When on call, the 1220 bleep-holder role varies between days and nights. You should carry the 1220 bleep and the 45803 phone.
Long Days Monday-Friday 07:30-19:30
Your role is to have an overview of adult theatre activity and troubleshoot any problems. Try as much as possible to delegate tasks (e.g. breaks) You should work closely with the theatre 12 consultant and 4th floor nursing theatre coordinator (45662 or bleep 1490).
Emergency cases - RLH does a lot of emergency operating. Surgical teams must discuss cases with 1220 or the theatre 12 consultant before adding them to the emergency list, so you will receive calls from surgeons about this. Decide with the theatre 12 consultant at the start of the shift whether they want to discuss these cases themselves or whether they are happy for you to discuss cases with the surgeons.
If it is necessary to interrupt a list for a life or limb-saving operation, liaise quickly with the theatre co-ordinator to identify which theatre can be used and inform the team of the case they can expect. If a list finishes early the anaesthetist should contact you; if possible, use these teams to help with emergency cases / coffee breaks, but they should not then overrun as a result.
Code Red and Black - code Red is for an unstable trauma patient in ED, and Code Black is for a neurotrauma emergency in ED. If you receive a bleep for either of these cases, you should attend ED if you can. The senior ITU trainee 1113 will also attend, and their role is to manage the airway and take the patient to scan, if required. You should find out about the case and liaise with the 1490 theatre co-ordinator if a theatre is needed. You can also assist with procedures such as placing large bore IV access/trauma lines.
Staffing - Anaesthetists calling in sick may inform you of their absence. Try and collate information about sickness and lists that are not adequately staffed, and discuss this with the Theatre 12 consultant. You may be able to suggest solutions, or help late-starting lists by seeing patients, but it is not your responsibility to reallocate consultants or trainees to cover lists. Please liase with the theatre 12 consultant before making any changes. Rounds - try to go round each area at approximately 09:30 and 16:00 (Main theatres, ACAD, IR, Recovery) and ask how the list is progressing. Be aware of any cancellations and inform the emergency theatre 12 team, as it may be appropriate to distribute some emergency cases to free theatres. Note any potential overruns, as this can affect out of hours staffing.
Breaks - If anaesthetists are covering a list by themselves for a whole day, try to arrange for someone to come in and give them a break. Prioritise those who doing long cases with no natural breaks, and those on three-session days.
Recovery - Recovery can get very busy, and bed pressures in the rest of the hospital can cause a backlog of patients. It is important to check in with the nurse in charge to see if there are any problems, and if they are looking after any HDU patients. You will frequently be the first port of call for any problems in recovery. This is especially the case after 18:00 when the day teams leave.
Difficult queries - if you are asked about staffing for lists at Barts, about booking MRI cases, concerns about patients in recovery, or anything else that you are not familiar with, please ask the theatre 12 consultant.
Weekend days 07:30-19:30
Duties are the same as for week days. The on call consultant will be present during the day, and there will be a second consultant in theatre 7. There are often 3-5 additional planned daytime lists on Saturdays (including at least one trauma list), and only one trauma list on Sunday. These lists are all staffed by consultants. If there are staffing problems please discuss with the on call consultant.
Nights 1930-0800
At night you cover emergency work. The hospital is very busy, and it is common to be operating throughout the night. CEPOD rules still apply, however it is not unreasonable to get some less life-threatening cases (e.g. abscesses) out of the way before midnight. The consultant on call will be present at handover and you can discuss planned cases for the evening and indications for calling them etc.
You are the first port of call for all the other anaesthetists in the hospital. At the start of the shift, it is worth checking in with your team and finding out what their workload is likely to be for the night.
We work as a big team and support each other. As a rule there are six possible sites (Paeds/Obs, 2nd Obs/Emergency Theatre 12/Theatre 7, and Mechanical thrombectomy). You must always have at least one free anaesthetist. If you need to open an additional location and you don't have free anaesthetists with the right experience, you must discuss this with the on-call consultant who may need to attend.
During a night shift you should identify the first few patients whose operations can happen in theatres 12 and 7 during the day. Try and see as many of these patients as you can. Most surgical teams are not ready to operate until after their handover, but try and speak to the surgical teams to offer them the chance to operate early.
Emergency calls – You should try and attend code red and black calls as above. You do not need to attend all fast bleeps but you need to be aware of them. ITU attend advanced trauma calls and cardiac arrest calls – the 1113 ITU trainee will call you if they are not able to attend and you should go in their place if you are free. Please also attend or at least contact the paeds anaesthetist if there is a paediatric trauma call or a paediatric arrest call, and the obs anaesthetist if there is a MOH (obstetric haemorrhage) or maternal cardiac arrest call.