Sir Humphry Davy Department of Anaesthesia,
University Hospitals Bristol and Weston NHS Foundation Trust,
Marlborough Street, Bristol BS2 8HW
Tel: 0117 342 2163
University Hospitals Bristol and Weston (UHBW) NHS Foundation Trust is a recently merged Trust, with a combined workforce of over 13,000 staff. The Department of General Anaesthesia sits within the Division of Surgery; however, the wider anaesthesia service bridges four clinical divisions of UHBW: Surgery (General Anaesthesia and Critical Care), Specialised Services (Cardiac Anaesthesia), Women's and Children's (Paediatric and Obstetric anaesthesia).
We are a large department and operate across multiple sites: Bristol Royal Infirmary, Bristol Children's Hospital, St Michael’s Hospital, Bristol Eye Hospital, South Bristol Community Hospital and Weston General Hospital. We welcome Novice Anaesthetists, Stages 1, 2, 3 and SIA residents, Clinical Fellows, CESR, SAS Doctors and Consultants and we have a strong track record of providing excellent educational and training opportunities. Anaesthesia within our Trust covers a wide range of surgical specialities and we are the regional centre for many tertiary specialties. If you are completing a General Anaesthesia module of training at UHBW, to benefit from the full range of training opportunities available, you will be expected to visit our multiple sites.
Anaesthesia Sub-specialties at UHBW:
Adult General Anaesthesia
Anaesthesia is provided for adults in all specialties except Vascular, Breast surgery, Neurosurgery and Urology. Bristol Royal Infirmary (BRI) is the regional referral centre for Head and Neck, Hepatobiliary and Pancreatic, Thoracic, Oesophago-gastric Surgery and Gynaecology, (including major oncology resections). We also deliver Colorectal Surgery with a high proportion of ELAPE and major abdominal wall reconstructive surgery. Some orthopaedic surgery is provided including a high proportion of geriatric (silver) trauma.
The BRI is a highly productive thoracic centre, with dedicated thoracic anaesthetists and surgeons. There is at least one thoracic surgery list on each day of the week, offering exposure to major thoracic resections and rapid turnover lists.
Head and Neck Anaesthesia supports Dental, Maxillo-Facial (OMFS) and ENT surgery. We have a full range of advanced airway management equipment available including regular lists requiring jet ventilation, major head and neck resections with free flap reconstruction and laryngectomies. The department also manages the Difficult Airway Rescue Team, combining skills from Anaesthesia with OMFS and ENT. Residents will often complete their SIA Head and Neck training in our Trust and the Post-CCT fellowship post is also popular.
The Obstetric Anaesthesia team provide care (on the Central Delivery Suite at St Michaels Hospital), for approximately 5000 deliveries per year. Our unit is the regional referral centre for complex maternal and neonatal patients, especially those with cardiac co-morbidities. We provide dedicated Consultant Anaesthetic and Obstetric cover for elective and emergency operative deliveries.
We also offer a wide range of major surgery including liver resections, pancreatic surgery (malignant and pancreatitis), oesophageal resections and other major abdominal resections. Day surgery for Colorectal, OMFS, ENT, Gynaecology and Upper GI surgery is undertaken in dedicated suites at St Michaels Hospital, South Bristol Community Hospital and Weston General Hospital.
Ophthalmic anaesthesia is undertaken at Bristol Eye Hospital for adult and paediatric patients. There are 4 elective lists per day and an emergency list every day, requiring regional and general anaesthetic techniques. There are also opportunities for training in Acute and Chronic Pain Management, Vascular access, Brachytherapy, ECT and Sedation for endoscopy.
Cardiac Anaesthesia and Critical Care
Bristol Heart Institute (BHI), the regional cardiology centre, is situated within the footprint of Bristol Royal Infirmary. It is comprised of three cardiac catheterisation labs, providing primary and elective percutaneous coronary intervention (PCI), tertiary cardiac electrophysiology (EP), and imaging (echocardiography and cardiac CT/MRI) services. The BHI is also the regional centre for out-of-hospital cardiac arrests, receiving approximately 130 admissions per year.
Cardiac surgery is delivered in three dedicated theatres and a hybrid theatre. We perform approximately 1200 valve or graft procedures per year, in addition to providing a large regional TAVI service. Cardiac critical care is provided by Cardiac Anaesthesia, in conjunction with General Intensive Care. Together they deliver the regional Extra-Corporeal Membrane Oxygenation (ECMO). We also house the Grown-Up Congenital Heart disease (GUCH) service with an increasing number of patients requiring anaesthesia and critical care for cardiac and non-cardiac procedures.
Stage 2 and 3 Anaesthesia residents will complete their Cardiac Anaesthesia training and competencies in the BRI and BHI. We also offer a Post-CCT fellowship in Cardiac Anaesthesia and Critical Care.
Paediatric anaesthesia
Bristol Children's Hospital, (BCH) delivers anaesthesia for all paediatric patients within the city. It provides a comprehensive range of surgical sub-specialities including Cardiac and Neurosurgery. Anaesthesia residents have many opportunities to see a wide range of paediatric surgery, critical care and pain management and are well supervised by consultants during on call sessions. BCH is the regional major paediatric trauma centre.
Stage 2 residents spend three months (whole time equivalent) at BCH, and Stage 3 residents spend further time in Paediatric Anaesthesia. Residents are also able to complete an SIA in Paediatric Anaesthesia, where in addition to Anaesthesia, they gain experience Paediatric Intensive Care and WATCH, the regional paediatric retrieval service.
Intensive Care
The General Intensive Care Unit is one of the busiest in the region, admitting 1300 patients per year into 40 beds. 30-40% of admissions are elective, following major surgery, with the remainder being emergency cardiology (post-cardiac arrest or specialist PCI or EP requirements), emergency surgery or medical admissions. We support the Bristol Haematology and Oncology Centre and frequently admit patients after complications of chemotherapy or bone marrow transplantation. All forms of organ support are provided with advanced cardiac monitoring and therapy, echocardiography, and critical care ultrasound.
Specific teaching in Intensive Care Medicine is delivered by the Consultants at weekly dedicated teaching sessions, journal club or via morbidity and mortality or quality improvement meetings. There is a multi-disciplinary team simulation programme in the unit.
Peri-operative Medicine
UHBW has a dedicated Pre-Operative Department which is responsible for pre-operative assessment of all elective patients. Direct consultant anaesthetic review is provided for all complex or high-risk patients, and rapid pulmonary function, echo or cardio-pulmonary exercise testing are routine for many patients. Care is tailored and patient-specific and we run a successful Prehabilitation Programme and several Pre-Operative multi-disciplinary team planning meetings (including cardiology, thoracic and hepatobiliary surgery). We provide an SIA and Post-CCT fellowship for anaesthetists with an interest in Peri-operative Medicine, both of which are extremely popular.
Education and Supervision at UHBW
Every resident is allocated an Educational Supervisor and College Tutor who they meet regularly, for the duration of their time at UHBW. Dedicated teaching is offered in ICM, Obstetric, Paediatric, Cardiac and General Anaesthesia modules. The department also holds a weekly meeting which often delivers excellent CPD for all.
The department houses an airway laboratory which is freely available to residents, to practice video laryngoscopy, fibre-optic intubation or front-of-neck access on mannequins or challenging models. We run an annual head and neck study day and the Difficult Airway study day.
There is an active simulation programme, jointly delivered with the Bristol Medical Simulation Centre. We also run introduction courses to Cardiac (One Heart) and Thoracic (One Lung) anaesthesia, as well as MEPA (Emergency Paediatric Anaesthesia), ALS, ATLS and APLS courses. Our Intensive Care Unit also delivers a national FFICM revision course at the Royal College of Anaesthetists in London.
The resident group have also initiated regular trainee forums open to all and supported by a College Tutor. These aim to improve trainee wellbeing and feedback during each module in an informal setting. The department has a strong focus on wellbeing, with rest facilities for on-call anaesthetists, continuous coffee facilities, a lounge with internet access and a library for meetings with AV facilities. We offer return to training systems for those requiring extended time away from clinical duties for whatever reason. In addition, we have a wide range of opportunities in research, quality improvement, and medical education available to those who wish to develop their skills in these areas.
The current College Tutors are Dr Alex Middleditch, Dr Natasha Joshi and Dr Kaj Kamalanathan, who are happy to be contacted regarding any training or fellowship opportunities within UHBW.
Alexander.middleditch@uhbw.nhs.uk
Kajan.kamalanathan@uhbw.nhs.uk