Trust Fellow in Cardiothoracic Anaesthesia and Intensive Care (ST3+)

Detailed job description and main responsibilities

The post is based in our Cardiothoracic anaesthesia (CTA) theatres and/or Cardiac Intensive Care unit (CICU). 

Cardiothoracic theatres for adult cardiac & thoracic patients:

§  The Freeman hospital has 2 adult cardiac theatres and 2 adult thoracic theatres running on almost daily basis. However, adult congenital anaesthesia run in different theatre and is provided by a different congenital anaesthesia team but ultimately come to our adult CICU after surgery where we manage them thereafter. One of the thoracic theatres is usually for Robotic surgeries.

§  The average number of cases for each cardiac theatre is usually 2 elective operations daily, while the average number of cases for thoracic theatres is 3 cases / theatre daily.

§  Parallel to CT theatres, we run daily anaesthetic list for cardiology patients in cath labs.

§  The CTA department also run a cardioversion theatre on weekly basis.

§  The CTA department also provide urgent and emergency perioperative care for all heart, lung or heart lung transplant patients, in addition, the service extends to cover MCS provision and aortic surgery covering the 24 hrs.

Intensive care for adult cardiac patients (CICU):

The CICU has twenty-one level three beds (six isolation cubicles) and seven level two beds in an adjoining area. CICU duties are based in these areas but extend to support deteriorating patients on the wards, support for cardiology emergencies and accompanying patients during transport to other centres.

§     We work closely with the transplant, VAD and ECMO teams, and the successful candidate will be expected to take a particular interest in the management of our complex patients requiring advanced support.  There are twice daily transplant and VAD rounds with further mutual support and joint decision making as required.  Freeman is unique in the UK in offering transplant services for all solid organs on one site and there are close ties with experts in other disciplines such as microbiology, radiology and haematology who frequently assist our team.

§     We support the cardiothoracic surgical programme which includes revascularisation, valve surgery, aortic root surgery, pericardiectomy and the successful candidate will be involved in the postoperative management of these patients in addition to adult congenital patients.  We are a national centre for adult congenital cardiac surgery and we care for these incredibly complex patients on our ITU following their surgery.  Our cardiology colleagues require support for some primary PCI or heart failure patients and we provide support in the management of patients who have had an out of hospital cardiac arrest. We have a thoracic surgical programme which includes laser and stents for major airway obstruction, robotic and minimal invasive lung resection. We have a team specialising in the management of pulmonary hypertension and we provide critical care support for their challenging patients.

§     We offer advanced haemodynamic monitoring for example by PA catheter and echocardiography. Besides pharmacological cardiovascular support we use various forms of mechanical support such as intra-aortic balloon counter pulsation, Impella, LVAD, RVAD, VV and VA ECMO. 

§     There are two medical ward rounds each day led by a consultant with an interest in Cardiothoracic Critical Care. Our morning round which is concerned with the detail of patient management and there is an evening business round to plan for overnight care.

§     We have a multidisciplinary approach, working closely with, for example nursing, physiotherapy, microbiology, nutrition, pain, psychology, speech and language therapy.

§     The trust is adopting a paperless medical record.  Our medicines prescription, administration, investigation ordering and results with various documentations are electronic, and we will be adopting a fully paperless system for critical care medical and nursing records in the near future.

Echocardiography

§     The appointee will have the opportunity to acquire a working knowledge of the fundamentals of echocardiography during the tenure of the post.  The cardiothoracic anaesthetic department runs a week long TOE course once a year. The appointee will be encouraged to get accredited with British Society of Echocardiography or European Association of Cardiovascular Imaging in Trans-oesophageal Echo with all possible help for theory exams and collection of cases for logbook.

Post-operative analgesia techniques, with special reference to thoracic surgery

§     Attendance on pain ward rounds is offered.

§     Cardiothoracic Theatres & CICU

Audit and research

§     The appointee will be encouraged to undertake audit and research projects during the post.

Education

§     The appointee will be encouraged to participate in teaching for medical students, nursing staff and less experienced trainees, and to undertake the preparation of topical reviews.  There are weekly departmental educational meetings which are co-ordinated by the Specialist Trainees. 

On-call

§     There is a 2-tier rotational trainee / fellow rota, with advanced critical care practitioners participating in the first tier rota.  A rotating ST3+ from the Northern region or an ACCP will be on a full shift rota covering ITU mainly.  The appointee will be 2^nd on-call on a full rota covering predominantly ITU, but providing support to theatres if required or appropriate, or if split rota is active which depends on the total number of fellows and trainees, in addition to ACCPs. 

The Trust Fellow appointed to this post will be allocated a consultant educational supervisor.  The fellow will be expected to maintain a logbook of activity, to ensure that his/her training can be easily reviewed and optimised in conjunction with the educational supervisor.  This logbook should be made available for external assessment if required. 

Flexibility: 

In line with the Trust’s core value of placing patients at the heart of everything we do, we are developing our service provision to be responsive to the needs of our patients. To meet those needs some staff groups will be increasingly asked to work a more flexible work pattern so that they can offer services in the evening or weekend.  As a result any offer of employment to a consultant post will be subject to you agreeing to work a new more flexible pattern or working in the future if required, including evening and weekend work.

Please read attached Job Description and Person Specification.