SOUTHAMPTON UNIVERSITY HOSPITALS NHS TRUST SPECIALIST REGISTRAR IN ADULT CONGENITAL HEART DISEASE WESSES CARDIOTHORACIC CENTRE JOB DESCRIPTION THE CARDIOTHORACIC CENTRE The Southampton University Hospitals Paediatric and Adult Congenital Heart Disease Unit currently serves a population of approximately 3.5 million people living in the counties of Hampshire, Dorset, Wiltshire, West Sussex, Cornwall, Devon, Somerset, the Channel Isles and the Isle of Wight. Government figures project a considerable increase in population of this region in the next decade. British forces families stationed abroad are also referred to the unit. Occasionally patients with special problems are referred from even further afield including Scotland and Eire. Integrated cardiac and cardiac surgical services are provided for all age groups and the centre is recognised for training in Paediatric Cardiology, Adult Congenital Heart Disease and Paediatric Cardiac Surgery. It is one of the major centres for fetal paediatric and adult congenital heart disease. Congenital heart disease surgery has been undertaken in Southampton for more than 35 years and there are consequently large numbers of adult patients with congenital lesions undergoing follow-up. Southampton is a modern city on the South Coast of England with extensive cultural, recreational and sporting facilities. The New Forest, South Coast beaches and several internationally famous sailing centres are within easy reach of the hospital. There are surrounding picturesque villages and local housing and schools are superb making Southampton a highly desirable place to live and work. There are excellent road and rail links to London (just over 1 hour), an international airport with flights to Europe and other parts of the United Kingdom and fast sea crossings to France from nearby ports. FACILITIES Inpatients The cardiac unit is an integrated facility situated on D and E level of the Southampton General Hospital and comprises 119 adult cardiology / cardiac surgical beds and a separate modernised children’s ward comprising 16 paediatric cardiology beds / cots. There are separate high care facilities for paediatric cardiology, adult medical cardiology, adult cardiac surgery and coronary care. Facilities are provided for mothers to be resident with their children on the paediatric cardiology ward. There is a house adjacent to the hospital where relatives of cardiothoracic unit in-patients can stay. This facility has been provided by the charity ‘Heartbeat’ which works to support the activities of the cardiac unit. Currently ACHD patients are admitted to ward E2, where a number of the nursing staff have developed a special interest in CHD. It is planned to establish a new young adult area adjacent to the paediatric cardiac unit. Heartbeat has agreed support this development. This will result in patients of all ages with congenital and acquired heart disease being in adjacent areas further developing our theme of ‘integrated care’ within the unit. Investigations There is a new purpose built non-invasive cardiac unit just completed in 2007 with transthoracic and transoesophageal echo, exercise testing, ambulatory ECG and blood pressure monitoring, transtelephonic ECG, tilt testing, pacemaker and implantable defibrillator programming facilities. The congenital heart disease service has 5 modern cardiac ultrasound machines. Two of these have tissue Doppler and 3D echo facilities. There are two dedicated echocardiography room on the children’s cardiology ward. There are four modern, fully equipped, digital Cardiac Catheterisation rooms, one with biplane imaging, with quantitative angiography, intravascular ultrasound and Doppler pressure and flow wire facilities. One lab is equipped for electrophysiology and ablation procedures. All rooms have computerised haemodynamic measurement equipment. The department of cardiothoracic radiology, staffed by 3 consultant cardiothoracic radiologists, is located in close proximity to the non-invasive facilities and to the catheter laboratories. The department provides a 24 hour service for the whole range of cardiac radiological imaging including magnetic resonance imaging and helical CT. The department of nuclear medicine is adjacent to the paediatric intensive care unit and provides the full range of nuclear cardiology. Intensive Care Children: There is a 16 bedded dedicated adult cardiothoracic intensive care unit. The paediatric cardiac patients are cared for in a purpose–built 16 bedded ‘level 3’ paediatric intensive care unit. 12 beds are currently funded and the paediatric intensive care beds are utilised flexibly. On average four of these are used for paediatric cardiology and cardiac surgery but this number can be increased according to demand. The Paediatric Intensive Care, Adult General Intensive Care, Cardiac Intensive Care, Cardiac Surgical High Care, Cardiology High Care and Coronary Care lie in close proximity to each other. Adults: The adult cardiothoracic intensive care has X beds and has dedicated cardiac intensivists available for the management of complex congenital cardiac patients. The high care and coronary care unit are available for the congenital patients when required. Operating Theatres There are four cardiothoracic operating theatres. Out patients There is a dedicated Adult Cardiac Outpatients Department with onsite technician-supported echocardiographic facilities. The adult CHD clinics take place in this area . One of these is a double clinic supported by 2 consultants. We are currently doing approximately 4 ACHD clinics per week. The ACHD surgical clinics are held in the same suite. The paediatric cardiology and paediatric cardiac surgical clinics are held in the adjacent dedicated Children’s Outpatients department. Transition clinics are being arranged. Support Specialties Southampton general hospital is a fully functional Regional/Supra-regional University centre for both paediatric and adult medicine. There are subspecialty services in respiratory medicine, genetics, obstetric care, GI, cancer medicine and the surgical specialties. There is close liaison with adult cardiology, cardiac surgery, paediatrics (including the numerous regional specialist paediatric services) and with the general medical sub-specialities. Regular joint educational meetings are held with the paediatricians as well as with the adult cardiologists and cardiac surgeons. Fetal medicine with fetal cardiology, obstetrics and gynaecology, genetics and neonatology are located in the adjacent Princess Anne Hospital immediately opposite SGH. There is the full range of adult medical and surgical specialties in this major university teaching hospital. Nursing support and liaison We have 2 Adult Congenital Heart Disease Liaison Nurses (1.4 WTE) and 2 Paediatric Cardiac Nurse Specialists (1.6 WTE). We also have an EP Specialist Nurse who is involved with the children and adult congenital patients with arrhythmias. The liaison team therefore comprises 5 senior nurses. Research The cardiothoracic unit encourages and promotes research activity within the department. Increasingly members of the Directorate are forming links with the Research Divisions of the Southampton University School of Medicine. Over 100 publications in peer reviewed international journals have been published by members of the cardiothoracic unit in the last 2 years. A copy of the Cardiothoracic Centre Research Portfolio is available for inspection. On the Southampton University Hospital site, there is an extensive range of research facilities including the Medical Research Council and Wellcome Research Units. Of particular note are the research departments of the fetal origins of cardiac disease under Professor Mark Hanson (BHF professor of cardiovascular science) and Professor David Barker and the genetic research laboratory headed by Professor David Wilson who has special interest in the genetics of congenital heart disease. Professor Saul Faust heads the Welcome Clinical Research Facility that has in patient beds and outpatient facilities for clinical research. It is hoped that, with the continuing expansion of the Southampton University School of Medicine, there will be an opportunity in the future to make full-time academic appointments to support the unit’s clinical and basic science interests. Activity of the Unit Clinics: Paediatric Congenital Heart Disease Clinics (Southampton) Paediatric Congenital Heart Disease (13 Peripheral hospitals) clinics Adult Congenital Heart Disease Clinics (Southampton) Adult Congenital Heart Disease Clinics (Peripheral hospitals) Total attendances at SGH clinics 5000 Peripheral Clinic attendances 1600 300 165 150 6 Non-Invasive Investigations - congenital heart disease (excludes outlying clinic work) Echocardiograms Transthoracic Transoesophageal Fetal 7000 300 400 Exercise Tests Tilt Tests 400 10 Cardiac Catheterisation Total procedures Interventional 300 200 Cardiac Surgery: About 1800 open-heart operations are performed each year, with around 300 for patients with congenital heart disease including approximately 80 neonates. Between 60-100 adults with congenital heart disease undergo surgery in the department. One of the strengths of this unit is the availability of carefully audited surgical results that compare favourably with anywhere in the world. These are available for inspection. STAFF Congenital Heart Disease Dr A P Salmon Dr J P Gnanapragasam Dr J J Vettukattil Dr G R Veldtman Dr K S Roman Dr A J Carroll - Consultant Paediatric & Adult Congenital Cardiologist Consultant Paediatric Cardiologist Consultant Paediatric Cardiologist Consultant Paediatric & Adult Congenital Cardiologist Consultant Paediatric Cardiologist Consultant Adult Congenital Cardiologist Cardiology Specialty interest Dr H H Gray Dr I A Simpson Dr J M Morgan Dr A L Calver Dr P Roberts Dr N Curzon Dr P Cowburn Dr A Yue Dr D Rhakit Dr S Corbett - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist - Consultant Cardiologist (Intervention) (Intervention) (EP) (Intervention) (EP) (Intervention) (Heart Failure) (EP) (Imaging) (Intervention) Congenital Cardiac Surgery Mr M Haw Mr M Kaarne - Consultant Cardiac Surgeon (Congenital and acquired disease) - Consultant Cardiac Surgeon (Congenital and acquired disease) Cardiac Radiology Dr I W Brown Dr C R Peebles Dr S Harden - Consultant Cardiothoracic Radiologist Consultant Cardiothoracic Radiologist Consultant Cardiothoracic Radiologist MIDDLE GRADE AND JUNIOR STAFF Congenital Heart Disease 1 Specialist Registrar in Adult Congenital Heart Disease 1 Senior House Officers in Adult Congenital Heart Disease 3 2 3 4 Specialist Registrars in Paediatric Cardiology. Rotating Specialist Registrars in Paediatrics. Trust Fellows in Paediatric Cardiology Senior House Officers in Paediatric Cardiology DUTIES OF THE POST The Specialist Registrar will work in Adult and Paediatric Congenital Heart Disease under the supervision of Dr GR Veldtman, Dr A P Salmon, Dr A J Carroll, Dr J J Vettukattil, Dr K S Roman and Dr J P Gnanapragasam. The Congenital heart disease team assist in the post operative care of the congenital heart disease surgical patients and the Adult Congenital Specialist Registrar will also work under the supervision of the Cardiac Surgical Consultants and of the Intensivists. Depending on their background training (i.e. paediatric or adult cardiology), he or she will be given the required training in paediatric, adolescent and adult patients undergoing cardiac investigation and treatment including surgery. Duties will include out-patient clinic work in Southampton and the peripheral clinic programme. Ward duties will include assessment of day cases and ward attenders, in addition to the care of in-patients on the wards, the adult cardiothoracic intensive care units and some patients on the medical, obstetric and surgical wards. The Specialist Registrar will also be expected to participate in research related to adult congenital heart disease. The Specialist Registrar will be required to undertake transthoracic and transoesophageal echocardiography and Doppler studies. He/she will supervise stress testing, tilt testing and ambulatory monitoring. Training will be given in cardiac catheterisation, pacemaker and arrhythmia management and electrophysiology. For those trainees with a paediatric background, pure adult cardiology may an important part of their training. There is a regular teaching programme consisting of case presentations, topic discussions, journal club and echo review meetings. Excellent opportunities are available for training in all aspects of Congenital heart disease. The trainee will be required to maintain a training record which will be countersigned by the educational supervisor to confirm the satisfactory fulfilment of the required experience, and the acquisition of the competencies enumerated in the specialty curriculum. The training programme will last a 2 year period. He/she will be involved in both undergraduate (3rd year, 4th year elective and 5th year students) and postgraduate teaching. Contribution to the clinical audit programme and research activities will be expected. Entry Requirements Before embarking on the training programme in adult congenital cardiology, the trainee should have obtained the MRCP or equivalent qualification in paediatrics or in medicine, and additionally have obtained at least a 3 year experience in adult or paediatric cardiology.