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

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.