CCT in ICM - programme overview unit ... - London Deanery

JOB DESCRIPTION
Specialty Training Programme in Intensive Care Medicine
London Deanery
The training programme – an overview
The CCST in ICM training programme is open to Anaesthesia, Emergency
Medicine, Medical or Surgical specialty trainees in years ST3, ST4 or ST55 of
their base specialty training programme. It is an advantage for applicants to
have completed 3 months of basic ICM training and 6 months complementary
specialty training at ST 1-2 level, but if necessary this training can be
provided within the ICM training programme.
The duration of the programme will vary from 1 to 2 years, depending upon
the previous experience of the trainee, but typically will consist of:
1. Intermediate Training: 2 x 3-month blocks of Intensive Care Medicine
done at ST3 level or above. Applicants who have already undertaken
Intermediate training as part of their base specialty training will not be
required to repeat the training, as long as it was done in a manner
consistent with the guidelines of the ICBTICM.
2. Advanced Training: 1 year of Intensive Care Medicine done during the
last 2 years of clinical training, typically ST6 or 7. Trainees must gain
experience in at least 3 different ICUs during their Basic, Intermediate
and Advanced training, and ideally at least 3 months of this should be
spent in a District General Hospital.
3. Complementary module(s): If not already completed at ST 1-2 level,
complementary module training can be undertaken as part of the
programme.
Hospitals participating in the training programme include Chelsea and
Westminster, Charing Cross, Guy’s and St Thomas’, Hammersmith, Homerton,
King’s College, Kingston, Royal Brompton, Royal Free, Royal London, St
Bartholomew’s, St George’s, St Helier, St Mary’s and University College.
Descriptions of the units are given below and applicants are encouraged to
contact individual units should they require further information. The pattern
of work and out-of-hours duties may vary in different units, but will be
compliant with the current guidelines for junior doctors’ hours. Annual and
study leave entitlement will be identical to that provided in the base specialty
training programmes.

DESCRIPTIONS OF UNITS PARTICIPATING IN THE PROGRAMME
Charing Cross Hospital
Contact: Dr Doris Doberenz (0208 383 00 00 bleep 5742,
ddoberenz@hhnt.nhs.uk)
Charing Cross Hospital has 550 beds and is part of the Hammersmith
Hospitals NHS Trust (1000 beds in total) and Imperial College Medical School.
The Intensive Care Unit is a modern facility on the 11 th floor with 12 general
critical care beds. Also on the 11 th floor are two high dependency facilities (a
9 bed surgical unit and a 13 bed neurosurgical unit), which are run by the
base specialities in close cooperation with the intensive care team. A 6 bed
medical level 2 facility is on the 5th floor to which the ICU team also has an
input, as required. The clinical workload is complex due to the nature of the
institution and this is reflected in the training experience likely to be gained.
There is significant level 1 activity in the hospital, which forms the major work
load of the outreach team (1 critical care nurse consultant and 2 G grades).
There are about 500 ICU admissions per annum, 70 - 80% of whom are
emergencies, with a mean length of stay of 7 days. Occupancy rate is
constantly between 95 – 100%. The case-mix consists of general surgery,
complex urology, vascular surgery, major head and neck cancer surgery,
trauma, neurosurgery, neurology, general and respiratory medicine,
gastroenterology and oncology. Ultimate responsibility for admission to,
discharge from and patient care on the ICU lies with the consultant intensivist
(‘closed ICU’) in consultation with the referring or other medical and surgical
teams, with whom cooperation is usually very good. Every bed has
standardized modular monitoring including PiCCO, with information
technology allowing access to results and patient documentation. The unit
has a sophisticated critical care specific database (AcuBase), which provides
for patient documentation, severity of illness assessment and complex
analyses, which is administered by a dedicated team of data collectors, audit
and research nurses and has been operational since 1992. The consultants
are full time with commitments to critical care alone. They work for a week at
a time to facilitate continuity of care. All junior staff work full shifts. The ICM
trainee forms part of a group of three “middle” grade trainees. The two
others are a respiratory medicine SpR and an international clinical fellow who
is usually a newly registered specialist. They work a shift pattern, which
amounts to an average 43 hours per week (including weekends) and provides
cover until midnight, presently with no overnight on-call (this is done by
consultants, SHOs and the anaesthetic SpR). The actual rota is organised
between the ICM trainee, SpR and clinical fellow themselves.

The ICM SpR duties (similar to those of the other two middle grades) are
predominantly on the ICU, however, there are critical care activities on the
remainder of the 11 th floor and elsewhere in which the trainee may become
involved if appropriate.
The middle grade group works in close cooperation with the consultants and
takes an active role in supervision and training of the SHOs on the unit.
All junior doctors, including SpR’s, get two induction days, organized by the
hospital and the local educational supervisor for intensive care medicine.
Opportunities for education, training, teaching and management
Two to three consultant ward rounds each day at 9 am, 4 pm and 9 pm with
bed-side teaching, and a daily meeting or ward round with consultant or SpR
in Infectious Diseases/Microbiology.
Some ward rounds are delegated to or done by the SpR’s under consultant
supervision.
Monthly dedicated half day for critical care teaching
Release for the regional critical care lectures half day
Weekly CX Hospital Grand rounds in term time
Weekly anaesthetic department teaching half day
Bi-monthly Morbidity and Mortality meetings
Monthly audit and research meeting
Bi-monthly unit multidisciplinary management meeting
Audit and Research
There is an active research programme. Interest and studies have included
promotion of native renal function, antibiotic kinetics, the impact of
physiotherapy on time to becoming ventilator free, and presently mainly
consist of a major examination of enteral and parenteral nutrition and
ventilator associated pneumonia, Selective Decontamination of the Digestive
tract, the relative merits of antacid therapies, ethical issues regarding bed
management and a number of sponsored studies. Projects are developed and
discussed in a monthly audit and research meeting. Interested junior doctors
usually carry out audit projects. Intermediate and advanced ICM trainee SpR’s
are expected and encouraged to participate in all educational, audit and
research activities and to develop their own projects. We would expect the
SpR to aim for at least one publication during their stay.
Critical Care Staffing at CXH
Full time Intensive Care Consultants
Dr Mark Palazzo – Chief of Service for Critical Care Medicine for Hammersmith
Hospitals NHS trust
Dr Doris Doberenz – Local educational supervisor for Intensive Care Medicine
Dr Roseanne Meacher – Lead for clinical governance
Dr Adrian Steele
Dr Anthony Gordon – Locum Consultant
Anaesthesia Consultants
2 consultants for weekends on-call 1 in 7: Dr Brian Porter, Dr Lynda Webb

Trainees
1 CCST in ICM trainee, intermediate or advanced (this post)
1 SpR in Respiratory Medicine regularly attached to ICU for six months
1 international Clinical Fellow
1 senior SpR in Anaesthesia on-call for anaesthetic ICU duties
1 junior SpR in Anaesthesia regularly attached for three months
7 SHO’s from other base specialities (Medicine, Surgery, A + E)
Chelsea and Westminster
Contact: Dr Neil Soni (0208-746-8000)
The Intensive Therapy Unit
The Intensive Therapy Unit is under the Service Directorship of Dr Neil Soni.
There are currently 4 Intensivists involved in running the ITU; Drs Soni,
Fauvel, Hayes and Keays. A fifth consultant is about to be appointed. The unit
has 11 intensive care beds, of which 7 are ventilator beds and 4 function as
ITU stepdown/HDU beds. At present there are 450 admissions per year
through the unit, but this is rising since the extra beds were opened, and is
expected to increase to 600 over the next 18 months. The occupancy rates of
the ITU vary between 90 and 100%.
It is a fully equipped modern unit, which caters for an extensive range of
specialties including trauma, vascular surgery, general surgery, oncology and
obstetrics.
The Intensive Care Unit is staffed by members of the Anaesthetic
Department. A SpR is allocated to the unit for a block of 3 months as part of
their training requirement. A senior SpR 3 or 4 is allocated to the unit for a
period of 3 months at a time. These senior trainees select to do ITU. There is
also a 1-2 yr post for CCST in ICM trainees. There is an active interest in
research with a wide range of research interests. There is a comprehensive
audit process using Acubase for patient data. At present clinical audit is
conducted in conjunction with the rest of the anaesthetic department.
The consultant roster is based on a week on call at a time, thereby
guaranteeing continuity of care. All admissions and discharges through ITU
are at the discretion of the Consultant in charge of ITU. The Intensivist and
the Intensive Care team is clinically responsible for the patient in the ITU with
open consultation relevant medical teams and in particular the admitting
team. The unit enjoys a good rapport with other specialties in the hospital.
We are in the process of developing a more formal Outreach Service.
Previously problems on the ward were referred to the ITU team for
consultation. It is hoped that we will have a team of ITU trained nurses who
will provide ITU advice and assistance in the management of problems in ten
acute ward areas. This team will be led by a Nurse Consultant in close
consultation with the ITU Medical team.

The post
This post will involve being the SpR in Intensive Care Medicine on a busy
General Intensive care Unit with five Intensivists involved who are on-call one
week at a time. There is an active teaching and research programme and
close links with the Brompton, Charing Cross and Hammersmith Hospitals.
During the time in this post, it is hoped that the SpR would be able to
consolidate technical and practical procedural work and to have further
education experience in Intensive Care Medicine.
Guy’s and St Thomas’ Hospital Trust
Contact : Dr Angela McLuckie 020 7188 7188 extension 83049/
Angela.McLuckie@gstt.nhs.uk
The Critical Care department consists of two 15-bed ICUs in the East Wing at
St Thomas’, a 13-bed ICU on the Guy’s site, a 6-bed medical HDU at St
Thomas’ and a 4-bed surgical HDU, again at St Thomas’. Each unit is staffed
by a dedicated team of medical staff, although staff rotate between units at
regular intervals. All beds are equipped with the most modern ventilators
(including HFOV), invasive monitoring equipment (PiCCO, LICO, PAC) and the
CareVue clinical information system. Calcium-Citrate haemodialysis and the
Genius system supplement the more usual forms of renal replacement
therapy. The unit also participates in the ICNARC national audit programme.
Over 2500 patients are admitted each year with a variety covering all
specialties with the exception of neurosurgery. Many regional tertiary services
e.g. cardiothoracic, vascular, renal and pancreatic transplant surgery are
based in the Trust. About 200 cases are referred from District General
Hospitals, mostly for the management of ARDS and multiple organ failure.
The unit has an active research programme undertaking studies in the fields
of sepsis and septic shock, haemodynamic monitoring, ARDS,
immunonutrition and renal replacement therapy.
Staffing
Consultant staff:
Nicholas Barrett
Richard Beale
Craig Davidson
Guy Glover
Nicholas Hart
Andy Jones
Boris Lams
Chris Langrish

Richard Leach
Angela McLuckie
Manu Shankar-Hari
Marlies Ostermann
Marius Terblanche
Ros Tilley
David Treacher
Adrian Williams
Duncan Wyncoll
Trainees:
7 CCT in ICM
1 Clinical Fellow
6 rotating STs in anaesthesia
3 rotating STs in respiratory medicine
3 rotating STs in Acute Medicine
1 rotating trainee in GIM/Infectious Disease
18 ST1-2 trainees from a variety of specialties including CMT, Anaesthesia
and ACCS
Duties of the post
The post holder will take part in a resident, full-shift, band 1A rota (involving
1:7 night duties). During Step 2 the post holder will be expected to assume a
greater level of responsibility e.g. conducting ward rounds under consultant
supervision. Active participation in audit, teaching and research will be
expected.
Teaching programme
Tuesday 8.15 - 9am Journal Club/Morbidity and Mortality meeting
Wednesday 1300 – 1400 Staff Round
Wednesday or Friday 8.15 – 9am Departmental Tutorial
Daily microbiology ward round
Bi-monthly audit meeting
Appointees will also be able to participate in the CME programmes within the
base specialty departments.
Attendance at the 3 monthly London Intensive Care Group meetings is
encouraged.
Research opportunities
Trainees spending more than 6 months in the unit are encouraged to
undertake a research project. The specific project will depend upon the

interests of the post holder. Assistance will be given for them to present the
results of their research at both national and international meetings.
Other training opportunities
The appointee will have the opportunity to attend management and
computing courses. They will also be involved in the ST1-2 interview process,
business planning for the ICU service, and invited to attend relevant meetings
between the consultants and finance/business managers.
Base Hospital – Hammersmith
Contact: Dr Adrian Steele (020 8743 2030, bleep 5626)
The General Intensive Care Unit at ‘The Hammersmith Hospital’ is a 16bedded
level 3 unit, which opened in the autumn of 2005. In addition there
is a 6-bedded Cardiothoracic Intensive Care Unit run by the Cardiothoracic
team and a Renal ‘Advanced Care’ facility run by the Nephrologists. The
General Intensive Care staff frequently supports both these facilities
The Hammersmith Hospital has a worldwide reputation as a centre of
research and teaching excellence. And is set to continue as a vibrant and
progressive medical facility. The Hospital shares its site in Du Cane Road,
West London, with the Medical Research Council and the Imperial College
School of Medicine. The hospital deals with referrals from all over Britain and
with patients with rare diseases from all over the world. It provides regional
services in several clinical areas including haematology and BMT. Cardio-
Thoracic and Cardiological services are leaders in their field and require
regular support from the General Intensive Care facilities. Recently the West
London Renal Services (including Transplantation Services) have moved to a
new block on the Hammersmith Campus.
Historically 400 patients were admitted per year, many with complex
medical conditions (this is likely to increase with the increased bed capacity).
Surgical specialties supported include Hepatobiliary, Endocrine, Renal
Transplantation, major Gynaecology, complex Cardiac surgery, complex
Obstetric. Medical sevices supported include Oncology, Neurology,
Cardiology, Gastroenterology, Respiratory Medicine, Infectious Diseases,
Nephrology, Haematology and Bone Marrow Transplantation.
Members of Staff:
Consultant Dr Graham Baldock FRCA
Dr Stephen Brett MD FRCA
Dr Robert Broomhead FRCA
Dr Parind Patel FRCA
Junior Staff 1 SpR (senior SpR trainee in ICM)
1 SpR (anaesthetic SpR345 rotation)

The post
1 Anaesthetic SpR 1,2 trainee
1 Anaesthetic SHO trainee
3 SHO’s from The Hammersmith SHO Medical Rotation
3 SHO posts appointed by the ICM Dept.
1) Clinical Education – Responsibility for the day to day management of all
patients in conjunction with the Intensive Care Consultant. A full working
ward round is held each morning, afternoon and evening, including
holidays and weekends. At the Hammersmith there are numerous
opportunities to interact with specialist colleagues who are equally keen to
offer expertise and teaching. We have a daily ward round with a
Consultant in Microbiology or Infectious Diseases. A Consultant
Radiologist reviews all radiographs with the team each weekday. We are
also fortunate to have very dedicated and experienced pharmacists,
physiotherapists and dieticians who support the medical and nursing staff.
2) Administration and Teaching – The Senior trainee is currently administers
the rota of those more junior positions on the unit, and assists the
consultant staff in the development and delivery of the teaching
programme
3) Audit and Research – Involvement in Clinical Service Improvement
projects is expected; times permitting the juniors present an audit project
to the multidisciplinary team during their time on the unit. Participation in
research is also encouraged (and facilitated, if we possibly can).
General adult intensive care unit with 10 beds and approximately 350
admissions each year. High porportion of patients requiring haemofiltration.
Particular interests in complicated upper gastrointestinal surgery and acute
invasive cardiology. We also have regular clinical involvement with patients in
the 10 bed cardiac surgical ICU/HDU.
Consultants are Dr Graham Baldock (North West Thames Network Director),
Dr Stephen Brett (Regional Educational Advisor) and Dr Adrian Steele. There
are 2 registrars and 6 SHOs/RMOs.
The rota will be resident 1 in 5 or 6.
There is an active research programme that currently includes the genetic
contributions to critical illness, and a follow up clinic to examine the long-term
consequences of critical illness. From time to time industry-sponsored studies
are undertaken. In addition, Dr Brett is a member of the North Thames ICU
Blood Interest Group, and the unit contributes to multi centre studies coordinated
by this group. Future projects will include epidemiological studies
in hospital infection.
There is an active programme of audits and there are opportunities for
trainees to carry out audit projects and from time to time contribute to the
research studies.

Homerton University Hospital
Contact: Dr Lawrence Tham (020 8510 7300)
This is a 500-bedded DGH situated in Hackney, east London. The ITU has 10
beds and is a mixed medical-surgical unit. Admissions per year total between
350 and 400 cases. Acute medical admissions make up approximately 60% of
cases. The remaining patients derive predominantly from elective/emergency
surgical work and obstetric emergencies. A substantial proportion of patients
are admitted directly from the busy accident and emergency department.
Nearly 60% of patients require mechanical ventilation on admission.
There are 6 ITU consultants; 3 have general medicine as their base specialty
while the remaining have an anaesthetic background:
Dr. Bob Ghosh (ITU physician and lead clinician)
Dr. John Coakley (ITU physician and Medical Director)
Dr. David Watson (Senior lecturer in anaesthesia & intensive care)
Dr. Lawrence Tham (Consultant anaesthetist and local educational
supervisor)
Professor Charles Hinds (Professor in intensive care medicine)
Dr. Karim Chadda (locum)
The trainee will participate in ITU ward rounds and ward work, and will have
an opportunity to ‘lead’ ward rounds when appropriate. He/she should gain
experience in performing percutaneous tracheostomies. There are fixed
educational sessions within the hospital, including a weekly postgraduate
meeting and weekly teaching/lectures in the department of anaesthesia.
Other trainees attached to the ITU include a surgical rotational SHO, a
foundation SHO and an anaesthetic PRHO.
King’s College Hospital
Contact : Dr Elizabeth Wheatley/ Dr Julia Wendon (020 7346 3252)
The Liver Intensive Care Unit
The liver ITU is a specialist intensive care unit and is part of the Institute of
Liver studies and the Liver Care Group within Kings College Hospital. The
Liver Care Group is composed of a multidisciplinary team of medical, nursing
and paramedical staff caring for patients with liver disease of all aetiologies.
There is a hepatology component (in and out-patient work), a liver transplant
programme, a hepatobiliary service and an intensive care service. In addition
to this there is a large and active research programme, with both clinical and
basic laboratory research being undertaken.
Complete dedicated diagnostic and therapeutic facilities are available for the
specialist treatment of liver disease of all aetiologies. There is a ten bed adult
intensive care unit with facilities for support of multiple organ failure. (There

are separate paediatric liver ITU beds within the department of paediatrics).
The unit admits patients from the local ward environment, (liver and
hepatobiliary), theatres (transplant and hepatobiliary) and other referring
hospitals for the provison of tertiary liver and hepatobiliary intensive care.
Approximately 500 patients per year are admitted to the ITU, with a mean
age of 48 years and an average mortality of 26%. Approximately 80% of
patients are ventilated and 42% have renal failure. Approximately 100 cases
per year will be admitted with acute liver failure. This cohort of patients are at
risk of developing cerebral oedema and intracranial pressure bolts are
frequently inserted in those that become deeply encephalopathic.
Hepatobiliary surgery accounts for 60-70 admissions a year , comprising a
mixture of elective surgery and liver trauma. Last year the Unit undertook 180
liver transplants with adult cases accounting for 120. The other source of
admissions are patients with sepsis and multiple organ failure who have had
previous transplants or surgery and those with decompensated chronic liver
disease. Increasingly there are developments in the area of extracorporeal
liver assist devices which are utilised in these patients groups.
The liver surgery is performed in a dedicated theatre which is co-located with
the Liver ITU and liver wards. One floor above the ITU there are laboratory
services for the clinical service and research components of the Institute.
There is active clinical research being undertaken within the ITU area and
staff are all encouraged to participate in such programmes.
The ITU is staffed on a 1:1 nurse to patient ratio with a high proportion of
ITU trained nursing staff. The medical cover at consultant level is provided by
2 full-time intensivists, undertaking weekday cover in one week blocks. Junior
cover is provided by a full-time shift system of registrars from a background
of internal medicine, surgery and/or anaesthesia. The rota involves a work
pattern of 1 night shift in 7 and is compliant with junior doctors hours.
Anaesthetic registrars from the liver rotation are also attached to the Unit as
thetare commitments allow. A senior house officer is also attatched to the
ITU, but does not partake in the on-call service. The on-call service for ITU
trainees would probably be as on on-call form home if they wished in a
“senior registrar “ type capacity with support from one of the consultant staff.
The ITU is supported by a dedicated consultant microbiologist and 2 specialist
pharmacists are attached to the liver service. The activity of the unit is
audited using “R.I.P.” software, data is input is undertaken by a dedicated
nurse. All routine investigations are retrievable electronically. A consultant
from radiology reviews the imaging of the patients on a daily basis within the
liver ITU. There is excellent support from interventional radiology and a
weekly X-ray meeting to review the images. Additionally there are dedicated
dieticians and physiotherapists all of whom play integral roles in patient care.
The unit is equipped to provide full ventilatory support at all beds, with a full
range of invasive monitoring techniques. Renal support is achieved with
haemofiltration and diafiltration and facilities exist to provide this in seven

eds at any one times. Facilities are available to monitor intracranial pressure
in patients with cerebral oedema.
The consultants in the liver intensive care undertake 2 ward rounds a day and
there are multidisciplinary meetings each evening with the transplant team to
discuss patients in the ITU. The hospital has an active post- graduate
education programme and in addition there is a regular programme within the
liver unit unit incorporating histology, X-ray meetings, case reviews, audit and
clinical governance. Particular to the ICU area there is a weekly journal club,
with regular clinical governance, audit and mortality and morbidity meetings.
The Adult General Intensive Care Unit
King’s College Hospital is fortunate in being one of the few London teaching
hospitals covering all the major specialties on one site. It functions as a level
1 Trauma Unit, receiving frequent referrals from HEMS.
The AICU is equipped for 18 beds, and is currently funded for 14. There are
separate general HDU (10 beds) and neurosurgical HDU (10beds). Three
month rotations to the Liver Intensive Care Unit or PICU are possible for
those interested. Dr Max Ervine (Director) and four other consultants (three
anaestheticts, one physician) provide continuous cover to the AICU.
The post would entail participation in the day to day running of the AICU and
HDU, with the opportunity to lead ward rounds and make management
decisions. The on-call rota is a 1:5 partial shift, with consultant cover from
home. Participation in the ICM teaching programme and research are actively
encouraged
The Royal Brompton Hospital
Contact: Dr Jeremy Cordingley (0207-352-8121)
The Royal Brompton Hospital, part of the Royal Brompton and Harefield NHS
Trust, is a 300 bedded specialist cardiothoracic hospital for both adult and
paediatric patients. The hospital is located in Chelsea adjacent to the Royal
Marsden Hospital and is a short walk from South Kensington tube station.
The Adult Intensive Care Unit is a 20 bedded facility (currently funded to 16
staffed beds) and is within the Department of Anaesthesia and Intensive Care
Medicine. There are approximately 1200 admissions per year and these are
mainly cardiac and thoracic surgical patients. About 150 admissions per year
are medical admissions referred by the departments of cardiology (including
GUCH) and respiratory medicine. In addition the unit accepts direct referrals
of patients with acute pulmonary failure from other intensive care units. The
hospital contains a five bedded overnight post surgical recovery unit and five
high dependency areas located within wards.

Four Consultants have sessions in Intensive Care Medicine and cover the unit
for one week at a time. In addition there are daily Consultant-led radiology
and microbiology meetings. Junior medical staffing comprises four Specialist
Registrars and six Senior House Officers. The Specialist Registrars work a
resident 1 in 8, 24 hour partial shift rota.
There is an organised educational programme that includes regular teaching
and journal club sessions, multidisciplinary intensive care meetings,
departmental audit and morbidity and mortality meetings. Trainees are
encouraged to contribute to audit, teaching and research projects and are
allocated non-clinical time for these activities.
The academic Unit of Critical Care of the National Heart and Lung Institute,
Imperial College, led by Professor TW Evans, is located at the Royal Brompton
Hospital and is active in both basic science and clinical research in the
intensive care unit with a particular interest in vascular biology and the acute
respiratory distress syndrome (ARDS). Research fellows participate in the
registrar on-call rota.
The Royal Free Hospital
Contact: Dr. Julian Howard ( 020 7794 0500)
The Royal Free Hospital has a total complement of 20 Level 3 Intensive Care beds.
A further 4 beds are due to be commissioned in due course. All medical and surgical
specialties, with exception of cardiothoracic surgery are covered. The Renal Unit at
the Royal Free provides services for the whole of the North Central sector. Tertiary
specialist services include liver transplantation, hepatobiliary surgery and
neurosurgery. All modern treatment modalities are catered for with the exception of
ECMO. The total throughput of patients is in excess of 1100 per year.
Senior medical cover is provided by 8 consultants. These consultants provide a 24
hour per day 7 day per week service worked in blocks to provide continuity. Dr
Steve Shaw is the Lead Consultant and Medical Lead for the North Central London
Critical Care Network. Dr Julian Howard is the Deputy Lead and Educational
Supervisor. The other consultants are Dr. Y Rajalingam Dr. B. Agarwal, Dr T.
Berlet, Dr. A. Genahr and Dr K Dhadwal. Comprehensive ward rounds at 08.00hrs
and 16.30hrs take place on a daily basis. All potential admissions to the unit be it
day or night are discussed with the ITU consultant. There is a high level of support
to the junior staff. There are weekly teaching sessions on Tuesday and Thursday
mornings and on Tuesday afternoons. There is a daily microbiology ward round and
X-ray meeting. We actively participate in, and regularly present at the medical
ground round.
Junior staffing is provided by 13 doctors working a full shift rota ( new deal and
EWTD complaint). There six specialist registrars from the School of Anaesthesia,
one NTN in respiratory medicine, one CSST post in intensive care and five Trust

senior clinical fellows and SHOs. The intention is to convert two of the senior clinical
fellow posts into two NTN’s in acute medicine.
There is a dedicated ITU Pharmacist, Dietician, Physiotherapist and Clinical Scientist.
There is active participation in audit – nationally with the INCNARC Case Mix
Programme and locally with generic and research data.
We have also developed a successful patient risk and outreach team supported by a
nurse consultant, (Dr. Carol Ball).
The Royal London Hospital
Contact: Dr Marie Healy (0207-377-7793, mob 07813 783725)
The Royal London Hospital (RLH) forms part of Barts and the London Trust.
The RLH ICU is a tertiary referral unit for neurosurgery, trauma, vascular and
renal services, and caters for a large deprived local population. The RLH is the
base hospital for the Helicopter Emergency Medical Service and the Accident
and Emergency Department caters for 100,000 patients per year. We are
currently funded for 16 ICU beds (this may soon increase to 18). There is a
12 bedded surgical HDU (currently staffed for 5 beds). A Patient at Risk
Team (ICU Outreach Team) was set up in 2001 and consists of one medical
and one nurse consultant, a senior physiotherapist and 2 F grade nurses. An
ICU out-patient follow-up clinic has recently been established. The ICU has a
dedicated laboratory, seminar room, X ray room / trainee office, consultant
office, on call room and relatives room. There are ongoing research
opportunities (clinical and laboratory based).
We have approximately 700 admissions per year (most children are
transferred). Bed occupancy runs at 92-95%. 14% of admissions are planned.
80% of patients are ventilated. Up to 10% of patients have had CPR in the 24
hours prior to admission. Case mix for the year ending Dec 2002 includes
neurosurgery / neurology 222, general surgery 192 and general medicine
141. Other subspecialties include major head and neck, upper GI and
hepatobiliary surgery. ICU mortality runs at 22-25%. Approximately 30% of
the ICU patient bed days are trauma related, including those with head injury.
There are 400 trauma calls per year and each is attended by an ICU doctor.
We have extensive experience in ICU audit and participate in ICNARC.
There are 2 consultant ward rounds per day and daily microbiology ward
rounds. There is an active educational programme. We have weekly x-ray and
trauma radiology meetings. We have a dedicated ICU teaching session each
week and a weekly ICU journal club.
We have 8 consultants who staff the Unit (3 senior lecturers and 5 NHS
consultants).
Dr David Goldhill, Director of ICU, Barts and the London Trust
Dr Stuart Withington, Director of ICU, Royal London Hospital
Dr Gerlinde Mandersloot , Lead Consultant Patient at Risk Team

Dr Marie Healy, Educational Supervisor, ICM
Dr Peter O Shea, Dr Gurdip Samra, Dr Dan Kennedy and Dr Huw Owen –
Reece.
All are from an anaesthetic background and have approximately 3 anaesthetic
sessions each per week. Consultant cover is for one week at a time although
this is currently being reviewed. There are 10 senior sisters / charge nurses,
who rotate so that one is in a full time teaching role. We have a full-time
“sudden bereavement support sister”, dedicated to the ICU. We have ICU
pharmacists (2), technicians (3), dieticians (1), physiotherapists (3) and ward
clerks (3).
We have 7 trainees who participate in a shift system (56 hours per week,
band 2A). 6 are anaesthetic SpRs (year2-5) who do 3 month blocks. The 7th
is a senior SHO in a 6 month post. We also have a neurosurgical and an
anaesthetic SHO who do not participate in ICU on-call. In addition funding
has recently been approved for 2 clinical fellow posts.
The ICM post
This is an additional post where the trainee would be able to gain experience
in many aspects of adult critical care, including audit, outreach, outpatient
follow-up and management. The unit offers particular expertise in all aspects
of the care of the severely injured patient, including the initial resuscitation.
The on call responsibilities will be commensurate with the training needs of
the individual who is likely to be second on call on a one in six basis.
Opportunities exist within the Trust for individual trainees to gain experience
in cardiothoracic ICU and haem-oncology.
This is a busy unit, which relies heavily on good multidisciplinary teamwork.
There are regular social functions and we aim to provide a stimulating and
fun working environment.
St Bartholomew’s Hospital
St Bartholomew’s and the London NHS Trust is the largest provider of acute
care in the country and is a major tertiary referral centre. St Bartholomew’s
provides tertiary services (cardiothoracic surgery, maxillofacial surgery, ENT
surgery, infectious diseases, cardiology, radiotherapy and oncology). The
Queen Mary & Westfield Medical School is affiliated with Barts and the
London.
Profile of the Intensive Care Unit
The ICU has educational approval from the Intercollegiate Board in Intensive
Care Medicine for training at all levels including advanced. Within the Critical
Care area there are 13 beds nominally allocated as 4 general intensive care &
9 cardiothoracic intensive care. There are 8 high dependency beds allocated
to cardiothoracic patients. In addition to providing intensive care services for
postoperative cardiothoracic patients, the unit admits patients with
haematological malignancy, after bone marrow transplantation, infections

including HIV, after major head and neck surgery, ENT, gynaecological
oncology and urology.
Six consultants specialise in intensive care (Dr M Messent - lead clinician, Prof.
C Hinds , Dr G Wray, Dr N Zimbler, Dr P Jones, Dr P Breen) and are
responsible for the clinical management of the patients on a weekly basis.
Resident medical staff is provided by 7 anaesthetic SpR’s who undertake 3-
6month full time ICU/cardiothoracic anaesthesia attachments. They work a
full shift rota, one being present during the daytime and one at night. There
is one full time Intensive Care Registrar post.
Clinical
The Advanced Intensive Care Specialist Registrar will gain experience in all
aspects of the management of the wide range of critically ill patients that are
admitted to the Intensive Care Unit. At all times they will be under the direct
supervision of the ICU consultant (with overall responsibility for training
resting with Dr Zimbler). The Advanced Trainee will have the opportunity to
conduct ward rounds under supervision and formulate management plans for
the patients. They will be responsible for the immediate supervision of the
resident medical staff.
Training and further experience will be gained in the range of therapeutic
manoeuvres available in intensive care. This will include training in mechanical
ventilation, fibreoptic bronchoscopy, percutaneous tracheostomy, noninvasive
ventilation, advanced haemodynamic monitoring including pulmonary
artery catheterisation, intra-aortic balloon counter pulsation, continuous renal
support, transoesophageal echocardiography and basic ultrasound imaging.
Hours of Duty
The post is full time and attracts Band 1A additional payments for a full shift
rota with an average maximum number of hours worked per week of up to
48. Weeks are generally worked as 9am to 5pm shifts Monday to Friday with
occasional full 12 hour shifts (day or night) depending on requirements of the
rota. The post is classed as band 2A.
Audit& Teaching
The intensive care unit has an active audit programme and is a member of a
national intensive care audit (the ICNARC case mix programme). The post
holder will gain experience in intensive care audit and will be expected to
undertake an audit project utilising the computerised database. They will also
be responsible (under supervision) for analysing and presenting the data for
the monthly audit/mortality and morbidity meetings.
There is a weekly journal club/teaching session on Tuesday mornings to
which the postholder will be encouraged to contribute to when on duty.
Regular tutorials will be arranged for the Advanced Trainee in order to assist
them in their preparation for the Diploma in ICM.

Management and Administration Experience
Attendance at the Directorate and Critical Care Management meetings will be
encouraged in order to gain experience and insight into the management of
an intensive care unit.
St George’s
Contact : Dr Mike Grounds (0208-725-3130)
St. George’s Hospital is a 1000 bed teaching Hospital in South London.
The Critical Care Units comprise the following:
Adult Intensive Care
18 beds, 1400 new patients per year. Surgical and Medical.
ICU mortality 20% Hospital mortality. Average length of stay 3.5 days. All
specialities catered for. Varied case mix.
7 consultants (1 professor, 1 reader, 1 senior lecturer, 4 consultants)
7 registrars (2 ICU advanced trainees, 1 medical registrar, 2 lecturers, 2
clinical fellows)
9 SHO’s (2 anaesthetists, 2 physicians, 1 surgeon, 1 A&E, 3 fellows)
2 pre-registration house officers
There is an active research program producing approximately 6-10 peer
reviewed publications per year and over 150 in the last ten years.
Active teaching program recognised by the Intercollegiate Board for ICM
Advanced Training.
Neurosurgical Intensive Care
7 beds. 500 new patients per year. Neurosurgery and neurology.
3 Consultants directly responsible for ICU. On call cover provided by 8
anaesthetic consultants.
6 SpR’s (from anaesthesia) provide direct care for the patients with input
from the neurosurgical and neurology teams.
Active teaching program.
Cardiothoracic Intensive Care
8 beds. Main ICU. 600 new patients per year.
6 beds progressive care unit and fast track unit 600 patients per year.
5 consultants with direct responsibility for ICU patient care.
On call provision from these consultants and also from the 6 cardiac
anaesthesia consultants.
St. George’s Hospital also has a Respiratory Unit providing non-invasive
ventilation for patients who do not require formal ITU. This unit will soon be
upgraded to 8 beds. Trainees will have their training program tailored to
meet their individual specific requirements and training can be provided at St.
George’s for the complementary specialties. St George’s Hospital is a large

Teaching Hospital and the opportunities exist for extra training within the
specialties at the hospital.
St Helier Hospital
St Helier serves a population of 350,000 (500,000 as a combined trust;
Epsom and St Helier)
6 bedded ICU and 5 HDU beds (run as single unit)
Epsom Hospital (3 ICU beds)
Currently the ICM trainee works only at the St Helier site.
5 consultants; M Stockwell FRCA Clinical Director
S Jankowski FRCP FRCA Lead Clinician and Educational
Supervisor
A Hussein FRCA PhD
L Mulleague FRCA
Locum P Sarkar
All consultants serve the unit for a week at a time (on call Mon/Fri/Sat/Sun)
Eight Trainees; 1 anaesthetic SpR, 2 anaesthetic SHOs, medical SHO (on
rotation), FY2, Surgical SHO on rotation, ICM higher trainee, one free
standing post (approved by RCP)
ICM trainee timetable
Daily Ward rounds 08.00, 12.00, 17.00
Monday; monthly M+M with surgeons
Wednesday am; bronchoscopy list
Thursday am; medical grand round, 12.30 Hospital Grand Round
Friday am. General anaesthetic/ICU meeting,
13.00 Meeting with ICU Consultants (discuss all patients admitted to the unit
during week)
The casemix of patients (350 ICU and 450 HDU per annum) includes a variety
of medical/surgical patients (elective and emergency). Average APACHE II
score 18, mortality rate 21%.
We are also a tertiary renal referral centre with an interest in pulmonary-renal
syndromes.
St Mary’s Hospital
Contact: Dr Richard Leonard (0207-886-1248)
The Intensive Care Unit at St Mary’s has 13 beds and an occupancy of over
90%. 25% of patients are dialysed during their stay and the mean APACHE
11 score is 22-23. The hospital is a centre for tertiary cardiology, cardiac
surgery, renal and major vascular surgery. The ICU casemix also includes
medical and general surgical cases. The post is busy, and provides exposure

to all major specialties with the exception of neurosurgery. There is great
emphasis on teaching within the department.
Staffing
3 Consultant Intensivists
6 SpRs
6 SHOs
University College/Middlesex
Contact Dr Mervyn Singer (020-7679-9666)
This post offers extensive training opportunities for clinicians wishing to
pursue a career in adult intensive care medicine. The post is offered for 12-18
months subject to training requirements. Training will encompass the
following key areas required to equip the candidate for consultant status in
intensive care, namely: exposure to a broad range of adult critical illness;
decision-making skills; practical skills; technical knowledge; teaching skills;
medical audit; patient transfer; outreach, survivor follow-up clinic, and
research opportunities.
The base hospital will be University College London Hospitals NHS Trust; this
has 22 general ICU beds, 18 on the Middlesex Hospital site and 4 located 10
minutes’ walk away at University College Hospital. Annual admissions total
1400 (approx). The UCH site adjoins the main campus of University College
London. Specialities include haem-oncology, tropical diseases and tertiary
referral of patients with severe ARDS and sepsis. Most external referrals are
collected by the SpRs (or consultants) in a dedicated ICU ambulance.
Clinical management of patients is primarily undertaken by the intensive care
team and is largely directed by evidence-based unit protocols that are
regularly updated. An electronic monitoring/recording system is now in place
with the intention of going completely paperless by 2003. The ICU subscribes
to ICNARC. The seven intensive care consultants provide a consultant-led,
week-on service with 24 hour per day availability and supervision. The
consultants, SpRs (5) and SHOs (10) come from anaesthetic, medical and
surgical backgrounds. A strong multidisciplinary approach is fostered with
significant input from nurses, physiotherapists, dietitians, pharmacists, etc..
The advanced trainee will join the SpR full-shift rota (1-in-5) which is fully
hours-complaint. In a five week cycle, he/she will work one week of days and
one week of nights. There is one training week and two weeks for holiday/study
leave. Attendance of courses, ICU symposia and congresses is strongly
encouraged.
There is an active educational programme including weekly journal club,
weekly grand round, monthly mortality/morbidity meeting, audit meetings,
visiting speakers, and meetings/courses organised by the Bloomsbury

Institute of Intensive Care Medicine or Centre for Anaesthesia (see later). The
trainee will be expected to contribute towards these activities and to the
training of SHOs.
Through the University departments of the Bloomsbury Institute of Intensive
Care Medicine and the Centre for Anaesthesia, a wide range of clinical and
laboratory research activities are undertaken. Particular interests include
sepsis, infection, ARDS and haemodynamic monitoring, with recent
publications in the Lancet, BMJ, and Am J Resp Crit Care Med, among others.
Major funding support comes from the MRC and Wellcome Trust. Participation
in research is welcomed though the busy clinical commitment precludes major
involvement during the two 1st on-call weeks.
It is intended to rotate the advanced trainee to one or more of the following
ICUs for 3-6 months as appropriate and to suit the individual needs of the
trainee: Royal Free (general, hepatic, neuro); the Heart Hospital
(cardiothoracic) and the National Hospital for Neurology & Neurosurgery
[subject to the latter two units gaining training recognition]