University Hospital Southampton NHS Foundation Trust

• Emergency and elective admissions:

  Medical

• Cardiology including post OOHCA, Respiratory, Renal, Hepatology, Neurology, General Medicine
• Haematology including post CAR-T therapy, complications related to chemotherapy and bone marrow transplantation, thrombotic thrombocytopenic purpura regional centre for plasmapheresis
• Regional centre for Infectious diseases and HIV

Surgical

• Major Trauma (regional Major Trauma Centre), orthopaedics
• General Surgery including complex abdominal failure, reconstructive surgery, and major exenterations.
• Tertiary Hepatobiliary, Upper Gastrointestinal and Thoracic surgery
• Complex head and neck/airway surgery with Maxillo-facial and ENT,
• Gynaecology and obstetrics, Vascular (regional centre) and Urology
• There is no split site working within this Unit

The General intensive care unit (GICU) at University Hospital Southampton has an expanding research portfolio led by dedicated academic intensivists (Professor Mike Grocott, Professor Denny Levett, Associate professor Rebecca Cusack, Associate Professor Ahilanandan Dushianthan, Dr Max Jonas), microbiologist (Associate Professor Kordo Saeed) and a pharmacist (Associate Professor Cathy McKenzie). The research is supported by the Perioperative and Critical Care Theme of the NIHR Southampton Biomedical Research Centre. We have ongoing academic fellowships, and PhD programmes. We also supervise 3-4 research residents who support the research activities in GICU.

These posts provide opportunities for residents to pursue research projects at a variety of levels both in ongoing studies within the department and research in areas of individual interest. In addition, the quality agenda is a high priority and research or publication in this area is strongly encouraged and there are a variety of opportunities to make use of established datasets to explore personal ideas. Research mentoring, journal clubs and a program of research training seminars ensure that all fellows will complete their program with new transferable skills. It is expected that the post holder will contribute to the teaching and training programme on GICU. We will encourage and support fellows to present research findings and other novel work at local, regional, national, and international meetings. All residents will have the opportunity to engage in the NIHR Associate Principal Investigator Scheme.

We recruit and participate in both national (REMAP-CAP, GUARDS, MOSAICC, SIGNET, GENOMICC, T4P, INVENT, ABBRUPT, etc) and local (MecROX, Gut-Biome, MitoICU, MitoCOVID, Epipneumonia, MMICS, CovSURF-NIV, etc). University Hospitals Southampton Critical Care department has an active multidisciplinary research programme. Recently completed and ongoing pre-doc and post-doc fellowships, Masters and PhD programmes have a broad focus including acute lung injury and surfactant metabolism, mechanistic understanding of hypoxia in the critically ill, interventions for the treatment and prevention of psychological trauma post critical illness, oxygen therapy, early rehabilitation, rapid microbiology detection, antibiotic stewardship and delirium. . Ongoing areas of research include:

1. Applied human physiology including adaption to hypoxia and the epidemiology and improvement of perioperative outcomes (Mike Grocott – Professor in Perioperative Medicine and Critical Care). https://orcid.org/0000-0002-9484-7581
2. Acute lung injury, surfactant and phospholipid metabolism, mechanistic effects of hyperoxia, pneumonia and mitochondrial dysfunction in ICU (Ahilanandan Dushianthan - Hon Associate Professor in Critical Care). https://orcid.org/0000-0002- 0165-3359
3. Physical and psychological rehabilitation, effects of microbiome in the critically ill (Rebecca Cusack – Honorary Associate Professor in Critical Care). https://orcid.org/0000-0003-2863- 2870
4. Cardiopulmonary exercise testing (CPET) perioperative medicine (Denny Levett - Professor of Perioperative Medicine and Critical Care) https://orcid.org/0000-0002-8418-1675
5. Antibiotic stewardship, rapid diagnostics and infection prevention (Kordo Saeed - Hon Associate Professor Infection Prevention). https://orcid.org/0000-0003-0123-0302
6. ICU Delirium (Cathy McKenzie- Hon Associate Professor and Consultant Pharmacist) https://orcid.org/0000-0002-5190-9711
7. Perceptions and needs for palliative care in the ICU (Carol Davis – Palliative Care Consultant).

Minimum staffing (often higher than what is stipulated )

GICU per shift

• 4 ICM Consultants during the day 2 Consultants 1700-2200
• 1 Consultant non-resident from 2200
• Minimum Junior Staffing per shift.
• Two airway-trained personnel; (ICM and Anaesthetic registrars along with Senior fellows and ACCP’s)
• 4 non -airway-trained resident doctors or ACCPs; (IMT, ACCS, Foundation doctors, Junior fellows and ACCPs)

SHDU per shift

• 1 GICU consultant during day and overnight cover as per GICU
• 2 resident doctors during the day 1 at night

We have a high caseload of emergency and elective admissions, with usually 10-20 referrals per day, comprising a wide range of pathology, and often requiring input and intervention from a broad range of sub-specialities. We work closely with our other specialist intensive care units, including Cardiac ICU, Neuro ICU and Paediatric ICU.

Unique exposure to multiple tertiary-level clinical cases, including:

• Major trauma resuscitation and management as Major Trauma Centre
• Complex haematological and oncological disorders, including CART cell therapy, chemotherapy and bone marrow transplant, TTP with emergency plasmapheresis.
• Management of infectious diseases and HIV related illness
• Complex head and neck surgery, with complex airway reconstruction
• Thoracic surgery, including trauma, lung reduction surgery, Video & Robotic assisted thoracoscopy and empyema management
• Major vascular surgery including emergency AAA surgery and complex vascular reconstruction.
• Surgery for abdominal failure, exenteration, hepatobiliary and oesophageal surgery.

Multiple therapeutic interventions available on site for involvement/observation

• Cardiac catheterisation, catheter directed thrombolysis and thrombectomy (IR/neuro), ablations, echo clinic.
• Endoscopy with ERCP and LAMS
• Tertiary interventional radiology

Point of Care Ultrasound Training

• The department has several supervisors in FUSIC Heart, Lung & HD.
• Full training offered for completion of Intensive Care Society FUSIC Accreditation.
• Opportunities for extended echo accreditation, including echo clinics & FUSIC HD.

We have forged a close working relationship with allied sub-specialties including anaesthetics, emergency medicine and acute medical specialties allowing keep in touch days during EDT. For single specialty ICM residents we offer the opportunity to gain experience in our Perioperative Medicine service, CPET and high-risk surgery clinics or in ICU focused Palliative Care. Both our Perioperative Medicine and Palliative Care services have international academic recognition.

For Stage 3 equivalent residents we offer opportunities to act up as an ICM Consultant, including leading ward rounds, managing referrals, and acting up on call out of hours, including off site.

We also offer our senior residents the opportunity to act as Chief resident., This role allows the development of non-clinical leadership skills in representing junior residents and ACCPs. This involves:

• Attending consultant meetings to discuss departmental and training issues, and help resolve issues within the unit.
• Act as a conduit between consultant, nursing and AHP groups.
• Help with organisation of dept teaching
• Implement initiatives to maximise resident and ACCP wellbeing

Twice yearly stage 3/post FICM regional training days held onsite, specifically to help prepare senior ICM residents for consultant applications and consultant practice (as part of regional teaching programme).

• Weekly protected 2-hour consultant-delivered Thursday afternoon teaching, which includes a journal club.
• Twice-monthly high fidelity in-situ simulation teaching directed at residents of all seniority teaching clinical and non-clinical skills.
• Regional UHS FFICM revision course (biannual)
• Regional ICU emergencies course for senior residents (SHoCCS Southampton Critical Care Simulation Course).
• Regular trainee-led 10-minute micro teaching sessions
• CVC manikin insertion teaching, leading to sign off for CVC insertion
• Monthly POCUS meeting
• Clinical education resident fellow
• POCUS/echo resident fellow; regular FUSIC/POCUS accreditation opportunities
• Monthly rolling half day education morning

• Fortnightly M+M meeting led by Dr Martin Knight; discussing all unit deaths as well as success stories, dissemination of learning from AERs and other notable cases, highlighting of FERFs and unit good practice.

Facilities available:

• Large communal resident/ACCP office within GICU, comprising workstations and sofa area. Located adjacent to consultant and nursing office.
• Large communal rest area
• On site parking available for all medical staff
• Availability of after-work rest facilities
• 24/7 availability of hot food and drinks within hospital
• Free on-site gym within newly built Wellbeing Hub
• Separate private hot-desk areas with work stations, for completion of EDT and other work.