The Royal United Hospital Bath
Overview
Dept of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG / 01225 428331
The Royal United Hospitals Bath NHS Foundation Trust provides acute treatment and care for a catchment population of around 500,000 people in Bath, and the surrounding towns and villages in North East Somerset and Western Wiltshire. The Trust occupies a 52-acre site about 1½ miles from Bath city centre and became a National Health Service Trust in 1992.
The Trust provides 732 beds and a comprehensive range of acute services including medicine and surgery, services for women and children, accident and emergency services, and diagnostic and clinical support services.
The department has 30 Consultants, 11 Associate specialist/ Specialty doctors, 7-8 Clinical fellows, 7 Registrars (ST5-7) and 10 ACCS/Core trainees. There are regular academic departmental meetings on Monday mornings 7.30am as well as a consultant led trainee M and M / “Gaff of the week” meeting on Thursdays 7.30am. There are 4 tiers of on call operated within the trust.
1st On Call - Covering emergency theatre
2nd On Call – Covering obstetrics and acute pain services
ICU – Covering the ICU, ICU-outreach overnight and cardiac arrest
3rd on call – Overarching support to the other tiers of on call and primary representative at all trauma calls.
There are two separate dedicated Consultants on call for General theatres / obstetrics and for Critical Care.
The hospital carries out a full range of services including:
24 Hour Emergency theatre – This runs 24 hours a day and is supported by three additional elective NCEPOD lists a week. It is Consultant led in working hours and out of hours covered by the 1st On call anaesthetist. The emergency service has been enrolled in the NELA project for 5 years and has been heavily involved in reducing the mortality in Laparotomy patients.
An Obstetric unit which is responsible for over 5,500 deliveries, over 1,000 LSCS and over 1,100 epidurals a year. The unit has been recognized for Higher and Advanced (6 months in a LTFT capacity) obstetric training. It is a Consultant/Associate Specialist delivered unit in daytime hours and is covered by the 2nd on call anaesthetist out of hours.
Intensive Care Medicine – a 13 bedded ICU/HDU which admits over 800 patients per annum. There are seven Core trainees (from ACCS, Anaesthesia and Acute Medicine), 4 middle grades, 1-2 ACCP’s and 1-2 advanced ICM trainees. There are 12 consultants who provide direct input into the unit as well as a 7-day a week outreach service. The unit runs regular X ray teaching sessions (Tues 3pm), Journal clubs (Monthly), M&Ms (Bi-monthly), as well as protected teaching for trainees (Thurs 2pm).
Paediatrics – There are over 2000 anaesthetics carried out a year in under 16 year olds. Paediatric specialties covered in the hospital are Urology, General Surgery, ENT, Max fax/ dental, Orthopaedics and MRI. There are a dedicated group of eight Consultant paediatric anaesthetists. The RUH also transfers around 20-30 children per annum to PICU so exposure to the initial stabilization and transfer of the sick child is relatively common and we expect all of our 3rd on (Registrars) to have up to date competency in the resuscitation of children (either via APLS or recent completion of their Intermediate Paediatric training block).
Regional Anaesthesia – There are numerous opportunities within the field of regional anaesthesia including upper arm “Block only” lists and one of our registrars operates as the “Block Fellow” for 3 months to increase their exposure and proficiency at providing blocks such as Interscalene, Supraclavicular, Axillary and forearm blocks. All trainees should expect to become proficient at US guided lower limb blocks such as Femoral, Iliacus, Adductor canal and popliteal blocks.
Acute Pain Service – The acute pain service is run in conjunction with the obstetric pain service and has a dedicated team of nurses attached to it.
Chronic Pain Service - The Chronic pain unit is a multidisciplinary service serving the needs of the local population. In addition to the three consultant pain specialists, there is a dedicated team of nurses, psychologists and administrative staff, based in a stand-alone pain unit with integrated interventional facilities. The service sees 1200 new patients a year. The majority of patients have long-term non-cancer pain, and are seen as outpatients. In addition, there is a highly regarded nurse-led in-reach service to the RUH wards, and a significant cancer-pain workload. This latter work is supported by weekly pain / palliative care MDT meetings. The service performs over 500 xray guided procedures per annum, and is active in teaching, training and research.
Academic and research- The department has two professors within the consultant ranks and in 2015-16 published over 60 papers and editorials as well as winning grants in excess of 5 million pounds. Thirty seven different trainees achieved a publication from work carried out while they were with the department and work from the department won 16 prizes at national and international meetings (mostly by trainees). Trainees of all grades are actively encouraged to get involved in either their own original ideas or help with work already ongoing in the department. The department is a strong supporter of STAR and RAFT driven topics (local audits, iHYPE etc). The department actively wishes to increase its involvement in NIHR portfolio research and trainee involvement in this is a huge help. The department aims to actively support trainees in service evaluations and research and welcomes trainees who wish to discuss this before arriving in Bath.
Quality Improvement. The department is active in QI, the trust QI lead is in the department and there are frequent opportunities for trainees to be involved in QI projects. The department has been active in the emergency Laparotomy Collaborative (ELC) for three years and will soon be taking part in PQIP. The department takes an active part in numerous national audits.
Audit. The department runs monthly audit meetings and trainees are actively encouraged to get involved. Much audit is multispecialty or multidisciplinary and targeted at QI or quality assurance.
Management and leadership – A senior trainee has been appointed in a deputy chairman role within the department to enable them to get hands on management experience of running a department. With the current Medical director and leader of clinical Risk for the trust within the department trainees are encouraged to attend board and departmental meeting and shadow some of the senior consultants within the department.
In addition to the above the other services where anaesthesia is involved in the trust include: elective general surgery, Urology, ENT (Including cancer and laser surgery), Orthopaedics, ophthalmology, Max Fax, Endoscopy, ECT / DC Cardioversion, cardiac cath lap, radiology and gynaecology (including Oncology).
If you require any further information about the department please contact one of the departmental admin team of Rachel Jones (rjones9@nhs.net) or Stacey King (staceyking1@nhs.net ) or on 01225 825056 (7) or Dr Rob Axe (College Tutor) robaxe@nhs.net or Dr Tom Simpson (tom.simpson@nhs.net)