Anaesthetics

Anaesthetics

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Core Anaesthetics

Guildford is a DGH with 420 acute and general beds + 112 specialist beds serving a population of 320,000 in Surrey County. It is also a major Cancer unit for the South East region. There are 12 operating theatres in main theatres. Two theatres are modified for major laparoscopic surgeries with state of the art technology and the facility to transmit live, locally and internationally.

The main theatres also offer the use of Oesophageal Doppler, fibreoptic laryngoscopes and vascular ultrasound machine for vascular access and regional blocks. The number of operations performed makes an annual turnover of approximately 3500 inpatients and 5000 day cases. There is also an obstetric theatre, two day surgery theatres, a procedure room and a high dose radiation theatre where radiotherapy given under anaesthesia.

The Department space comprises two anaesthetic offices, a consultants’ office, a seminar room, a trainees’ rest room with sofas, fridge and a computer with dedicated printer.  There is a small Department Library and the hospital has a Library in the Education Centre.  There is an active Sports and Social Club within the hospital and Surrey Sports Park opposite the hospital.

Grade

CT1, CT2 and ACCS

Training Programme

Anaesthetic Modules

Modular training is available in ICM at all levels. Currently we have trainees in the ICM at CT2 and ST3 levels but we have recently been accredited for training at higher levels.  Other modules at the ST3 level include Pain, Obstetrics and Paediatric Anaesthesia and at the ST5/6/7 level General,Hepato-biliary, Head & Neck and Management.

It is well recognised that Guildford has become the Regional Cancer Centre, in addition to being the tertiary referral centre for Maxillo-facial surgery and upper GI surgery.  This has resulted in an increase in the number of major, complex operations performed on the site and an increase in ITU/HDU capacity.  In addition there are a large number of surgical sub-specialties not found in other comparable DGHs, all of which makes the RSCH a demanding and challenging arena for a specialist trainee

Surgical specialties

The hospital offers a wide range of surgery in the following specialities: Orthopaedics (including trauma), General (including breast, upper GI, Hepatobilliary and pancreatic surgery, Colorectal), Urology, Gynaecology, Head and Neck, ENT, Ophthalmology. Anaesthesia is also provided for a variety of other procedures in radiology, radiotherapy and endoscopy.

Day surgery 

The Day Surgery Unit is a stand-alone unit within the hospital grounds.  There are 2 day surgery theatres, each with its own anaesthetic room, performing a mixture of operating including gynaecology, orthopaedics, maxillofacial, urology, ENT surgery and chronic pain treatments. There is also a procedure room.  The Unit has 23 trolley spaces, which includes 6 dedicated paediatric bays and 1 individual room and a five bedded recovery unit.  There are also three rooms devoted to pre-assessment clinics. At the RSCH, 72 – 75% of patients admitted for surgery as day case patients.

Obstetrics

The obstetric unit has about 3,500 deliveries per year, the majority of whom have some form of anaesthetic intervention.  The overall epidural rate is about 37%, almost exclusively low-dose.  The Caesarean section (CS) rate is about 24% and there are elective CS lists each weekday morning, which are covered by a consultant anaesthetist.  Nearly 98% of elective CS and 85% of emergency CS are done under regional anaesthesia.  The obstetric population is generally low-risk and there is consultant obstetrician cover during each weekday.  Anaesthetic cover is usually provided by a consultant with a trainee in the mornings, a SAS grade in the afternoons and a registrar out of hours.

Intensive care

There is an 27 bedded Intensive Care Unit comprising level2 and level 3 care beds and has average 1000 admissions per annum.  There are 12 consultants with intensive care sessions providing 24 hour cover on a separate rota. In the last three years the number of admissions has doubled and the standardised mortality rate (SMR) has reduced by 35% at the same time.

Anticipated duration of programme

One year

Standard rotation details

There is a separate anaesthetic and obstetric 1:8 full shift rota which is EWTD compliant at band 1A. . The Intensive Care Unit also has a trainee rota on a 1A banding.

Educational Opportunities

Regional CT1/2 Teaching programme: study days are held on a rotational basis across the Region.  As part of this the Department hosts Primary FRCA VIVA/OSCE days – twice a year.

Regional ST3/4 and Senior Teaching programmes : organised by St George’s School (study days are held on a rotational basis across the Region).  As part of this the Department hosts Anaesthesia for Cancer Surgery Day once per year.

Other courses offered by the Department: ATLS, ALS, CCrISP, APLS, Airway day, Simulation training.

In addition the Anaesthetic Department offers quarterly educational half days including morbidity and mortality discussions, a weekly journal club and M+M, weekly regional anaesthesia teaching, two weekly exam oriented primary FRCA tutorials. All trainees are rotated through a day of MDT obstetric PROMPT teaching. All teaching is consultant lead.  The ICU organises monthly morbidity and mortality meetings and weekly teaching.

The department also has a 5 fellowship programmes in Upper GI, Gynae Oncology and Colorectal, Regional anaesthesia, Advanced Airway and CPET which are taken by the ST6 level trainees as OOPE/T.

Exam preparation

Trainees are always allowed to take revision study leave both for private study (a maximum of one week per year) and for courses where possible.  In addition the Department provides a Primary FRCA Viva/OSCE revision/practice day for the Region.

One of our consultants is one of the two Primary FRCA examiners in the Region there are many consultants familiar with exam requirements and available for viva practice. The department provides intensive viva practice for both primary and final FRCA taking trainees.

Educational Supervision

All trainees are allocated a grade specific educational supervisor who is closely involved with their development during their time at Guildford. Dr Amish Patel and Dr Dow are the module supervisors for ICM and pain respectively. The department has total of 38 consultants of varying special interest and educational supervision.

The Faculty Lead supervises the overall training and educational needs of all the trainees.

 

Consultant Anaesthetists

Dr John Stoneham – Maxillofacial Anaesthesia

Dr Hamish Griffiths – Upper GI

Dr Gareth Jenkins

Dr Paul Saunders – ICU Clinical Audit

Dr William Fawcett – Acute Pain / Hepato-biliary   Anaesthesia

Dr Nigel Payne – Acute Pain/Recovery

Dr Nial Quiney – Clinical Director Acute Medicine Hepatic Resection Anaesthesia

Dr Girish Dhond

Dr Snjezana Comara – Co Lead Obstetric Anaesthesia Gynaecology

Dr Tony Lucas – ICU, Clinical Lead for Day Surgery

Dr Mehrun Zuleika – ICU / OG

Dr Kristen Carter – ICU, ACCS lead

Dr Jane Tilley – Director of Medical Education,

Dr Pradeep Prabhu – HPB anaesthesia/Lead for Clinical Risk Management / CPX

Dr Harsh Saxena – Pre assessment/Equipment

Dr Visweswar Nataraj – Core Training TPD KSS

Dr Mike Carraretto – Clinical Lead ICU

Dr Mathew Berry – Head of Department, Trauma Lead, Rota master

Dr Amish Patel – ICU/ICU risk management

Dr Bhavesh Patel – Airway and Resuscitation, Paediatrics, Regional, Paediatrics Lead

Dr Mark Way – Head and Neck, Regional, Obstetrics, Faculty Lead, Trainee’s rota master, lead for Obstetric Anaesthesia

Dr Mathew Dickinson – Clinical Director, Upper GI surgery

Dr Gillian Foxall – Regional Anaesthesia Lead

Dr Allister Dow – Chronic Pain

Dr Catherine James – Chronic Pain

Dr Suzi Lomax- Simulation Lead Anaesthetics

Dr Daniella Tonucci- Chronic Pain

Dr Justin Kirk-Bailey – ICU, Research

Dr Chris Jones – Upper and Lower GI, Medical Student Lead, High Risk Fellows

Dr Ed Walter – ICU

Dr Wendy King – Airway, Max Facs, Obstetrics

Dr Piers Johnson – Governance Lead

Dr Alex Fletcher -ICU

Dr Rachel Savine – ICU

Administration

Hazel Still – Anaesthetic Manager

Anita Horne – Anaesthetic secretary

Nicky Millar – Anaesthetic secretary

Lucy Caple – Medical Education Coordinator

Clinical Leads

Dr Mark Way – Faculty Lead

Dr Visweswar Nataraj – Core Training TPD KSS

Dr Jane Tilley – Director of Medical Education

Dr Chris Jones – Medical Student Lead

Dr Amish Patel – RcoA Primary FRCA Examiner

 

 

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