CRITICAL CARE UNIT

Information about trainee placements within the Critical Care Unit at Medway NHS Foundation Trust.

Welcome

We have a busy 25 bedded critical care department, admitting around 1800 patients/ year, comprising a separate 9 bedded ICU, 10 bedded surgical HDU and 6 bedded medical HDU.

Being one of the busiest critical care units in the region, the department provides trainees with opportunities to gain experience in a diverse case mix of critically ill medical patients alongside a large number of elective and emergency post-surgical patients The case mix for the level 3 admissions is approximately 90%-10% emergency: elective split and approximately 70:30 medical: surgical split.

The hospital houses the local vascular and ENT services and therefore we receive the casemix associated with these specialties.

Ventilators (Draeger Infinity C500) with advanced modes including APRV are in use in the unit. Citrate anticoagulation (Nikkiso Aquarius) is first line for CVVH and we use Edward’s EV 1000 and PiCCO for cardiac output monitoring. There is an active interventional radiology department and we take advantage of this service to deliver unique modalities of therapy (e.g. catheter directed/ ultrasound assisted thrombolysis for intermediate risk pulmonary embolism).

The emergency department is the busiest in the region and treats wide ranging acute illnesses. Respiratory medicine department has a comprehensive range of services (TB, lung cancer including interventions like EBUS/ Thoracoscopy, pleural service, busy sleep and domiciliary NIV service) and works in close collaboration with critical care. There is a 24/7 on-call GI bleed rota in place and 24/7 on-call service is also in place for cardiology and major surgical specialties (ENT, orthopaedics, vascular, urology).

There is a well-established Post-ICU clinic with physiotherapists and a counsellor embedded within the team.

Image by Jair Lázaro
 

About training in the Critical Care Unit

Research


We have been the busiest unit in the KSS region with research with significant involvement in RECOVERY and REMAP-CAP trial. We are about to initiate ACCORD-2 as well.

We are currently recruiting in BLING and EMPRESS trial. Previously completed studies include “65 Trial”, PRISM, Ingenza and TEST-IT, LEOPARDS, ACCUPASS, CALORIES, PROMISE, FREE, IOSWean, ISOS, EPOCH, TRAC-MAN, OSCAR, FIRE, ECLIPSE and ETHICUS among others.

Locally developed research studies are currently being contemplated. Trainees are encouraged to complete their GCP and participate in the research activities.




Audit


There is an active audit department and monthly audit and QI meetings are held under the guidance of Dr Divekar.




Staffing


Junior medical cover is made up of a combination of ICM, medical and anaesthetic trainees. Advanced Critical Care Practitioners participate in the HDU rota. F1 doctors are part of the team as supernumerary members. Senior cover is provided by the consultants on-site (0800-1800) seven days a week and distally out-of-hours, with readiness to be on-site whenever needed.
There are 7 days physiotherapy cover and in-house dietician and pharmacist cover. Currently the junior rota is 1:6 full shift cover.




CCU Training Opportunities


There are a variety of available training opportunities on CCU such as:

  • ICU BASIC course is delivered yearly through the department.
  • There are opportunities to learn bronchoscopy with single patient use bronchoscopes available within the unit
  • There are dedicated Ultrasound scanners available in each of the three critical care areas for use in clinical services and training.
  • Opportunities to perform regularly performed ICM procedures including percutaneous tracheostomy.
  • It is possible to be involved in regular research activities within the department.
  • There are opportunities for being involved in hospital wide “Medilead” project.
  • There is scope to gain exposure in domiciliary NIV services due to close association between ICM and respiratory medicine department.
  • There can be opportunities to be involved in regular teaching for medical students.
  • There can be opportunities to gain exposure to post ICU follow up clinic.
  • Trainees regularly get involved in regular multidisciplinary teaching including simulation based teaching





 

More information from the professional and statutory body for the specialty of intensive care medicine.