute to the provision of a comprehensive and efficient critical care

service.
2. To provide evidence-based care for all inpatients.
3. To have regard at all times to the clinical and quality standards set out in the
Patients Charter and the local purchasers’ contracts.

Accountability

The appointees will be accountable to the lead Clinician for Critical Care, DrDan
Kennedy.

Clinical Governance

The post holder is expected to participate in the Trust’s clinical effectiveness

activities, and to encourage and foster improvements in the quality and standards of
clinical services. The post-holder will assist with the safeguarding of high standards
of care by participating in the creation of an environment in which excellence in
clinical care will flourish.

Infection Prevention and Control Roles and Responsibilities

All staff - core statement

 To adhere to Trust policy and infection control principles and standards to

minimise patient risk and ensure high quality patient care.
 Undertake appropriate training and practice to ensure you (and your teams)
have the right skills and are competent.
 Are responsible for keeping the environment clutter free, clean and raising
issues of concern in the interest of staff and patient safety.
 Ensure high cleaning standards to prevent infection and increase patient's
confidence

Study, Training and Teaching

Critical Care Fellow 10/2012 4
Study leave is available as provided for under the Terms and Conditions of Service of
Hospital Medicine and Dental Staff (England and Wales) subject to the approval of
the lead clinician for ICU.
There will be formal teaching, and attendance at postgraduate educational meetings
will be strongly encouraged. Opportunities exist for gaining experience in other
activities such as Patient at Risk Team, ICU follow-up clinic, ultrasound-guided
central venous access, echocardiography, invasive monitoring and airway
management etc.

Research and Development

Extensive research facilities exist at Barts and the London NHS Trust and research
will be actively encouraged.

Equal Opportunities

The post holder must at all times carry out responsibilities and duties with due regard
to the Trust’s Equal Opportunities Policy.

Health and Safety

The post holder is expected to undertake the appropriate management responsibilities,

and be aware of individual responsibilities in accordance with the Trust’s Health and
Safety policy and report as necessary, any untoward accident, incident or potentially
hazardous environment. The post holder will promote and implement the Health and
Safety Policy. The Trust operates a No Smoking Policy.

Salary and Conditions of Service

The post is subject to the Terms and Conditions of Service of Hospital Medical and
Dental Staff (England and Wales), to the General Whitley Council Conditions of
Service and also to the National Health Service Pension Regulations.

Due to the nature of the work in this post, it is exempt from the provision of section 4
(2) of the Rehabilitation of Offenders Act 1974, by virtue of the Rehabilitation of
Offenders Act 1974 (Exemption Order 1975).

Applicants are therefore not entitled to withhold information about convictions,

including those, which, for other purposes are “spent”, under the provisions of the
Act, and are required to disclose convictions including those pending, to the Trust.
Failure to disclose such information may result in dismissal or disciplinary action.

Salary will be paid in accordance with seniority and a 1A banding supplement.

Further Information from:

Prospective candidates are encouraged to visit the Trust, which may be arranged by
Critical Care Fellow 10/2012 5
contacting one of the following:

Dr Mo Thavasothy, c/o Intensive Care Unit

Dr Vishi Verma, c/o Intensive Care Unit
Dr Malgorzata Starczewska, c/o Intensive Care Unit
The Royal London Hospital, Tel: 0203 594 0346 or 0203 594 0347 – ICU secretary

Other Aspects of the Post / Additional Information

The above is an outline only. It is not exhaustive and may be altered from
time to time in accordance with the needs of the Service. The post holder will be
required to be co-operative and flexible in accordance with the needs of the service.
He/she would be able to gain experience in many aspects of adult critical care
including audit, research, critical care outreach, out-patient follow-up and
management.
The unit offers particular expertise in all aspects of the care of the critically ill
patient. There is a considerable commitment to the resuscitation of patients presenting
to our busy Accident and Emergency Department.
Currently, 30 trainees participate in a 2 tier full shift system. The advertised
posts form part of the 2nd tier of trainees based on both the HDU and ITU sides of
ACCU and they will have duties commensurate with the training needs of the
individual.

BARTS AND THE LONDON NHS TRUST

Part 2: The Critical Care Unit

Critical Care at The Royal London Hospital

The Royal London Hospital (RLH) forms part of Barts and The London NHS
Trust. The Critical Care unit is a tertiary referral unit for neurosurgery, trauma,
vascular, hepatobiliary and renal services, and caters for a large deprived local
population. The RLH is the base hospital for the London’s Helicopter Emergency
Medical Service (HEMS) and the Accident & Emergency Department caters for over
100,000 patients every year. We are currently funded for 22 level 3 beds and 22 level
2 beds.
We have approximately 1,000 admissions per year to the ICU and approx
1400 admissions to HDU. There are about 1,000 trauma calls each year and an ICU
doctor attends each one.
We have extensive experience in Critical Care audit and participate in
ICNARC. There are 2 consultant ward rounds per day and daily microbiology ward
rounds. There is an active educational programme with a dedicated Critical Care
teaching session each week and a weekly Critical Care journal club. In addition, there
are weekly M&M meetings, which all trainees present at, and weekly radiology
meetings.
A Patient At Risk Team (Critical Care Outreach) was set up in 2001 and
Critical Care Fellow 10/2012 6
consists of a nurse consultant, a senior physiotherapist, 2 F-grade nurses. The
Intensive Care unit has a dedicated laboratory and equipment library, 4 seminar
rooms, 2 trainee offices, consultant offices, on-call rooms and relative’s room. There
are ongoing research and audit opportunities.

A multidisciplinary ICU outpatient follow-up clinic has been established since 2002,
staffed by a lead consultant and 2 ICU nurses, an occupational therapist and a
physiotherapist. The clinic is conducted once per month and is offered to all patients
who have been on the unit for 4 days or more.
We currently have 17 consultants with sessions on the unit. Consultant cover
is for one week at a time although this is currently being reviewed. We have ICU
pharmacists (2), technicians (5), physiotherapists (3), a dietician, 3 ward clerks and 2
full-time secretaries.
The ACCU caters for a wide variety of acutely unwell medical patients. The
casemix includes patients with respiratory failure and sepsis along with
gastroenterological, renal and endocrine disorders, and elective surgical patients from
a variety of surgical specialties. There are more than 1400 admissions per year, with
an average length of stay of 3 days. Invasive monitoring and multiple organ support
are provided.

BARTS AND THE LONDON NHS TRUST

The Anaesthetic Department

The Anaesthetic department provides anaesthetic services at the three main hospitals
in the Trust. A Department of Anaesthesia exists at each of the 3 sites, with a local
Chairman/woman, under the overall managerial control of the Anaesthesia and
Critical Care Clinical Academic Unit (CAU). The CAU lead is Dr Simon Harrod.
There are also a number of lead clinicians for the various anaesthetic subspecialties.

Hours of work

The successful candidates will participate in a full-shift rota (1:6) compliant with the
New Deal on Junior Doctors hours. Each of the trainees will work 3 to 4 x 12.5 hour
shifts per week (08:00 to 20:30 or 20:00 to 20:30), an average of 48 hours per week
and 1:3 weekends (with internal cover).

Critical Care Fellow 10/2012 7

 Person Specification
Post: _______ Clinical Fellow in Critical Care_________________
Base Hospital: ___ The Royal London Hospital________
Qualifications:
Higher Qualifications:
Knowledge
Clinical expertise in Speciality
/Sub speciality:
Training Expected:
Management/Audit Experience:
Academic Achievements:
Research/Publications:
Personal Skills:
Personal qualities
Signed: Dr Daniel D Kennedy
Date: September 2012
Critical Care Fellow 10/2012
Essential Desirable
MB BS or equivalent Primary MRCP, MRCS, FRCA
or equivalent
Current GMC registration
MRCP, FRCA
Some critical care experience
1 to 2 years at SHO level in
Acute Medicine, Emergency
Medicine, Specialist Medicine,
Surgery or Anaesthesia
Some evidence of academic
work outside standard MBBS
course.
Flexible approach to work and
evidence of team working
IT literate
Self motivated
Ability to work under pressure
Able to work as part of a team
Reliable work record
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