West Suffolk Hospital Orthopaedic Department
Population of around 275,000
The West Suffolk is a district general hospital situated in Bury St Edmunds. We are a cohesive and proactive group of 12 consultants and one associate specialist covering the usual sub-specialities. There are 7 Lower limb arthroplasty, 3 foot and ankle and 3 upper limb surgeons. Spines are covered by Ipswich.
Whilst at the West Suffolk there is lots of opportunity to progress both clinically and academically. As a group we will support and prepare you for the FRCS and your life in orthopaedics.
There are nine registrars, five of whom are regional trainees. The others are on fellowship from Sri Lanka, Belgium, and Egypt. Registrars tend to be in years 1-4 and rotate through at least two consultants, one every 6 months. Some jobs are linked so the registrar works for two consultants at the same time.
On calls are covered by one of 10 consultants who work from Monday 8am –Thursday 5pm or Thursday 5pm – Monday 8am. When on call the consultant has no elective duties. Registrars work a 24 hours on-call, with a rest day the following day, an on-call room is provided. There are foundation doctors both covering the wards and on-call commitments.
Working with us there is also a Consultant orthogeriatrician, six nurse practitioners and two trauma nurse practitioners. They all play a vital role in the running of the department and are highly qualified and regarded.
The timetable for the whole department is kept on medirota and is available on any computer or available on your phone as an app. You will be given access to this once you arrive but guest access can be given, if required, once you know you are allocated to rotate here. Registrars cross cover clinics and theatre for their colleagues. The usual 6 weeks’ notice is required for leave unless in exceptional circumstances.
The on call rota is organised in a rolling fashion and has been issued for the whole year. Week by week the SPR duties can change a little as due to the fact that a rest day occurs following an on call there is an element of cross cover. This means that a week by week rota also exists. Recently the medi rota system has been introduced and this can now be viewed on line. Every effort is made to ensure that this is correct but if you notice any problems please let Bev and sheenagh know as soon as possible. There is also some flexibility within the consultant’s working week meaning that there may be extra clinics or lists in any available sessions so it is worth looking out for these.
Educational Supervisor: Miss Lora Young
Rota Co-ordinator: is Bev London (firstname.lastname@example.org)
Human resources: 01284 713528
- Miss Deakin – Clinical director – foot and ankle and Paediatrics
- Miss Thorisdottir – Foot and ankle – Rota co-ordinator
- Mr Vaughn – foot and ankle
- Miss Young – Shoulder and Upper limb – SPR educational supervisor
- Mr Sjolin – Shoulder and upper limb (no on call)
- Mr Wood – Upper limb and hands
- Mr Dunn- hip and knee arthroplasty and soft tissue knee
- Mr Nicolai – hip and knee arthroplasty and soft tissue knee
- Mr Schenk – soft tissue and arthroplasty knee
- Mr Parsons – Hip and knee arthroplasty and revision hip
- Mr Porteous – Hip and knee arthroplasty and revision hip (no on call)
- Mr Atrey – Hip and knee arthroplasty and revision hip
- Mr Al- Hadithi – Associate specialist – hip and knee arthroplasty
6 nurse specialists help in both clinics and theatres. They are very valuable members of the team and some are extremely experienced. In clinic they see their own patients for post op follow up and also see and assess new patients alongside the consultants. In theatres their role is as an assistant and general help. They will assist both consultants and SPR’s allow for independent operating when the SPR becomes capable. Make friends with these guys they can offer significant support and make your life so much easier.
- David Higgins – Foot and ankle
- Donna Taylor – Upper limb
- Sue Lafflin – Arthroplasty (Mr Schenk and Mr Nicolai)
- Gemma Salt – Foot and ankle (Mr Vaughn) Hip (Mr Atrey)
- Sara Davey – Hip (Mr Parsons and Mr Al-Hadithi)
- Sarah Reader – Hip and Knee (Mr Dunn and Mr Porteous)
Annual leave can generally be taken when suits the individual. It is however important to ensure not too many SPR’s are off at any one time. (Usually 2 but exceptions can be made if it is possible to cover all clinical work). Leave should be booked using the form which is available on line or from Bev in the office.
As the medirota is planned 6 weeks in advance it is necessary to give 6 weeks notice for leave in order that clinics can be reduced accordingly. Please also let the relevant consultant’s secretary and Bev and Sheenagh know of any planned leave so that clinics are reduced and theatre sessions covered.
Fracture clinics are run in the mornings. There are usually 2 clinics being run simultaneously but sometimes on the end of clinic will be elective patients. There will always be 2 people in a fracture clinic. Either one SPR and one consultant or 2 SPR’s. When a consultant or SPR is on leave another available SPR will be asked to cover the clinic. This ensures that the number of patients being seen remains reasonable. It also allows one SPR to be free to hold the on call bleep and be able to leave clinic if needed to attend A+E.
Some consultants now only have alternate week fracture clinics which may be an issue in booking follow up appointments e.g. for 1 week with an Xray. Generally though it is not an issue especially if you explain to the clinic staff what is needed and why.
Tea and coffee is provided in clinic but a contribution to the fund is required. Shelly or any of the others in the plaster room will happily advise.
Orthopaedic clinics are now not covered when SPRS/Consultants are away so the clinic numbers should be reduced accordingly. When your boss is away a clinic will still run but the patients will all be follow-ups and numbers should be kept to a manageable amount. There is usually another clinic running at the same time though if you need any advice.
Virtual Fracture Clinic
This is a patient free clinic that runs on Mon/Wed/Fri every week starting at 7.30. All the consultants are involved on a rota system. A+E and GP’s can refer to this clinic. All A+E patients that need review will be discussed in the next available clinic. Their imaging and history are reviewed from the notes and a plan for treatment arranged. E.g. review in clinic, admit for theatre or discharge. The patient is then contacted by phone and the plan explained to them.
Patients cannot be booked into any other clinic from A+E. It is therefore important if you see any patient in A+E that the documentation on what has happened is clear. Especially if a discussion has taken place with the on call consultant. The VFC can be used as a way or ensuring patients get booked into the relevant clinic if it is clear that a plan has already been made. For example if Miss Young were to see a patient when on call at the weekend and wants to follow the patient up in her clinic a VFC appointment can be given but it should be clearly documented in the notes (preferably at the beginning) what the management plan is. The staff running the VFC can then just book the necessary appointment and not waste time re reviewing the patient’s history.
Although it is not compulsory for SPR’s to attend this clinic it is really useful to go along to see what happens and get involved. If the clinic isn’t too busy it may be possible to take the ‘hot seat’ and run the clinic with supervision.
We have managed to keep the rota to an on call system and generally it works very well. The on call’s are a 24hr non-resident shift. The following day is given off as a rest day. The rota is a rolling rota and therefore is a fair as possible in terms of cover for weekends and bank holidays. As there will be rest days off during the week following on call some regular commitments may be missed from time to time however due to the rolling nature of the rota the same things should not be missed all the time.
Swaps can be made within the rota provided both SPR’s involved agree. It is useful to arrange these as soon as possible. If you wish to take leave when you are, meant to be on call it is your responsibility to swap out of these on call shifts.
The consultant on call rota is Mon-Thurs then Thurs-Sunday with the handover being at 5pm on Thursday evening and 8 am Monday morning. Trauma meetings take place at 8am every morning in the discussion room on the F3/F4 corridor. These should be attended by everyone whenever possible.
There is a very extensive database of all the trauma in the form of an excel spread sheet. This is saved on the hospital O-Drive but is usually up and running in the meeting room. This should be kept up to date and acts as the working list as well. All admissions should be added to this list and the admitting problem coded (list of codes on the wall). Coding the list allows for searches to be performed easily for any projects or audits. When a patient is discharged or a new consultant takes over the oncall they should be removed from the working list and added to the database. Copies of the list are printed out each morning by the on call SPR for use in the meeting and on the ward round.
As it is a non-resident on call rota it is possible to leave the hospital at night (usually after about 10pm) provided you are within 15-20mins of the hospital. An on call room is provided if you are unable to go home. The key to this room is kept in the reg office and should always be returned the following day. The room is cleaned everyday so don’t leave anything personal in there.
Emergency patients should be booked for theatre using the booking form found in the theatre office. This should be given to the co-ordinator of the emergency list (theatre 3). There is an emergency list that runs 24/7 and is a shared list between all surgical specialities. A dedicated trauma list is run the theatre 8 every afternoon 1.30-5.30pm. Patients can be put onto the trauma list in the morning meeting by the theatre team. It is helpful though to do an emergency booking form for any cases that could be done in the morning in the emergency theatre. Especially things like MUA in children and wound washouts. There is often time to get a case or two done on this list before the general surgeons get going and it can really help to take the pressure off in the afternoons.
The FY2’s are often quiet junior and have little T&O experience so can require quiet a lot of support when on call. Before 10pm at night all referrals from A+E and GP should go direct to the reg, this helps to allow decisions to be made early and avoid delays in A+E. Because of this if you are on call and due to be in theatre arrangements should be made for someone else to hold the bleep. This can be a little frustrating if you are the one in clinic but it usually balances itself out over the 12months. It is polite to arrange this yourself rather than leaving it to the person finishing their on call to sort it out or chase around trying to find someone to hold the bleep. Overnight the referrals are taken by the F2 on call. The night F2 covers both T&O and general surgery. They will generally be happy to clerk patients in but the on call SPR should review the patients in the morning to help make a treatment plan and complete any paperwork for theatres prior to the morning meeting.
The orthopaedic theatres are theatres 7, 8 and 9. Lists run in these theatres more or less all day every day. Day surgery is also used most mornings and afternoons. Elective patients are usually admitted to F4 ward (if their MRSA screening is clear). The patients should be seen on the ward on the morning of their surgery by the team. They should be marked and all paperwork completed. A team brief will then take place in the anaesthetic room with the whole theatre team to plan the lists first thing. For afternoon lists the patients will arrive at 11ish and a team briefing will take place around 1.15.
There are a lot of forms to fill in; all are pretty self explanatory though. Patients aren’t allowed to leave the ward unless all paperwork is done though. The important ones are: WHO forms, consent, EPARS and the VTE assessment.
Theatre shoes can be arranged through Dennis who is located in the front main theatre office. He is very helpful and efficient so if you need shoes talk to him. Lockers are also available but are sometimes in short supply (especially in the female changing room) but ask in the office and you might get lucky.
Everyone is very friendly and approachable so if in doubt just ask.