Guy’s and St Thomas’ NHS Foundation Trust

Guy’s and St Thomas’ NHS Foundation Trust Critical Care is one of the largest in the country, admitting well over 5000 patients across almost all sub-specialities of Critical Care each year. We are the regional tertiary referral centre for cardiothoracic surgery, vascular surgery, renal and pancreatic transplant surgery and adult congenital heart disease, in addition to many medical specialities including dermatology, haematology, oncology and renal medicine. We also receive referrals for Interventional Radiology and the Pulmonary Embolism Lysis Team. Hepatobiliary, major trauma, major burns and neurosurgery are not represented.  In February 2021 the Royal Brompton and Harefield joined Guy’s and St Thomas’ NHS Foundation Trust, bringing together world-leading expertise in the care and research of heart and lung disease. 

Guy’s and St Thomas’ is the designated Severe Respiratory Failure (SRF) centre for the South East of England. This Consultant delivered service offers; remote advice, retrieval and advanced respiratory management techniques to patients in our catchment area. Pre-COVID the unit provided Extra Corporeal Membrane Oxygenation (ECMO) for approximately 100 patients per year with severe respiratory failure.

The Critical Care footprint includes:

• East Wing 1, St Thomas’ (15 bedded level 2/3 area)
• East Wing 2, St Thomas’ (15 bedded level 2/3 area)
• East Wing 6, St Thomas’ (11 bedded level 2/3 area)
• Doulton HDU (DHDU)/ East Wing 8, St Thomas’ (5 bed level 2 area)
• Victoria HDU (VDHU)/ East Wing 10, St Thomas’ (15 bed level 3 area)
• Guy’s Critical Care Unit (GCCU), Guy’s Hospital (13 bed level 3 area)

Overnight Intensive Recovery (OIR) predominantly delivers perioperative level 3 care to cardiac, vascular and comorbid surgical patients. It is managed by Cardiothoracic Anaesthetists within the Trust. Lane Fox Unit is a tertiary referral unit for type 2 respiratory failure and complex weaning, covered by the Lane Fox Unit Consultants.

The three level 3 units (EW1, EW2, and EW6) at St Thomas’ receive predominantly high acuity (ICNARC predicted in hospital mortality of 9.7%) medical (60%) and surgical (40%) patients from the Emergency Department, the hospital wards, operating theatres and other hospitals. The average APACHE 2 score is high (15.6) and a large proportion have significant comorbidities. Thirty percent require 3 organ or more support, with nearly 60% requiring advanced respiratory support (intubation & ventilation). 

Guy’s Critical Care unit receives 60-70% surgical admissions (mainly transplant, head and neck, thoracic surgery, complex urology and co-morbid surgical patients) and 30-40% medical admissions (mainly haematology, medical oncology, and renal). APACHE 2 score is also high (14.1) but hospital predicted mortality for these patients is lower at 2.5%.

Overnight Intensive Recovery and Doulton HDU receive predominantly surgical patients (mainly cardiothoracic, vascular, upper GI and co-morbid patients). These patients have a median stay of 2.7 days and predicted in-hospital mortality 1.4%.

The unit submits data to the Intensive Care National Audit and Research Programme (ICNARC). Risk-adjusted mortality is consistently below predicted across all of our units. NHS England data in 2021 revealed GSTT to have the lowest rate of COVID deaths (per COVID per day) in the country.

There is split site working within this Unit

Critical Care and Lane Fox Research Strategy

The department has a strong research strategy delivered by research active clinicians from a multi-professional background and dedicated research nurses. The key areas of research include sepsis, acute and chronic multi-organ failure, advanced organ support, nutrition, respiratory physiology and critical illness in general.

The research programme is broad and includes CLRN supported portfolio studies, investigator-led research projects and commercial trials. The team has close links with academic groups at KCL, other universities in the UK and the Intensive Care Society UK but also academic networks in Europe, North America, Asia and Australia, and industry partners. The department acts as a host centre for research training on behalf of other international societies. 

The department offers many opportunities for trainees to engage in research activities:

• Active participation in departmental research meetings
• Access to training courses offered by KCL
• Opportunity to act as Associate Principal Investigator as part of the new NIHR Associate PI research training scheme
• Support and training for trainees who wish to pursue an academic career or a higher degree
• Opportunities to support research studies as research collaborator

Training in point of care ultrasound (POCUS) is available

An Echocardiography program delivered with a range of practitioners including BSE level 2 accreditation is offered

Theatre exposure for airway experience can be facilitated 

Opportunities for Inter-hospital transfers occur

Opportunities to attend a Cardiac Catheterisation lab can be facilitated (usually as part of Cardiac block)

An established Supported Consultant Activity (acting up) program for  Stage 3 trainees is offered

FFICM Viva Course runs bi-annually

FFICM Viva practice sessions run bi-annually

FRCA Primary and Final Viva practice is offered via the Anaesthetic department

Airway Rescue Course runs every 2-3 months

Cardiac Advanced Life Support Courses run every 2-3 months

Vascular Access Course runs four times a year

St Thomas’ Introduction to Critical Care Course runs four times a year

Simulation – both in-situ and in centre is facilitated

Extra-corporeal Membrane Oxygenation (ECMO) course runs three times a year

Hospital-wide

Grand Rounds – multi-speciality weekly meeting 

The Resuscitation Department – Nationally recognised courses including ATLS, ALS, APLS, NILS,

The SAIL centre (Simulation) run a number of simulation courses including facilitation training

The Medical Education School of Improvement offer free training in many areas, including:

• Coaching and mentoring, Stress and Resilience

• Clinical and educational supervision

• Consultant interview preparation

• Civility saves lives

• Junior doctor leadership

• Speaking up and effective escalation

• Safety Connections

Departmental ICM Teaching runs monthly 

• ST1-2: 0900-1600 second Thursday of the month
• ST3+:  0900-1600 third Tuesday of the month 

Journal Club runs weekly 1400-1500 (Tuesdays)

A Severe Respiratory Failure MDT runs weekly 1500-1700 (Wed)

Unit MDTs (EW1/EW2/GCCU) run weekly 1400-1430 (Wed)

ECHO/FUSIC teaching runs weekly 14.00-16.00 

ECHO virtual sign-off sessions run frequently

Bedside teaching daily

Consultant led microbiology ward rounds run daily

Departmental courses as detailed include Introduction to Critical Care Course, Vascular Access course, CALS, ECMO course, Airway Rescue Course, FFICM Viva course, FFICM Viva practice.