DEPARTMENT OF ANAESTHESIA
Information for New Trainees
Welcome to the Anaesthetic Department at Charing Cross Hospital. Below is listed some of the information that you may find useful whilst you are working in this department.
DAY TO DAY DEPARTMENTAL INFORMATION
COMMUNICATION / ADMINISTRATION
All junior staff are required to carry a hospital bleep whilst they are at work. Bleep holders are responsible for the safety of their bleeps which will be allocated by the anaesthetic secretary on arrival. Spare batteries are available from the anaesthetic secretary or the security desk on the ground floor. To bleep someone dial 456 and the operator will issue instructions. A list of useful bleeps and telephone numbers are given in appendix 1. Bleep numbers are also printed on the anaesthetic rota. Additional bleeps are carried by the SHO for acute pain (8197), SpR 1 / 2 on call (8189) , admin SR (8225) and ITU SR (8844).
2. All staff must carry an identity card. These are obtained from the security desk next to the Main Reception on the ground floor.
3. The Personnel Department is located on the 1st floor of the Education Centre. The person responsible for the anaesthetic department is Aideen Moore. To go to the Education Centre take the lift to the ground floor, turn left when you come out of the lift and follow the signs for the chapel. Go out through the double doors just before the chapel, turn right and walk about 50 yards.
4. The working day normally runs from 8a.m. to 6p.m. Anybody whose list is cancelled or finishes early must speak to the Admin SR or his deputy to find out if there are shortages elsewhere. The weekly rota is done by the admin SR on Tuesday mornings. He or she should be informed of any changes to the on-call before Tuesday of every week. This is to ensure that the rota does not get circulated with errors! The on-call rotas are produced by a representative of each grade, who should be approached with any requests.
Car parking on the Charing Cross site is available to permit holders. Application forms for permits are available from the anaesthetic secretary. There is a policy of clamping those vehicles parked outside permitted areas or those without a permit or pay and display ticket.
If any one requires assistance with their list e.g. with regard to cover, coffee/lunch break, please contact the Admin SR (or the person who carries the Admin bleep) who will organise suitable cover. If you are unable to contact him/her, please contact the starred consultant or the anaesthetic secretary.
THEATRE WORK
Anaesthesia should only be administered in the following areas:
Main operating dept/recovery 14th floor
Day surgery unit 1st floor south wing
X- ray dept 1st floor north wing
A & E Ground floor north wing
ITU 11th floor north wing
Coronary care unit 5th floor south wing
CVP lines should only be inserted in the main theatre suite, ITU, CCU , A&E or HDU.
If any junior is unhappy or unsure about anaesthetising a particular patient they should speak to the Admin SR or to the consultant responsible for the list or to the consultant who is “starred” on the rota. Do not anaesthetise patients you are not competent to deal with.
All trainees are expected to see all patients pre-operatively for all lists irrespective of whether a consultant has seen them.
Cases should not be cancelled without discussion with the senior anaesthetist responsible for the list.
Operating lists for main theatres for the following day are available from theatre reception after 4pm. X-ray lists are not distributed from the X-ray dept until after 5pm but can be obtained directly from the department earlier (x30777).
There is a copy of the Fire Policy for the operating department in the anaesthetic library and on the main departmental notice board. All staff are expected to familiarise themselves with the procedures.
Major Accident Policy. This is now available on the Trust Intranet and a hard copy is available in the library. All staff are expected to know their responsibilities in this event.
ACUTE PAIN
Nurse-led acute pain ward rounds take place every day. Once/week the consultant in charge of acute pain (Dr. Stranix/Dr.Kalbag) leads the ward round . If your name appears on the acute pain slot in the rota, please meet Dr. Stranix/Dr.Kalbag and/or the pain specialist nurse at 14.00 in the anaesthetic coffee room.
There are special forms and stickers for i.v. Morphine or i.v.Fentanyl PCA available in all anaesthetic rooms in the theatre complex as well as recovery. Forms and stickers must be completed for all patients on PCA.
All trainees should familiarise themselves with the workings of the PCA pumps used and the policies of the team which are given in the appendix and also on the main departmental notice board.
At the present time there are facilities for managing epidurals only on the 4 South ward in the hospital. All other patients with epidurals MUST be managed on ITU or HDU.
Any problems should be referred to the consultant in charge of the service (Dr.N.Stranix/Dr.Kalbag)).
Transfer of Patients
All junior staff are reminded that the policy regarding the transfer of any critically ill patients whether from A&E, the ward or theatre to another hospital for Intensive Care is that the consultant on for Intensive Care must be contacted prior to any decision about the transfer. There are no exceptions to this rule and there is no time during day or night when this rule does not apply. Only post-fellowship SpRs are allowed to transfer critically ill patients.
Private Patients
PPs should be anaesthetised AT ALL TIMES by a Consultant Anaesthetist. If any trainee finds that there is a private patient on the operating list that they are responsible for and no consultant anaesthetist has been informed or is involved with the procedure then the policy is that the consultant surgeon should be informed and the case cancelled.
PPs who develop acute anaesthetic problems out of hours, must be assessed by the on-call anaesthetic team (SpR1, 2 or 3,4) in the first place and the consultant who anaesthetised them must be contacted and informed as soon as possible.
Harassment and bullying helpline
The freephone helpline is available for all trust staff on 0800 091 2064
LEAVE
If you wish to take annual leave/study leave, please speak to the Anaesthetic Secretary to find out if the leave is available, then complete a leave form and a copy of approval will be given to you.
ANNUAL LEAVE
Depending on the number of your working years you are allowed 5 –6 weeks annual leave, in addition, 2 STAT days /year are given to all grades on a pro rata basis.
All leave is processed in order of date application. You should therefore submit leave requests as early as possible, at least 6 weeks in advance.
No more than 5 members of junior staff can be away at the same time, maximum 1 of the SHO’s and SpR’s 1/2 and SpR 3/4 on annual leave and 2 others on study leave will be allowed. Only 1 trainee from each grade will be allowed on study leave at the same time.
Everyone is responsible for his/her on-call cover, regardless of leave and must personally arrange to swap with colleagues. SpRs 3,4 need the agreement and signature of either Dr. Ladas or Dr. Doyle to swap an on-call.
No one other than Dr Ladas must sign to authorize leave in the diary. The Deputy Tutor is authorizing the annual leave for SHOs and if Dr. Ladas is away, all other leave applications too.
Please ensure that you take all of your leave before you complete your rotation at Charing Cross Hospital as you will not be paid for any leave not taken. You will not automatically be allowed leave at the end of your rotation.
During the ITU module, only pro-rata leave is allowed i.e. max. 7.5 days during a 3 month attachment. SpRs starting the competency programme, as far as possible should spread their annual leave entitlement throughout their tenure at CXH in order to avoid disruption of the modular training programme.
LEAVE FOR RITAs
If you are invited to your RITA, please let Dr.Ladas know well in advance and give details about the exact time of your appointment. The RITA day is not a day off and you are expected to be in theatres the rest of the day.
STUDY LEAVE
All trainees are entitled to 30 days study leave per annum on a discretionary basis.
This must be applied for at least 6 weeks in advance to ensure refund of expenses. A copy of the application form is attached.
The study leave budget is approx. £800 per head. Individual applications are at the discretion of the college tutor and postgraduate clinical tutor.
Private study leave will be at the discretion of the College Tutor as departmental staffing levels allow. For pre-fellowship trainees this will be a maximum of 5 days for a 6 mo rotation or 2.5 days for a 3 mo rotation.
All trainees will be expected to attend a day during each year of their training at the Chelsea and Westminster Simulator.
All SpRs 3,4 are expected to attend the compulsory SpR 3,4 Study days, one has to stay for the rota and carry the 8844 bleep for ITU.
SICK LEAVE
If you are sick please bleep the ITU SR at 8.00am on bleep 8844. If the bleep is not answered, please a) contact the consultant on your list and b) leave a message on the voice mail in the Anaesthetic Office. Do not leave a message with anyone on call the previous night as often the message does not get relayed as the on call anaesthetists are normally going off duty. The ITU SR will record your sickness in the respective book that can be found in the Anaesthetic Office.
If you are due to be on call we will call upon the professional responsibility of your colleagues and ask them to provide cover and organise a swap.
If the nature of the illness e.g. d & v is such that you think you may be able to cover the night, then you must arrange with the admin SR that you will confirm this no later than midday.
On your return please fill in a Trust sick leave form, sample of which is enclosed. These are available from and returned to the anaesthetic secretary. All absences up to 7 days must be self-certificated. In order to cover absence over 7 days, you must visit your GP and obtain a certificate. This must be forwarded to the Chief of Service, the Medical Personnel and a copy given to Dr. Ladas without delay.
If you are absent on 3 or more separate occasions in a 3 month period, you will be invited to an attendance review meeting, as per Trust policy (you can find the Sickness absence policy on the Trust intranet).
All sick leave is recorded in your personal file.
FACILITIES AND PERSONNEL
The main door to the department should be locked at all times. Both the departmental property and your personal belongings are at risk if this is not done. You are expected to keep the coffee room tidy at all times and to wash up any mugs/plates/cutlery that you have used.
There is a library in the West wing comprising large textbooks accessible to all. There is an extensive selection of other books and interview/SAQ/MCQ files, which will remain in a locked cupboard accessible only to members of the department. Please discuss any suggestions you may have for future purchases with Dr. Ladas.
The key for the locked cupboard is available from Dr. Ladas or her deputy. Books can be borrowed from Thursday am to next Thursday am.
The main medical school library is in the Reynolds building and contains basic textbooks and journals.
There are two computers for trainee use with printers. Both are connected to the Internet and Medline and have Microsoft xp installed.
There are five departmental notice boards one for departmental notices and guidelines, exam calendars and courses of general interest, ITU etc.
Access to the changing rooms is by swipe card. Lockers in the changing rooms are accessed by using a £1.00 coin. There is a limited number of “safe” mini lockers available in a separate CCTV controlled room, keys can be obtained from Ms. Angie Sexton. Shoes are available from the laundry in the hospital basement below the geriatric block.
There is a £5.00 charge per month for milk, sugar, bread etc. This will be collected by the SHO in charge of the coffee fund.
The main hospital canteen is located on the 2nd floor south wing. There is a coffee/sandwich shop on the first floor and a restaurant facility in the theatre suite open from 9am to 2pm during weekdays. On the ground floor there is a mini market and a card/gift shop.
There is a general hospital doctors mess located on the 3rd floor above the main hospital canteen.
There is a sports and social club with a swimming pool, bar, squash courts and gym located adjacent to the main residencies. See Appendix.
On Call Rooms
There are 2 adjacent rooms on the 9th Floor (Marked “Private” – near stairwell). Outside door code – XXXXXX. These are currently available for the anaesthetic SpR’s on-call.
KEY PERSONNEL
Dr. Lena Anagnostopoulou-Ladas College Tutor. Module supervisor for Chronic Pain. Academic afternoon supervisor
Dr. Stuart Berry Lead anaesthetist Imaging Dept. Rota/anaesthetic services co-ordinator
Dr Doris Doberenz Educational supervisor ITU. Module supervisor for ITU
Dr. Patrick Doyle Chief of Service
Dr Peter Evans Consultant in charge Chronic Pain. Module supervisor for Chronic Pain
Dr. Paul Gunning Module supervisor for Vascular Anaesthesia. Research lead
Dr. Chris Hopkins Academic afternoon coordinator. Lead anaesthetist for DSU
Dr Mark Palazzo Chief of service ITU
Dr. John Picard CME teaching- Coordinator. Lead anaesthetist for Recovery
Dr Brian Porter Regional Advisor. Module supervisor for Ophthalmic anaesthesia
Dr. Fiona Porter SHO Mentor. Linkman for AAGBI
Dr. Nicky Stranix Consultant in charge Acute Pain. Medical student coordinator. Module supervisor for ENT anaesthesia
Dr Drinka Uzeirbegovic Audit lead for Anaesthesia (HH/CXH). Clinical effectiveness lead
Dr Peter Ward Module supervisor for Anaesthesia for plastic surgery
Dr Lynda Webb Module supervisor for Trauma / Orthopaedics. CME teaching- Coordinator
Dr Jason Wilson Module supervisor for Neuroanaesthesia. Deputy College Tutor
Mrs. Toddie Manne Anaesthetic Office Administrator. PA to Ms Anne Hall , General Manager. PA to Dr. P. Doyle, Chief of Services
TEACHING
Wednesday afternoon is Academic afternoon. The Grand Round is held in the Postgraduate Education Centre. This starts with a buffet lunch at 12.30pm and is followed by two presentations finishing around 13.45. This is followed by the Anaesthetic Academic meeting which is held in the Anaesthetic Library commencing at 14.00 and finishing at 17.00.
No routine surgery takes place on this afternoon. Life threatening emergencies may be undertaken by the on-call team with the express permission of Dr Ladas .
Attendance at this meeting is compulsory for all except those who have been on-call the previous night when attendance is voluntary but highly recommended. There are no exceptions to this without express permission of Dr Ladas.
Between 14.00 and 15.00 there is either a consultant lecture or three trainee presentations (by SHOs/SpRs 1,2/SpRs 3,4,5) or a critical incidents meeting (see teaching programme). The trainee presentations are coordinated by the admin SR or his deputy. The allocations are made at least one month in advance taking into account annual/study leave and on-call as far as possible. Please note that you are responsible for swapping any dates/topics allocated to you after this time. Your presentations are assessed by all attending consultants and will contribute to your final assessment for this rotation.
The presentations are followed by a tea break and discussion up to 15.30. After that trainees are divided into two groups: a pre-fellowship group, where VIVAs/OSCEs/SAQs/MCQs are practised for the Primary or the Final FRCA and a post-fellowship group for those no longer involved in exams.
Once every two months (usually the last Wednesday of the month) there is an interesting cases, critical incidents and deaths ( ICCID ) meeting organised by Dr Ladas and the admin SpR. It is compulsory to complete a clinical incident form on line on the hospital’s intranet (double click on Clinical Governance and then on Clinical incident reporting) , but a hard copy will be required for the meeting.
One morning or afternoon session per month is dedicated to teaching for the whole Directorate (CME teaching). This is organised by Dr. Picard and Dr. Webb and you may be asked to contribute with a presentation at some stage. Attendance on the Charing Cross site is compulsory for all directorate staff.
Useful Telephone Numbers
Coffee Room - x30501
Anaesthetic Office– Toddie Manne - x7017 -
Day Unit (1st Floor) - x1460
Intensive Care Unit - x1965
Meeting room South Wing, 13th floor - x30500
Acute Pain Nurse - Bleep 4001
Pain Clinic (2nd Floor, South Wing) - x7134
Personnel - x33403 (Aideen Moore)
Recovery - x30310
Theatre Reception - x1456
Theatres 1 - 10 - x30359 - 30369
Competency Based Training SpR Years 1-5
Each trainee will have an entry appraisal within the first month of arrival at Charing Cross. A second appraisal is usually carried out at 6 months, depending on the individual trainee’s need and a final appraisal with review of achieved competencies and consultants assessments at the end of the year.
We do not currently have a mentoring system here, except for the SHOs. Most trainees in the past have been able to talk confidentially to one of the consultants here, but a mentor is available centrally within the School (Dr. Brian Porter).
A modular training system has been implemented in our department since February 2002. A module should comprise of at least twelve consultant-supervised lists/clinics/ward rounds in the appropriate subspeciality. If you have any problems with this in terms of annual leave, study leave etc. you must notify Dr. Ladas as soon as possible. You must not swap modules amongst yourselves.
All Year 1,2 SpRs as well as year 3,4 SpRs now have the opportunity to undertake Core modules lasting two months each in Neuroanaesthesia, Pain, Vascular Anaesthesia, ENT/Head and Neck, Ophthalmics, Plastics, rauma/ A&E and DSU. In addition they can undertake a 3 month ITU module during their 6 mo stay at Charing Cross, which must be agreed with the Training Programme Director first.
The syllabus for each module can be found in the RCOAs booklet on the CCST in Anaesthesia and competency will be assessed by the relevant module supervisor at the end of the module. An example of the workplace assessment record is also enclosed in the appendix. If the module has not been completed by this time, then Dr. Ladas and the training programme director (Dr Shelley Ward, or Dr Michelle Hayes) should be notified so they can arrange for you to complete this module at a later stage.
You must contact the module director as soon as you start the module to discuss your training needs. It is your responsibility to ensure that you complete and be signed off for each module. On completion of the module one copy of the assessment should be put in your personal portfolio, one should be sent to Dr. S. Ward/or Dr M Hayes and one should be handed out to Dr. Ladas.