ICM Unit Brief Part 1 Hospital Details 1.1 Hospital name Guy s and St Thomas NHS Foundation Trust 1.2 Full address (you must include postcode) 1.3 Hospital Telephone number Department of Intensive Care ICU Support Offices, 1st Floor Becket House, St Thomas Hospital, Lambeth Palace Rd, London SE1 7EH 0207-188-7188 Part 2 ICU Department contact details 2.1 Direct telephone number to Department 0207-188-8768 2.2 Faculty Tutor name 2.3 Faculty Tutor Email address Dr Andrew Retter Dr Simon Sparkes andrew.retter@gstt.nhs.uk simon.sparkes1@gstt.nhs.uk Part 3 Unit Structure 3.1 Number of Beds 3.2 Number of admissions 57 3261 3.3 Percentage of elective vs emergency admissions 85% Medical, 15% Surgical (28% non-elective) Page 1 (of 3)
3.4 Overview of case mix within the unit Over 3200 patients are admitted each year to acute critical care units at GSTT, with referrals from most medical and surgical specialties (with the exception of neurosurgery). Many regional tertiary services e.g. cardiac, thoracic, vascular, renal and pancreatic transplant surgery are based in the 3.4 trust. Details A quarter of training of critical opportunities care admissions the unit are referred directly from the emergency department and a similar number from both the wards, and theatres or recovery. GSTT is the designated severe respiratory failure centre for the South East of England. This Consultant delivered service offers; remote advice, retrieval and advanced respiratory management techniques to patients in our catchment area. The unit provides extra corporeal membrane oxygenation (ECMO) for approximately 100 patients per year with severe respiratory failure. Around 80% of all admissions are medical referrals, with a large proportion of all patients having significant medical co-morbidities (25%). Patient acuity is high, with a mean APACHE II score of 15.2 and a higher than average incidence of comorbidity. Over 35% receive invasive ventilation on admission. Average length of stay (ICNARC data, all patients) is 64hrs. The unit is a member of Intensive Care National Audit and Research Programme (ICNARC) Data shows the standardised mortality ratio (SMR) for Guys and St. Thomas critical care is well below predicted at 0.9 (ICNARC criteria), despite the high severity of illness. 3.5 Names of Consultants, roles and areas of interest Name Role (eg clinical lead, consultant) Areas of Interest Dr Andrew ASWANI Vascular access lead Translational research in the field of sterile inflammation and multiple organ failure Ultrasound in critical care Dr Nicholas BARRETT Professor Richard BEALE Dr Aimee BRAME Lead for Extra Corporeal Membrane Oxygenation service (ECMO) Professor of Intensive Care Medicine, King s College London Co-Leader, Allergy, Respiratory Medicine, Anaesthetics, Critical Care and Pain Clinical Academic Group, King s Health Partners Undergraduate block lead for emergency medicine and critical care. Critical Care ACHD lead. Severe Respiratory Failure Severe Cardiac Failure The role of ECCO2R Sepsis Haemodynamics Nutrition in the critically ill ICU informatics. Pulmonary Hypertension, Right Heart Failure Dr Helen CAHILL Lead for HDU Critical Care Outreach Interstitial Lung disease Dr David CAIN Morbidity and mortality Lead Organ donation committee Perioperative medicine Sepsis Dr Luigi CAMPOROTA Lead for trainee research attachments Respiratory failure. Mechanical ventilation and respiratory monitoring research. ECMO. Dr Kyra DINGLI Lead for Overseas training, fellowships and observerships. Critical Care Lead for Undergraduate education Delirium Page 2 (of 3)
Dr Guy GLOVER Professor Nicholas HART Dr Nicholas IOANNOU Dr Andrew JONES Dr Boris LAMS Lead for ICU Outreach (Clinical Response Team; CRT) Clinical Director Lane Fox Respiratory Service Academic Director of Lane Fox Clinical Respiratory Physiology Centre GSTT Director of Research Delivery Joint Editor-in-Chief THORAX Safety Lead for Critical Care Critical Care Lead for Echocardiography Audit and Quality improvement Lead for critical care Organiser ICM Regional Training days Pan London Lead Consultant for Respiratory Medicine ECMO Severe Respiratory and Circulatory Failure Temperature management Complex weaning, rehabilitation and home ventilation ECMO Severe Respiratory and Circulatory Failure Critical Care Echocardiography Respiratory disease in critical care End of Life Care Respiratory disease management in critical care Dr Chris LANGRISH Consultant in Critical Care ECMO Critical Care simulation Dr Richard LEACH Clinical Director for Acute Medicine, GSTT and Associate Medical Director MFT Respiratory disease management in critical care Dr Phil MARINO Dr Angela McLUCKIE Dr Chris MEADOWS Dr Joel MEYER Clinical Lead for Pulmonary Hypertension & Consultant Lane Fox Unit Training Programme Director (TPD) Joint ICM training programme London. Regional Education Advisor SE London Clinical Governance & Risk Lead for Critical Care; Director of ECMO Simulation; President, Critical Care Medicine Section, Royal Society of Medicine Co-Lead for Critical Care Follow-up Lead for Critical Care Peer Support Critical Care representative for Trust Clinical Guidelines Pulmonary Hypertension, Chronic Respiratory Failure & Home ventilation Postgraduate training in Intensive Care Medicine. Extracorporeal therapies and advanced ventilatory techniques for severe respiratory and cardiac failure; implementation and sustainability of safety cultures; codesign and co-production of service improvements to the patient pathway. Post-intensive care recovery and follow-up Dr Patrick MURPHY Consultant Lane Fox Unit Domiciliary ventilation, sleep disordered breathing and respiratory physiology Dr Marlies OSTERMANN Dr Hina PATTANI Renal Lead for Critical Care Trust Lead for Organ Donation Medical Careers Officer for the Royal College of Physicians Clinical management and research related to renal disease in critical care Multi professional training and development and chronic respiratory failure and weaning Dr Richard PAUL Critical Care Consultant Dr Michelle RAMSAY Consultant Lane-Fox Unit Home mechanical ventilation, sleep disordered breathing and respiratory physiology. Page 3 (of 3)
Dr Andrew RETTER FICM Faculty Tutor Haematology Lead for Education Lead for Mortality and morbidity Dr Manu SHANKAR-HARI NIHR Clinician Scientist Sepsis epidemiology, adaptive immune system, longer-term outcomes from sepsis, sepsis and ARDS sub-phenotypes. Dr Peter SHERREN Dr Andrew SLACK Dr Simon SPARKES Dr Joerg STEIER Critical Care simulation and human factors lead Critical care major incident lead Lead for Guy s Critical Care Lead for Critical Care Follow-up FICM Faculty Tutor Lead for Education Consultant Physician and Reader in Respiratory and Sleep Medicine Prehospital medicine Resuscitation Critical Care ultrasound Post-intensive care follow-up and recovery Renal Medicine Critical Care Ultrasound, Echocardiography, Retrieval and Transfer Medicine Sleep & Ventilation Medicine Dr Eui-Sik SUH Consultant Lane-Fox Unit Home mechanical ventilation, sleep disordered breathing, respiratory physiology Dr Marius TERBLANCHE Consultant Critical Care Technology innovation in healthcare Dr Rosalinde TILLEY Dr Stephen TRICKLEBANK Dr Duncan WYNCOLL Trust Guardian of Safe Working. Trust Director Undergraduate Medical Education Lead for Critical Care Junior doctors, rotas and induction. Departmental Airway Lead. Physician Associate Lead. Consultant rota Lead Infection control Lead for Critical Care Management and delivery of undergraduate and post graduate education and training. Airways in Critical Care/ Airway training. ECMO Research in particular in the fields of sepsis and transfusion 3.6 Details of research projects being undertaken within the unit Critical Care and Lane Fox Research Strategy The research strategy is mapped onto the Trust s strategy for clinical service expansion. With the delivery of an expanded clinical infrastructure to enhance the capacity in critical care and the Lane Fox Unit to meet the London Emergency and Intensive Care Society Core Standards, there has been a focus to further increase the non-commercial and commercial clinical trials portfolio and support the data modelling and translational research activity. Specifically, the research strategy will prioritise four highly active programmes: (1) Acute Kidney Injury (2) Clinical Respiratory Physiology (3) Critical Illness Data Science (4) Sepsis Immunobiology These key priority areas combine research programmes in skeletal muscle biology and immunobiology across Guy s & St Thomas NHS Foundation Trust and Kings College London with important pilot feasibility and multicentre clinical trials funded by the main government funding bodies as well funding major industry partners. The established CLRN funded research personnel and space infrastructure combined with access to a large numbers of diverse patient groups across the division ensures high recruitment activity to a broad range of studies. In addition, access to local, national and international critical care data resources provide the platform for the critical illness data science programme and extension to a health service and delivery programme supported by Kings College London. Finally, the strong collaborative links with a number of technology industry partners extend from investigator-led intellectual property and patent development through expert advisory board support of proof of concept commercial product development to clinical trial delivery. Page 4 (of 3)
3.7 How is the unit staffed We expect to open an additional 11-bedded ICU in Feb 2017, after which there will be 3 ICUs at St Thomas and 1 at Guy s. There are also 3 HDUs and the Lane-Fox unit at St Thomas. There is on-site Consultant cover between 0830-2030 7 days. There is a dedicated Consultant available for each unit over the phone 24/7. The junior doctors rota has 1 ST1-2 tier and 2 x ST3+ tiers. Staffing levels adhere to the FICM standards. Part 4 Training 4.1 Details of training opportunities on the unit The department manages Critical Care units on both hospital sites. The St Thomas site currently consists of two 15-bed units (East Wing 1 and East Wing 2), each providing mainly level 3 care. [We expect to open a third unit East Wing 6 in Feb 2017]. HDU cover is provided in a 10-bed medical HDU and a 4-bed surgical HDU. A 13-bed mixed level 2/3 unit is based on the Guy s site. In addition, the Lane Fox Respiratory Service is a national referral centre for weaning, rehabilitation and home mechanical ventilation. This 14-bed Lane Fox Respiratory Unit comprises 10 Level 3 weaning beds and 4 elective beds to assess and review patients with chronic respiratory failure. Recently, a 20 bed virtual extension to the Lane Fox Respiratory Service has opened, the Lane Fox REMEO Respiratory Centre within the grounds of East surrey Hospital. Each area is staffed by a dedicated team of substantive medical, nursing, physiotherapy, dietetic and pharmacy staff, who rotate between units at 3-6 monthly intervals intervals. Care is enhanced with daily microbiology ward rounds and regular multi-disciplinary meetings where complex respiratory and long-stay patients are discussed. All beds are equipped with the most modern ventilators, and a variety of invasive monitoring equipment is available. Calcium-Citrate haemodialysis is offered in addition to heparin based haemofiltration. The CareVue clinical information system documents all clinical activity and provides a data base for audit and service improvement purposes. Communication in the department is enhanced with bimonthly faculty meetings, which involve trainee representatives, clinical and educational supervisors as well as the department s education administrator. The department has introduced a text messaging service for urgent communications. The department has a strong culture of safety and governance with opportunities to attend meetings, undertake quality improvement projects and take part in educational roles for junior doctors and medical students. 4.2 Details of departmental teaching 4.3 Details of clinical governance meetings days and / or M & M Journal Club 0830-0900 (Tuesday) Departmental ICM Teaching, 1330-1730 (Wed) - alternate weeks ST1-2 /ST3-7 Daily bedside microteaching sessions Daily microbiology ward round Staff Grand Round Wednesday 1300 1400 Severe Respiratory Failure meeting 1530-1700 (Wednesday) The department has a proactive approach to clinical governance and promotes a safety culture. Trainees are encouraged to participate through risk reporting, incident reflection, attending meetings, Page 5 (of 3) writing guidelines, quality improvement projects and audit. Meetings include: - Clinical Governance monthly meetings (incl M&M)
4.4 Number of trainees on each tier of the rota ST1-2 Tier: 27 doctors ST3+ (general: airway trained) Tier: 1:8 ST3+ (general: non-airway trained) Tier: 1:10 on call for retrieval ST3+ (SRF) Tier: 1:10 (on call for retrievals) Page 6 (of 3)