Information about the ICU's in the East Of England 

Addenbrookes Hospital General ICU - Cambridge

The John V Farman Intensive Care Unit has twenty beds and admits over 800 patients per year. Only 10% of admissions are elective -  comprising mostly high risk and complex post-operative surgical cases.  The remaining 90% of patients are emergency admissions with a wide range of medical and surgical pathologies. These include patients with acute and chronic liver failure, renal failure and haematological malignancies. The hospital is also a regional liver and kidney transplant centre.

Over 70% of patients require mechanical ventilation and up to 30% require haemofiltration. A full range of invasive monitoring and all major forms of organ support are utilised. The unit has recently undergone significant modernisation and the bedside monitoring, ventilators and other equipment are all of a high standard.  In addition to the trust physiotherapy staff the unit has a dedicated senior physio and an ODP/technician who assist with transfers, procedures and devising weaning plans.

Eight consultant staff run the ICU and they are present on the unit throughout the day and into the evening. There are six F2/CT1-2/ST1-2 trainees and six Senior trainees/clinical fellows, all of whom work on EWTD compliant rotas. These posts are recognised for ICM training upto Advanced level. In both cases the responsibilities of the post can be adjusted according to the needs of the trainees. The increased number of trainees and fellows has allowed us to split the rota into ‘junior’ and ‘senior’ tiers. Overnight there are two trainees present on the unit and this change has relieved pressure on what was previously an overstretched role.

The intensive care team undertake all day-to-day aspects of management of the patients, liaising and coordinating with all members of the multidisciplinary team. There are microbiology ward rounds five times a week.

Trainees are encouraged to undertake ICU-based audits and participate in the active research programme within the unit, which is run in collaboration with the University Department of Anaesthesia under the lead of Professor David Menon. A Clinical Lecturers post in Critical Care has just been funded by NIHR and will be advertised in the coming months. This post will carry recognition for both the base speciality from which it will be appointed and dual CCT training.

The unit is registered with the ICNARC Case Mix programme and Cost Block programme and has two full time audit clerks and a part time audit nurse. There is an outreach team and a follow up clinic runs twice a month. There is a regular teaching programme covering a variety of  core topics. Senior trainees will take a leading role in ward rounds and be given management experience. They will also be expected to participate in teaching medical students, Foundation trainees and nursing staff. They also take an active role in producing the regional ICM training program.

Dr Peter Bradley, Consultant Intensivist 

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Neuro Critical Care - Cambridge

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Bedford Hospital

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James Paget - Great Yarmouth

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Norfolk and Norwich University Hospital

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North West Anglia NHS Trust - Peterborough

Peterborough City Hospital (PCH) is a large District General Hospital (DGH) in the North of the region.

We have a 12 bedded mixed level 2/3 Critical Care Unit and offer the usual array of critical care services (haemodiafiltration, CO monitoring, Evita XL and V500 ventilators, transthoracic echo etc).  

We admit around 650 patients to the critical care area per year.  Our unit takes post op vascular, general surgical and max-facs patients with ENT surgery also on site.  We refer out Neurosurgical cases to Cambridge and Paediatric cases to Leicester, both after a period of initial stabilisation by ourselves.  Medical services on site include a large Coronary Care Unit with a catheter lab, a Hamatological Oncology Unit and an outpatient Renal Dialysis Unit.

PCH currently has 11 consultants with an interest (and sessions) in Critical Care, with two consultants on the unit during weekday daytimes, one of whom covers for 24 hours.  Weeks are shared between two consultants to give continuity of care.

Our junior medical staff range from FY1s to ST7s with most being CT 1 and 2, with at least two trainees on during daytime sessions and one covering the evening and night (on a standard full shift rota).  We are aiming to take an advanced ICM trainee in the future.  

PCH has a Ministry of Defence (MOD) commitment and you will be working alongside military nurses and doctors whilst with us, many of whom have experience working in Camp Bastian (Afghanistan).  Finally the hospital is a warm, friendly DGH and we aim to offer a good quality training experience with a truly varied casemix during your time with us.

Dr Toby Elkington, Faculty Tutor 

 

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Peterborough and Stamford Hospitals NHS Foundation Trust critical care webpage

West Suffolk Hospital NHS Trust - Bury St Edmonds

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Royal Papworth Hospital (Cardiothoracic)

Papworth is indeed a different brand of intensive care and it is not surprising that there are experiences and skills you will not obtain elsewhere. 

All regional registrars in anaesthesia rotate through the department during the course of their three-month cardiothoracic module at Papworth and undertake a combination of day and night shifts on the unit.  Advanced ICM trainees currently work long days only with days off to compensate. 

The backbone of patient knowledge comes from the F2s with the ICM registrar providing technical skills, moves to CT and supervision of the juniors.   The presence and work of Critical Care Practitioners in the department is fairly unique in the region - these are senior nurses who possess an extensive knowledge of cardiothoracic intensive care and an extended range of skills permitting them to manage many aspects of patient care without recourse to a doctor.  Unlike some other units medical staff from other specialties are also never far away, including cardiologists, cardiac surgeons and the transplant team.  Don’t be surprised if nursing staff call them before you and certainly don’t take this personally - it is not a comment on your competence.  Indeed you will often appreciate the depth of specialist knowledge these teams possess and you will learn as much from them as you will from the intensivists.  Allied to this the unit enjoys an excellent relationship with haematology and microbiology services.

Cardiac arrests are an area where differences exist from a general hospital.  You might run to the catheter lab where rather pleasingly the immediate cause of the patients VF arrest can be treated in front of you eyes with the clot being sucked out and proudly presented for general perusal.  Post surgical arrests sometimes end in a chest being opened.

As you might expect there are a specific set of skills and understanding that you can acquire during your time at Papworth; Swan Ganz catheters, ECMO and ventricular assist devices allow an understanding and an ability to manipulate and support physiology in unique ways.  This is not to belie the fact that there is also an awful lot of good general intensive care, from respiratory weaning to inotrope usage.  Amongst post-surgical patients many of the problems centre around bleeding and its various squealae - management of massive transfusion and the appropriate use of blood and blood products are important learning areas. 

In summary the Papworth unit is where you need to get stuck in with the hurly burly and be positive.  Pick up the education from those around you whose knowledge is extensive and accept that you will inevitably spend a degree of time in the CT scanner.  Everyone will rapidly know who you are so good working relationships are important to cultivate from the outset and good ones will make your time more enjoyable and more educational.

Dr David Evans, Advanced Trainee ICM

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Papworth Hospital NHS Foundation Trust critical care webpage

Thursday, 14 November, 2019
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