Intensive Care at the Royal Liverpool University Hospital

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The
Intensive Care Unit (ICU) [photo]
is situated on the 1st floor of the Hospital, XYZ side. It moved into its
present accommodation in 1992.
It is a separate Clinical
Directorate with an annual budget of about £7M (€10M)
within the Royal
Liverpool University Hospital, an acute teaching
hospital with an annual budget of over £320M (€460M), close to Liverpool
City centre.
Contacting
us
Telephone:
ICU Secretaries: Lynne
Wilcock and Gillian Chantre:
0151 706 3191 or 0151 706 3853
Either can be e-mailed
with the format: firstname.surname@rlbuht.nhs.uk
The ICU direct line:
0151 706 2400
Fax: 0151 706 5853 or 0151 706 5646
[If calling from
overseas dial: + 44 151 706 XXXX]
Postal
address:
Department of
Intensive Care, 12th Floor, Royal Liverpool University Hospital, Prescot Street,
LIVERPOOL, L7 8XP
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Medical
Staff
The
Clinical Director of Intensive Care:
- Dr
Lawrence McCrossan (Critical Care Outreach
Lead)
The
other Consultant Intensivist Staff are:
- Dr
Andrew Axon (Education
Lead)
- Dr
Arpan Guha (Equipment
Lead)
- Dr
Jonathan Walker (Audit
Lead)
- Dr
Richard Wenstone (ICS
Linkman, Mortality & Morbidity Lead, Critical Incident Lead; AMICU
Treasurer) [photo]
Staff can be e-mailed
with the format: firstname.surname@rlbuht.nhs.uk
The consultant staff
are supported by a Clinical Fellow (a 12 month post), currently Dr.
Elizabeth Flockton,
and
other trainees who operate on a shift system designed to produce an average
working week of 48 hours:
Senior House Officer
(SHO) and Specialist Registrar (SpR) trainees are seconded from The
Department of Anaesthesia. We
also train about five "FY2" (Foundation Year 2) SHOs.
Under the Working
Time Directive*, trainees are allowed to work a maximum shift duration of 13 hours and must have
a minimum of 11 hours free in every 24 hours. Trainee Rota shifts
are 08.00 - 21.00 and 20.00 - 09.00 hrs, with handover ward rounds at 08.00 and
20.00 hrs.
The consultant to
consultant handover ward rounds, where necessary, are at 08.00 and 17.00
hrs.
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*Working
Time Directive
Since
1 August 2004 Doctors in training:
- May
work an average of no more than 58 hours/week (56 hours from August
2007 and 48 hours from August 2009*)
and
- Must
have a minimum of 11 hours of continuous rest in every 24 hour
period and
- Must
have at least a 20 minute break when a shift exceeds 6 hours and
- Must
have a minimum of 24 hours of rest in every 7 days or 48
hours of rest in every 14 days.
- The
SiMAP Ruling indicates that time spent resident whether working or
not must be considered as working time.
- The
Jaeger Ruling indicated that compensatory rest should be taken
immediately when an overrun beyond scheduled working had occurred or
when an on-call period at home had been interrupted by a period of
work.
*The
New Deal has limited the working week to 56 hours since 2003.
For
consultants and non-consultant career grades the 48 hour maximum
working week is already in force.
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The Department of Anaesthesia's medical staff
manage the Hospital's Post-operative Critical Care Unit (POCCU).
Occasionally
supernumerary trainees from The Department of Accident & Emergency Medicine
and also The Liverpool Women's
Hospital (trainees in gynaecological oncology or feto-maternal medicine) are
seconded to the ICU.
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About
the ICU
- A "closed" unit providing a range of acute respiratory
and renal support modalities for the population of Merseyside and beyond.
- Number of admissions (2007): 496
(78% were ventilated and 17% had renal replacement therapy)
- Number of beds: 13 (all funded); occupancy (2007) 93%
- Mean
APACHE II score (2007): 18
-
Formal consultant intensivist ward rounds take place twice daily
at 0800 hr (0900 hr at weekends) and again at 1700 or 2000 hr.
- Tutorials for trainees take place Tuesday mornings and Educational meetings are held every Friday lunchtime. There are
also regular multi-disciplinary audit or ethics meetings.
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Research,
Development and Audit
- This Unit was one
of the sites for phases 2 and 3 of the Glaxo Wellcome study of L-NMMA
in septic shock and their study of remifentanil
in ventilated patients. We were also a site for the Transcend
multi-centre study of glutathione in acute lung injury
and multi-centre work with other nearby ICU's looking at the role of a
re-formulated
fluconazole. We were one of the centres involved in the recently
terminated Leo
Pharma study of porcine surfactant in acute lung injury
[further information from RW].
We were enrolled into the recently completed GSK phase II LIPOS
study.
- We were involved in the ("CESAR")
multi-centre
study of ECMO and
were one of the phase III centres involved in the study of
activated protein C in sepsis. We also took
part in the recently completed multi-centre study of Mycograb,
a novel
therapy in candidiasis
[further information from GRM].
- We
have active research interests in HLA-DR expression,
GM-CSF and selenium supplementation in sepsis in co-operation with
the University of Liverpool's Departments of Immunology and Chemical
Pathology [further information from RW]. There is also close liaison with the Department of Chemical
Pathology with a particular interest in cytokines and micro-nutrients.
- The
Unit has been using, since 1996, inhaled nitric oxide
therapy for patients with acute lung injury. Typically we use NO where prone
ventilation has not been helpful or possible [further information from RW].
- Other projects underway, planned or recently
completed include:
- an evaluation of sensitivity of noninvasive
determinants for capillary leakage syndrome in septic patients.
- work on failure
to wean critically ill patients from mechanical ventilation due to constipation
[Presented in 2000 at the Rome meeting of ESICM
and published in Br.
J. Anaes] [further information from RW];
- the role of acupuncture
as a sedative in the ventilated patient [further
information from RW];
- Using APTT
waveform analysis as an early predictor of outcome in critically
ill patients, in co-operation with University of Liverpool's Department of
Haematology. Part of this work has already been presented at
international meetings and published in haematology and critical care
journals. Continuation of this work has attracted an MRC
grant [further information from RW or
IW];
- the role of NSE and
S-100 in predicting functional outcome after cerebral injury, [Presented
in 2002 at the Barcelona meetings of ESICM]
[further information from RW];
- We have also
carried out a prospective study for estimation of
cardiac responsiveness to fluid administration using stroke volume
variation in mechanically ventilated patients with severe sepsis. [Presented
in 2002 at the Barcelona meeting of ESICM];
- changes in fat metabolism during critical illness including the effect of body weight, in sepsis, on the production of
adipokines, glucose metabolism and
outcome [further info from IW];
- Use of
BIS monitoring during percutaneous
tracheostomy [further info from EF];
- Validation of the
Charleson Score in a critical
care population [further info from AG].
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Audit
- The Unit subscribes to the national case-mix study under the
auspices of The Intensive Care National Audit and Research Centre, ICNARC.
Our audit and ICNARC medical lead is Dr
Jonathan Walker, our data lead is Mr.
Steve Davies and our nurse audit lead is Sister Kate Vickers.
Charge Nurse Mark Clark liaises on behalf of the ITU with our local Critical
Care Network.
- The Unit also subscribes to the Critical Care
National Cost Block Programme run by the Critical Care National Working
Group on Costing. The Coordinating Centre for this is MERCS (Medical
Economic and Research Centre) in Sheffield. Tel: (+44) (0) 114 271
3510/1810,
Fax: (+44) (0) 114 271 1979.
-
Nursing
Staff
& Critical Care Outreach
- The Associate Directorate Manager, Critical Care is
Justine French.
- The Directorate Manager is
Ann Conley,
who also manages the nurses in the Anaesthetic Directorate's POCCU
and the Surgical Directorate's 5HDU. She is also the Directorate Manager of
Surgery.
Staffing
complement:
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Directorate Manager & Clinical Services Manager: 1
G grade: 7.5 Whole Time Equivalents
F grade: 11.5 WTE
E grade: 55 WTE
D grade: 7 WTE
This
equates to 6.2 WTE trained nurses per bed.
In addition we
employ 6.3 WTE of auxiliary nurses or health care assistants. |
- Nursing
Educational meetings are held every Thursday lunchtime. There are
also occasional multi-disciplinary audit or ethics meetings.
- For
further information about nursing staff, activities and job
opportunities e-mail Ann Conley, Justine
French or telephone at extension
2633 or 2499.
- We
occasionally receive nurses on the University
of Liverpool Clinical Specialist Nursing MSc course as part of their
preceptorship.
- Some
of the teaching materials used by our nursing staff
to teach colleagues about Swan-Ganz catheters and the PiCCO can be found here.
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Other
Staff
As well as Medical,
Nursing, Physiotherapy and Medical Engineering Staff, the Unit is complemented
by two specialised technicians (Operating Department Practitioners), David
Brown
[photo] and John
Murphy.
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Education
and Training
Dr.
Shearer can provide further information about the Certificate of Completion of
Specialist Training (CCST) in Intensive Care Medicine, as advised by the
Intercollegiate Board for Training in Intensive Care Medicine (IBTICM).
Further information is also available from the Intensive
Care Society.
- Some
of our nursing teaching materials
about Swan-Ganz catheters and the PiCCO can be found here.
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About
Critical Care in our local area:
- For
further information about Intensive Care in the Cheshire & Mersey
area, follow the links to the Association of Mersey Intensive Care Units, A.M.I.C.U.
(A link
to the Cheshire and Mersey Critical Care Network's own web site can be
found here.)
- The Intensive Care Unit is one of over 30 ICUs in the North West
of England which take part in the Intensive
Care Bed Information Service, I.C.B.I.S.
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WebMaster: RW
Page last updated: Sunday, 30 March 2008
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