Introduction for Anaesthetic Trainees

Welcome to St John’s Hospital. We hope you enjoy your rotation with us. This induction information constitutes only part of your introduction. Please read this before you begin your attachment with us and then keep it for reference later on.

DAY ONE - Please arrive promptly on the day. For August/Feb starts, there is a Wednesday hospital induction course. Please try not to be on-call the last night at your present hospital, if at all possible. Let us know if you will not be here. Report to the Anaesthetic Seminar Room after the Hospital Induction (please call our secretary Mrs Yvonne Mallon to let her know you’ve arrived on 53064) or at 0800 on other days. One of our staff will be available to show you around and ensure that all the appropriate paperwork is completed.

Car Parking- the entrance to main car park is currently restricted to patients.

Car parking forms for the other car parks will be given to you to complete on your arrival. Please return them to Yvonne ASAP. There is no guarantee of security - car theft and break-ins unfortunately do occur. Do not leave valuables in your car especially while on-call over night.

Clement daylight cycling is encouraged- Dr Stewart can advise.

Please ensure you are fit tested for a face mask that we have in the hospital and are aware of current COVID guidelines.

Due to COVID, the current elective work is reduced and there are more changes to lists. Below is a description of what our normal activity is! There are 9 operating theatres in the main theatre suite. They cover general surgery, urology, ophthalmology, ENT, plastics, hands, orthopaedics, gynaecology, breast and maxillofacial surgery. Theatre 4 is the CEPOD theatre.

OTHER THEATRES

The labour ward has its own theatre, which is used for all obstetric cases on a 24-hour basis. There is currently a Caesarean Section list five days/week and an epidural service is available. Out of hours Obstetric Anaesthesia cover is 6 shared with ICU and theatres.

There are two theatres, 11 & 12, on the second floor with their own day bed area for pre and post op care –ophthalmology and hand surgery is usually carried out there, however, it is currently on standby for extra ICU capacity.

ECT in the psychiatry suite (OPD6) on the first floor, on Monday and Thursday mornings, at 10.00 hrs.

Bronchoscopy list in the Endoscopy Suite on Thursday afternoons - ground floor at the front of the hospital

We have currently 7 Consultants who cover ITU during the day, for a week each, on rotation. We have usually have a second doctor attached, who can be anyone from FY1 (towards the end of their attachment) to a consultant – they carry the 3561 bleep – currently there is an extra tier on the rota associated with COVID and staff grades /speciality doctors and trainees are staffing ITU with consultants allocated to theatres.

If it is quiet in ITU then ensure you see what’s going on in theatre.

The ITU is funded for 80% occupancy for 4 ITU and 2 HDU beds but this can vary, depending on the situation.

Any post-op epidurals should be managed in HDU & discussed with the ITU Consultant prior to insertion and Elspeth Ewing or Lesley Cameron informed.

All ITU/HDU referrals should be discussed with the ITU/on-call Consultant, prior to decision for admission. There is an introduction to ITU for your perusal later in this induction.

There are several Consultants who cover Obstetric Anaesthesia during the day, with another doctor CT2+ carrying the “obstetric” bleep (3948).

There is a separate introduction to Obstetric Anaesthesia from Claire Caesar. Please read carefully and fill in the various forms appropriately then return to Yvonne.

The weekly anaesthetic rota has the bleep numbers of all the members of the anaesthetic department, at the bottom and is circulated on the Thursday of each week.

To bleep: dial 110 on any internal hospital extension, the bleep number, followed by the extension from which you are bleeping.

Obstetric/Emergency anaesthetic bleep is 3948. It is carried by the oncall anaesthetist and handed over – e.g. at 2000hrs and 0800hrs. You must test this bleep every time you take it.

Obstetric Anaesthetic Consultant on call bleep is 3590. The ITU/Emergency bleep is 3561 and is carried by the Anaesthetist for ITU.

You will need an ID/security swipe card with your name and your department. The porters at the front desk at the main entrance will take your photo and activate a card for you. Please remember to bring this every day, as you will need it for access to ITU, Labour suite, theatre and its changing rooms, maternity wards and the children’s’ ward.

ANNUAL LEAVE

CT 1/2's get 12.5 working days per 6 months worked and ST 3-7`s get 15 working days per 6 months. The new deal shift working patterns may restrict your freedom to go when you want. To apply for annual leave, first check the diary (kept in Yvonne’s office) and then liaise with Dr Caesar directly or via Yvonne. There are forms kept by Yvonne that need to be signed, before you buy your air ticket!

STUDY LEAVE

STs get a half-day per week study leave. This is generally for the afternoon course, on a Tuesday or Thursday, or for private study when the courses are not running. Do not forget to tell us which educational course you are currently attending. You must apply using a study leave form for these courses. If you have already done this, please advise Dr. Geddes, in writing, as soon as you arrive. If you “save up” for long blocks, you must give 6 weeks’ notice, and you must be prepared to do the on-call, as study leave for private study at home applies only from 9am-5pm.

To apply for study leave, get a form from Yvonne, fill it in and give it to Dr Geddes /Dr Caesar for signing before sending to NES. Also ensure that the NES have given approval for time and money for the particular course you want to go on. Note: even courses held at NES still need approval from the finance branch.

WEEKLY THEATRE ROTA

Drs Geddes and Caesar do the weekly rota, which allocates daytime work. It will be available from the Thursday prior to the week to which it applies. It is increasingly difficult to draw up the rotas to accommodate swaps/shifts/New Deal Compliance/Study Leave, etc. Therefore, occasionally there may be errors. We would appreciate if you would all check ahead for any such anomalies. You should report these as soon as possible, to Yvonne. If you are unallocated by mistake, we will still expect you to be here. Should your list be cancelled or finish early, liaise with the on-call Consultant Anaesthetist for reallocation.

MONTHLY OUT-OF-HOURS ROTA

Dr Geddes organises the Consultant rota, with Dr Caesar coordinating the trainee rota – IT IS YOUR RESPONSIBILTY TO GET IN CONTACT IF YOU NEED TIME OFF/NOC. OUT OF HOURS TEAMWORKING.

There are two resident Trainee/Staff Grade/Consultant anaesthetists on call, ideally one more senior and one more junior and one non-resident consultant. You should work as a flexible team. There is currently a third junior tier, including some non anaesthetists, to help man the ITU during the day. Between them they cover theatres, Obstetrics, ITU, A&E and the rest. All calls to anaesthetics tend to come via the theatres/Obstetric Anaesthesia bleep. They will include inappropriate requests. You should call for advice and assistance from the senior Trainee / Staff Grade / Consultant if needed. See below about that.

ABSENCE/APPOINTMENTS

If you are unwell, please inform the department as soon as possible. Either telephone the anaesthetic secretary or speak to a consultant. Do not just leave a message on the answer phone – make sure that you actually speak to someone.

TIME MANAGEMENT

We expect you to be punctual. Please read the notes on start and finish times for trainees’ on-call carefully. Please see the patients pre-operatively; please don’t turn up & expect to be spoon-fed! You are contracted to be at work and training. If your name is left off the daily rota in error, we still expect you to be here and for you to liaise with the on-call consultant. Please look for other educational opportunities, ensure your colleagues have had a break and offer assistance to the on call team before you leave the hospital. The lists should finish by 5pm and this is the normal “finish time” except for ENT lists, when it is 6pm.

ATTENDING TEACHING

Ed Mellanby organises the weekly teaching programme, the timetable for each week will be emailed and posted on the door of the seminar room.

Mastery Skills programme - Lothian has a mastery programme for practical procedures such as chest drain insertion, spinals & epidurals.

If you are interested in a particular topic there is a list of which Consultant is responsible for teaching in this area in the Anaesthetic Seminar room whom you can approach and ask to attend or arrange a teaching session.

There is also a diary in the Anaesthetic Seminar room of teaching events that have been scheduled, you may need to book Study Leave to attend some of these sessions so please ensure you do this if required.

Please ensure you can login in to Microsoft teams – a lot of our current meetings are hybrid and are likely to stay that way.

GET INVOLVED

Trainees will be expected to be actively involved in the teaching programme and do at least one presentation to the department and one case discussion to the trainee group.

Trainees can become involved in teaching for the FRCA Primary Course, which is held at St John’s on Thursday afternoons. Speak to Rowena Clark if interested.

PREOPERATIVE ASSESSEMENTS

Whenever possible, you should see and assess patients preoperatively and discuss their management with the consultant with whom you will be in theatre. This will enable you to maximise the educational opportunities on the list.

There is a Consultant-led pre admission clinic on a Tuesday and Thursday afternoon. Let Dr Caesar know if you would like to attend.

THEATRE EXPERIENCE

If you feel you are lacking in experience in certain lists/specialities, let Dr Caesar know and she will try to accommodate this in the rota. However, inform the relevant consultants if you are aware of any interesting cases on a day-to-day basis, with which you want to be involved in. Also, if there are specific topics you would like to discuss then let the supervising consultant know a day or two before (they may need time to prepare).

HEAD & NECK / ADVANCED AIRWAY TRAINING

Dr Gillan is leading the development of airway training at St John’s. Dr McNarry & some of the other ENT Anaesthetists have developed an airway training area within theatres, for the practice of advanced airway techniques on Manikins and which also has many up to date papers & information relating to the management of the difficult airway. There are many training opportunities for practice in such techniques whilst at St John’s, but as a Trainee, you have to look for these opportunities & avail yourself of them, by letting the Consultants know of your training wants & wishes, preferably in advance! We will try to accommodate you all, within reason!

ENVIRONMENTAL SUSTAINABILITY

Drs Cross, Carragher, Goddard & James Dick (ODP) are leading in Environmental Sustainability in SJH Theatres. There are a number of initiatives currently underway in the department & therefore if you are keen to be involved or to become more aware / learn about these issues, then please contact any of the consultants.

• Know who your supervising consultant is.
• Know how to contact that consultant quickly.
• Call that consultant when appropriate.
• Write that consultants name on the anaesthetic record.

The Specialty Doctors or Trainees undertaking solo anaesthesia require having a nominated “Responsible Consultant Anaesthetist”.  Out of hours, the Responsible Consultant is the “On Call” Consultant. 

Daytime Monday to Friday the Responsible Consultant should be identified on the rota. You must confirm the particular plan for that list. Know how to contact the consultant quickly. Call that consultant when appropriate. A senior trainee can help in first instance. Advice should be sought about anything which concerns you or with which you feel inexperienced. Overconfidence is dangerous! Consultation may fend off disaster.

Call for help for a very long list of things, which may be hazardous to the patient. Call about major illness, old or young age, poor airway/breathing/circulation. Call about ITU admissions, transfers, Obstetric problems, GA sections and much more.

Call early. Call, if you are unsure whether to call.

Our Anaesthetic library is now in the theatre seminar room, but in addition we keep some books in Dr Moultrie’s office & ITU books are kept in ITU. The theatre seminar room has folders with Trainee information above the computer. Feel free to look in these folders for information relevant to the department. Let Dr Gardner know if you think it can be improved. Computers are also available in the Doctors Mess and the Hospital Library.

COMPUTER ACCESS AND RESULTS REPORTING: You will need TRAK training and a password to use the computers for X rays, blood results and ordering. Computer terminals are located in ITU/theatres/ward offices & now many are “Sunray” terminals, which require a special Sunray card for access. Paperlite SJH notes get scanned and destroyed after discharge from the hospital, thus any previous admissions will be available via TRAK on SCI store. Please ensure you get training in the first couple of weeks.

Sarah Cross is the College Tutor. You will also have a Clinical Supervisor who will liaise with you to discuss your learning objectives and appraisal during your attachment, try to meet up with them in the first few weeks. You should also arrange to have a mid-point meeting and another towards the end.

If you do not already have an Educational Supervisor you will be allocated one by SESSA. This person will remain your ES throughout your training in Anaesthesia; you should meet up with them at least 3 times a year to discuss your progress and they will contribute to the annual report for your ARCP. You should make yourself familiar with the Lifelong Learning Platform and the changing curriculum requirements (see www.rcoa.ac.uk) as well as keep a logbook and a record of educational activities.

There is an informal mentoring system in operation at St. John’s. Feel free to approach any consultant with whom you feel comfortable and ask if they will be your mentor i.e. trusted advisor; if you have any problems/concerns or just wish advice. There is also a formal mentoring system in Lothian that you can access, for local trained mentors see here.

Anaesthetics and ICU can be a stressful business, eat, drink and rest when you can on shifts. Take care of yourself, make sure you are registered with a GP and do seek help if you need it. There are a number of local sources of support but let your supervisors know if you are struggling for any reason.

Here For You helpline 0131 4517445 Mon –Fri 8am to 6pm Here4U@nhslothian.scot.nhs.uk

Samaritans helpline 116123

Other support including crisis management on the shared drive.

A ‘critical incident’ is an event which could have led to harm if not noticed and acted upon (e.g. wrong drug dose, equipment failure). If you are involved in an incident or a distressing case try to speak to the Consultant before the end of the shift or as soon as possible after. Speak to your supervisors too. They can advise you how to proceed and organise more formal debriefing if it is helpful.

Please also report Incidents on a ‘critical incident form’ or submit as power point slides to Dr Harrington. They are presented anonymously at regular departmental meetings and are an opportunity for everyone to learn 12 from other peoples’ mistakes (hopefully avoid repeating them!)

There is a no blame nor shame policy for those who report incidents.

Online Datix forms should also be completed for harmful/adverse incidents, following discussion with a consultant.

There is one on-call room in ITU. The other designated on-call room on ward 11 is currently unavailable due to building work. There are on call rooms by the Hospital At Night office (first floor above main entrance) that you can book on a first come first served basis with a note on the door (write your name on the note and date you are booking the room for), keypad code 1234.

CASH MACHINE - Royal Bank of Scotland Cash line machine at the main entrance & there is an additional one in the shop.

POST BOX: At the main entrance.

FOOD

Hospital Dining Room - second floor on RHS.

Opening Hours:

Breakfast 0700-1100

Lunch 1200-1400

Supper 1700-1900

Coffee lounge and Café – second floor on LHS. They also sell quite reasonably priced sandwiches & scones.

Opening Hours:

0900-1630. 

Howden Café at main entrance. Teas/coffee, sandwiches, crisps, cakes, juice and biscuits – expensive.

Opening Hours:

0930 to 2000hrs 7 days a week. 

WRVS situated at the maternity OPD area is currently closed.

OUT OF HOURS FOOD

There is a vending machine in the coffee lounge area. It has hot and cold meals, sandwiches, crisps, and chocolate. There is also a microwave for heating meals and a hot and cold drinks machine. (There is a microwave in ITU and the theatre kitchen.)

Obstetric Anaesthetic Handbook

Pain Manual

Palliative Care Manual

Scottish Simulator Skills and Drills

ITU Protocols Training Folders

There are electronic copies of these on this app. 

All the above paper copies are kept in the Theatre Seminar Room. A copy of the Obstetric Anaesthetic Handbook is kept also in Labour Theatre and recovery. You will not get individual copies.

Emergency guidelines are kept in a red folder in every anaesthetic room and can also be found on this app. Copies of local and national guidelines are also available on the NHS Lothian companion app, please let us know if you think any of the information is out of date.

Equipment instruction manuals are centralised in various folders in theatres/ ITU. You are personally responsible for ensuring that you do not use equipment until you know how.

Please ensure that you are shown how to set up Epidural & PCA pumps before your first night on-call.

You should complete one audit or QI project while you are at SJH. Please discuss your plans for QIPs with your clinical supervisor. Refer to the RCOA QI Compendium online for ideas and information.

David Falzon is the departmental lead for QI, and there is a trainee led regional SQuAResNet committee (Email Squares.chairperson@gmail.com). Both can help support you in setting it up/point you in the right direction.