| 1. General Principles |
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1.1
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The anaesthetic specialist registrar (SpR) is one of two doctors in training ensuring continuous medical cover for all patients admitted to the Intensive Care Unit / Critical Care Area (CCA), under the direct supervision of the consultant intensivist.
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1.2
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The aim is to provide both anaesthetic and surgical SpRs assigned to the CCA with an equal share of training opportunities, workload and responsibilities.
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1.3
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The anaesthetic SpR will be responsible to the consultant intensivist when assigned to the CCA.
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1.4
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The anaesthetic SpR will carry pager #500 and be immediately available to deal with any situation in CCA at all times.
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1.5
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The anaesthetic SpR has direct responsibility for any patient allocated by the consultant intensivist.
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1.6
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It is expected that the anaesthetic SpR will be aware and knowledgeable about the care of
all patients admitted to the CCA.
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1.7
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Except when clearly specified otherwise by the consultant intensivist, the anaesthetic SpR has responsibility for all patients remaining in CCA for more than 24 hours (with the exception of transplant/VAD patients) and all non-surgical admissions.
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1.8
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Responsibilities include (but are not restricted to):
- Discussion of management with consultant surgeons and intensivists;
- Appropriate documentation of medical history and progress in patients notes;
- Prescription and update of therapeutic plans;
- Ensuring plans are acted upon and specific diagnostic tests carried on diligently;
- Liasing with other medical specialities if required;
- Carrying all technical procedures;
- Updating CCA audit collection system;
- Collecting information related to patient and integration in clinical plans;
- Communication with patient’s relatives, GP, referring hospital and Coroner, etc.
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1.9
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The anaesthetic SpR should collaborate closely with the Critical Care Practitioner (CCP) in the management of patients.
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1.10
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The anaesthetic SpR must collaborate closely with the surgical SpR and other medical colleagues intervening within CCA.
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1.11
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The anaesthetic SpR is expected to attend Critical Care Meeting as indicated by the consultant intensivist. This includes active preparation and participation at these meetings.
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| 2. Working in shifts in Critical Care |
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2.1
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Working shifts during weekdays (including bank holidays) are starting at 07:00 hours (day shift) and 19:30 hours (night shift), and ending at 20:00 hours and 07:30 hours, respectively. |
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2.2
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Due to the multidisciplinary nature of the work, it is mandatory that shifts start at the specified time. |
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2.3
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While general principles apply to day and night shifts, specificities to the day or night shift work are identified where appropriate. |
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2.4
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It is expected that both the anaesthetic and surgical SpRs ending a night shift will review clinically all patients before the hand-over time. The SpRs will at that occasion be made aware by the CCP of all clinical issues dealt with during the night. They will also deal with all administrative issues such as filling forms and checking accuracy and completeness of records (with appropriate actions taken to correct inaccuracies or complete records). |
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2.5
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The SpRs ending the day shift will have reviewed the patients during the late afternoon ward round. |
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2.6
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The SpRs ending their night shift will transfer all information they have about all patients to the SpRs starting the following shift. This hand-over will be done in the presence of both anaesthetic SpRs and both surgical SpRs. A form has been designed to help in that process and can be printed from the CCA intranet site. This will include (but is not restricted to) the clinical progress of each patient, results of discussion of management with consultant surgeons and intensivists and update of therapeutic plans; update on technical procedures; update on communication with patient’s relatives, GP, referring hospital and Coroner; etc. |
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2.7
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Except in exceptional circumstances, the morning hand-over must be finished by 07:30 hours. The evening hand-over must be finished by 20:00 hours. |
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| 3. Critical Care ward rounds |
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3.1
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At 0830 hours (sometimes later on Thursday), the anaesthetic SpR will join the daily CCA ward round lead by the consultant intensivist. Each SpR will be allocated specific patients according to primary problem, learning opportunities and overall workload in CCA. |
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3.2
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Additional rounds may take place during the day at the discretion of the consultant intensivist. In particular, the anaesthetic SpR will join the 1000 hours ward round with the transplant team. |
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3.3
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At 1730 hours (Monday to Friday), the anaesthetic SpR will join the evening ward round lead by a consultant. |
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3.4
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At 2300 hours, the anaesthetic and surgical SpRs will both review all patients in CCA with the CCP. |
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| 4. Record keeping and instructions |
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4.1
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The SpR is responsible for ensuring that medical entry in patients' records is kept as accurate as possible at all time. |
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4.2
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More specifically, all SpRs must document in the appropriate section of the patient’s notes all clinical interventions or discussions. This includes (but is not restricted to) the clinical progress of each patient, results of discussion of management with consultant surgeons and intensivists; all technical procedures; review of X-Rays, update on communication with patient’s relatives, GP, referring hospital and Coroner; etc. |
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4.3
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All medical orders must be signed at the appropriate place and the name of the SpR must appear clearly alongside a signature. |
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4.4
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All relevant documents that are seen by a registrar must be legibly signed (e.g. laboratory results sheet or microbiology results slips). |
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| 5. Assessment of ward patients in view of admission |
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5.1
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The anaesthetic SpR will review any non-surgical patients that are flagged by other members of staff as probably requiring CCA admission. |
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5.2
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Admission to CCA will be discussed with the consultant intensivist. |
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| 6. Transfer |
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6.1
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The anaesthetic SpR will usually be in charge of the transfer of patients to other hospitals and within the Trust for diagnostic procedure. |
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6.2
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The anaesthetic SpR will ensure with the consultant intensivist that clinical cover for CCA is provided during the transfer. |
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| 7. Theatre work while carrying bleep 500 |
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7.1
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The anaesthetic SpR holding bleep #500 will not work in theatre during working days. |
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7.2
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CCA patients requiring elective or semi-urgent surgery in theatre will not be anaesthetised by the holder of the bleep #500. |
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7.3
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At weekeneds and during the night, the holder of bleep #500 will ensure that continuity of care can be provided before going to the operating theatre. |
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| 8. Heart failure assessment, VAD and transplant patients |
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8.1
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As described above, the anaesthetic SpR will be aware and knowledgeable about the care of all patients admitted to the CCA. |
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8.2
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Due to the specific nature of some interventions, the anaesthetic SpR will collaborate closely with his surgical colleague, the transplant team and designated individuals leading the care of these patients. |
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A Vuylsteke June 2004
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