UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST
University Hospitals Bristol NHS Foundation Trust is the largest teaching hospital in the South West of England. It covers a population of 3.5 million for tertiary referral specialist services (adult and paediatric) and provides a full range of general medical services for the 300,000 local catchment population.
ACCS is delivered through the two co-located Emergency Departments (ED) with the adult EM service based in the Bristol Royal Infirmary (BRI) and the Paediatric EM service based in the adjacent Bristol Royal Hospital for Children (BRHC).
BRI is a Level 2 Trauma Unit whilst BRCH is the designated Regional Paediatric Trauma Centre. A helideck was completed in 2015 atop the hospital to facilitate the transfer of tertiary referrals for Paediatric Trauma and OOH Cardiac Arrest.
BRI ED sees around 75,000 adult (>16 years) attendances each year and is the busiest ED in Bristol having a high acuity case mix reflecting it’s position as an inner city department serving an area of social deprivation in the South and centre of the city.
There is 24 Middle Grade cover incorporating the EM ST 4-6 training posts, post CCT Fellowship Posts, Staff Grades and Clinical Fellows. There is also a separate 24 hour ST 1-2 rota comprising of Clinical Fellows, ACCS and GPVTS trainees. There is also 24 hour ENP service based at BRI and overnight (02:00 – 08:00) there are 2 ST1/2 doctors, 1ENP and 1 Middle Grade on duty. Consultant shop floor working is 08:00 – 22:30 with consultant led ward rounds taking place three times a day (08:00, 16:00 and 22:00) of the ED and it’s eight-bedded Observation Unit. These handovers are based on an ABCDE of handover model and are examples of best practice in patient safety in practice as well as excellent teaching opportunities.
UHBFT is the regional cardiac/cardiothoracic centre and 24 hour PCI has been available here since 2009. It is the Regional receiving ED for OOH Cardiac Arrest with ROSC and has close working relationships with SWAST, Cardiology and ITU ensuring an integrated approach and seamless transition of care for such patients for who the ED is the point of receipt and stabilization. In department RSI is performed by both emergency physicians and intensivists and the development of extended airway management skills is supported.
There are 12 Consultants within the department (including 2 Military consultants) who have areas of specialist interest including: Research and Academic EM. Medical Education, Point of Care Ultrasound, Emergency Airway Management, Pre Hospital Care, Clinical Toxicology, Simulation Training, Patient Safety and Social Media in Acute Care. The current consultant body includes: the National Clinical Director for Urgent and Emergency Care, the Head of Severn School of Emergency Medicine, the Medical Director of the SW Air Ambulance Service, the UHBFT Associate Medical Director for Patient Safety and the Lead Examiner for FRCEM Final Clinical Examinations ensuring that the department is at all times in the forefront of developments in all aspects of Emergency Care and Education regionally and nationally.
The department has close links with the University of Bristol for undergraduate teaching and also postgraduate and mutli-disciplinary education through the School of Emergency Medicine based at the University of the West of England which is led by Professor Jonathan Benger (Professor of Emergency Care) a member of the consultant body at UHBFT. The department is one of the leading Academic EDs in the UK and presents trainees with many opportunities in research and education. There are two nationally appointed Academic EM training posts based here.
Teaching / Training Programmes – there is a weekly in department teaching programme for Core trainees who are also ensured protected time for release to attend their relevant regional teaching programmes (VTS/ACCS).
There is a protected fortnightly half day in department HST teaching programme which incorporates training in: Critical Appraisal, point of care ultrasound, patient safety, toxicology, Simulation and emergency airway management utilizing the expertise of the consultant body in addition to a wide variety of clinical and non-clinical topics from invited speakers.
Multidisciplinary Simulation training sessions occur regularly and involve all grades of staff with structured feedback on Human Factors elements as well as clinical learning.
Consultants within BRI ED run an annual Mock FRCEM and trainees have excellent in department support for Exam preparation.
All trainees will at the commencement of their post be assigned to work within a multidisciplinary ‘audit team’ led by a HST trainee and supported by a named consultant. Each team must complete their designated project and present their findings at the annual departmental audit day in July when prizes will be awarded for the best project poster produced. Such projects have previously produced posters and presentations that trainees have taken forward into regional / national meetings.
E-Learning - Dr Rebecca Maxwell (ED Consultant) has developed and maintains an e-learning platform for the department which is multidisciplinary and which can be accessed for e-induction, in department teaching materials and much more.
BRI offers excellent training opportunities in a well supported environment with an extensive range of sub-speciality experience available through the diverse interests of the consultant body.
BRHC ED sees over 35,000 paediatric (<16 years) attendances each year and is the designated Regional Paediatric Trauma Centre.
The department has a 24 hour Middle Grade rota comprising both CT3 EM and ST4-6 paediatric trainees working on a single rota. It is a recognised site for paediatric EM sub-speciality training and the consultant body, which numbers 8, comprises individuals from both EM with paeds sub-speciality accreditation and Paediatricians with Paeds EM sub-speciality training. Consultant shop floor cover is 08:00 – 00:00 7 days a week. Staffing is at all levels separate from the adult ED service based in the BRI with those trainees placed at BRHC benefitting from focused, dedicated paediatric experience during their placements.
BRHC is a regional centre for the South West for all paediatric sub-specialities including: cardiology and cardiac surgery, bone marrow transplantation, renal medicine, gastroenterology, paediatric neurology and neurosurgery. The ED is adjacent to the dedicated paediatric radiology department and both underwent significant expansion and refurbishment in 2012 to give a spacious, modern and child friendly environment.
BRCH ED has a six bedded paediatric observation unit for sole use of ED and the department is the designated site for CT3 Paediatric EM and HST Sub-speciality PEM training in Severn.
All GP and tertiary referred patients are received into BRHC for initial assessment by the BRHC ED clinicians prior to discharge or ward admission with the exception of patients retrieved and directly admitted to PICU.
BRHC runs a weekly in department teaching programme which benefits from the wide ranging expertise within the wider consultant body of BRHC as well as in it’s ED. Trainees are encouraged to undertake and are supported in audit projects during their placements here.
BRHC offers a unique opportunity to gain experience and training in a wide variety of paediatric presentations with the full spectrum of acuity in a supported environment.