Oxford Region Intensive Care Units

John Radcliffe Hospital

Adult Intensive Care Unit (AICU)

The Adult Intensive Care Unit admits around 1000 patients per year. The majority of patients are level 3 and has an APACHE score of 20-30. The overall mortality is around 20%. Approximately 20% of admissions are elective surgical patients and the remainder are critically ill emergency patients with a wide range of medical and surgical pathologies. The Trust is the tertiary referral centre for major trauma, spinal, cardio thoracic, oesophageal, vascular, plastic, neuro and major maxillo-facial surgery, interventional cardiology/radiology and haematological malignancy. This is reflected in the pathology of patients on the AICU.

A full range of invasive monitoring and all major forms of organ support are employed. The vast majority of patients require more than one organ support and invasive monitoring. Trainees can expect to gain experience of intracranial pressure monitor insertion, oesophageal Doppler monitoring, thrombo-elastography, renal replacement techniques, echocardiography, bronchoscopy, ultrasound, BILEVEL and non-invasive ventilation as well as more basic procedures such as line placement and resuscitation.

The unit is medically staffed in three tiers: two tiers of trainees (from both an anaesthetic and non-anaesthetic background) and the consultant tier. The presence of trainees from a variety of backgrounds provides an unusual training opportunity. It is particularly useful for those trainees doing professional exams and helps our high success rate in the FRCA final.

The 8 consultants cover the unit on a split week system for “first on” and as a daily “second on”. This results in the availability of two consultants during daytime, and one during evenings, nights and weekends. The consultants come from a background in anaesthesia, general medicine, military services and research. There is local expertise in research, sepsis and genomics, ventilation, difficult airway, teacher training, international transfer and primary trauma in developing countries.

The unit has an active teaching programme for both tiers. This includes a morning per week of protected teaching, weekly unit meetings and daily microbiology rounds. The senior trainees have an active exam orientated program including one half-day per month of protected teaching. This contributes to the high success rate in the Diploma in Intensive Care locally.

Cardiothoracic Critical Care Unit

The Cardiothoracic Critical Care Unit (CTCC) caters for all postoperative adult cardiac and thoracic cases in a dedicated 8 bedded intensive care unit and 4 bedded high dependency unit (HDU). There are approximately 1000 admissions per year with the equal numbers of elective and emergency admissions. The majority of cases are following coronary artery bypass grafting. The other admissions reflect the wide interest of the cardio thoracic surgeons and include valve replacements, patients fitted with left ventricular assist devices, major aortic surgery and thoracic cases.

Neurosciences Intensive Care Unit

The Oxford Radcliffe Hospitals Neurosciences Intensive Care Unit is located in the new, purpose built West Wing of the John Radcliffe Hospital. The NICU provides level 2 and level 3 specialist critical care to both neurosurgical and neurological patients from the region. Its comprehensive facilities include neurosurgical theatres, CT, angiography and MRI.

The Unit currently contains 8 level 3 critical care beds, with planned expansion over the next few years to a 17 bed unit. We treat a full range of neurosurgical and neurological pathologies, with expert care in the management of traumatic brain injury and subarachnoid haemorrhage. In addition we admit ENT and Plastic Surgery patients following major head and neck or other reconstructive surgery. This provides a useful avenue of education in these specialties.

Year 1 Specialist Registrars are attached to the NICU for a period of 3 months, during which they will also be exposed to neurosurgical, plastics, ENT and ophthalmic theatre cases. During the day, the Unit is covered by 1 or 2 registrars, together with a Consultant Anaesthetist. A team of 6 NICU Consultants ensures that all week-day sessions are Consultant led, and this provides ample opportunity for training. The day starts with a joint neurosurgical ward round at 8am, and there is also daily input from the Microbiology department. There is also a Multi Disciplinary ward round on a weekly basis. At night, the Unit is covered by the registrar who is resident, on a 1 in 6 rota. There is often opportunity to join the Year 4/5 registrar in the neurosurgical theatres. There is dedicated on-call Consultant Neuro anaesthetist cover.

Registrars can expect to obtain good training in the principles of neurosurgical care. This will include neurophysiology, management of raised intracranial pressure, management of traumatic brain injury and subarachnoid haemorrhage, and the principles of transfer of the neurosurgical patient. The Unit provides an excellent opportunity to become familiar with neuro-critical care monitoring including ICP measurement, external ventricular drainage systems, transcranial Doppler, bispectral index and near-infrared spectroscopy. In addition, registrars are likely to observe brain stem death testing, and gather an appreciation for the events that occur with regards to organ donation. There is plenty of scope to get involved in audit within the NICU, and this is supported by both the weekly Neurosurgical audit meeting on a Friday morning, and also the bi-monthly anaesthetic department audit meeting. Furthermore, any desire to get involved in research will be welcomed and supported.

Paediatric Intensive Care Unit

The Paediatric Intensive Care Unit at the John Radcliffe Hospital provides tertiary referral services for all children from the surrounding counties of Oxfordshire, Berkshire, Buckinghamshire and Northamptonshire. It is currently funded for 7 beds. There are 5 dedicated full time Consultant Paediatric Intensivists with trainee support from the departments of anaesthetics and paediatrics. A consultant led paediatric retrival service to all district general hospitals in the catchment area as well as other regional PICU's is in place.

Horton General Intensive Care Unit

This unit can take up to 6 level 2 and 3 patients. There is close trainee supervision and the consultants are particularly experienced in the introduction to critical care and anaesthesia for the relatively new trainee. All trainees are strongly encouraged to undertake an audit and are supported by a consultant led teaching program, including primary exam focused teaching every week.

Milton Keynes Intensive Care Unit

This unit runs flexibly up to a maximum of nine level 2/3 patients. There is dedicated daytime consultant sessional commitment.

Specialist procedures performed routinely on the unit include percutaneous tracheostomy (about 50/yr), intra-cranial pressure transducer placement & monitoring, oesophageal Doppler cardiac output monitoring, Bi-Spectral Index monitoring and fibre-optic guided airway training.

There is a comprehensive mentoring system set up for trainees rotating through this unit, particularly those wanting to do research and audit.

Royal Berkshire Hospital Intensive Care Unit

This ICU has up to 11 spaces for mainly level 3 patients. The 7 consultants work a weekly rota incorporating a second consultant for extra supervision and teaching. The 7 trainees work a full time rota with provision of extra clinical experience in other departments such as echocardiography, microbiology and bronchoscopy. The weekly consultant led teaching and radiology sessions are particularly well evaluated. The unit has a progressive approach to educational supervision including 360 degree appraisal as standard.

In addition to standard pathologies, patients are treated after major urological, vascular and oesophageal surgery and spinal trauma. Level two paediatric patients are also supported.

Trainees can expect exposure to a variety of advanced monitoring and therapeutic procedures. Examples include percutaneous tracheostomy (60 per year), ultrasound, ODM, echocardiography, bronchoscopy, LIDCO and intracranial pressure monitoring (inserted by the ICU staff). Audit and research are encouraged and supported by a powerful clinical information system, research nurses and a data manager.

Reading also has expertise beyond the traditional boundaries of Intensive Care. The follow-up clinic is the second oldest in the UK and there is a 24/7 outreach service. A centrally funded bereavement expert co-ordinates relative follow-up, organ donation and staff pastoral care.

Stoke Mandeville Intensive Care Unit

This expanding ICU has 8-10 beds with input from 6 consultants. In addition to the usual DGH specialties, the unit is the regional centre for acute spinal injury and major burns. This provides exposure to these highly specialised areas of the Intensive Care syllabus including free flap reconstructive surgery, weaning and rehabilitation of acute spinal injury and burns patients. In addition to routine procedures, percutaneous tracheostomy and Doppler flow monitoring are performed on the ICU.

Wexham Park Intensive Care Unit

This unit has recently been rebuilt into a state of the art general ICU with 12 level 2 and level 3 beds. Nine consultants contribute to dedicated 24 hour cover and lead three ward rounds per day. The midday round is actively supported by specialist pathology / microbiology, pharmacy, clinical biochemistry and respective surgical specialties. There is a very busy outreach service which provides trainees an insight into flagging up potential ICU admissions and their management in the wards. An ICU follow up clinic run has been running for the last 6 years and is well established. Research & audit is greatly encouraged and actively taken up by most trainees. A weekly formal teaching programme is conducted within the department and all trainees have a protected half day for this activity. In addition 30 min tutorial is held every week in the ICU.

Practical procedures training is provided in routine ICU procedures such as lines, haemofiltration etc. Specialist procedures include percutaneous tracheostomy (about 50/yr), intra-cranial pressure transducer placement & monitoring, oesophageal Doppler and PiCCO cardiac output monitoring.