Intensive Care Management

Intensive care management is a dynamic specialty with the responsibility for caring for the most critically ill patients in hospital.

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Guide to an average day on ICM

East Surrey hospital has a 16 bed mixed medical and surgical adult intensive care unit, with 1100 unit admissions every year. The hospital has a large catchment area, including a portion of the M25 and also Gatwick airport which contributes to the wide range of acute medical pathologies seen. Our critical care unit is GMC approved for ICM training at all levels.

There are 10 consultants who take turns in leading the unit on a weekly basis. 3 further consultant intensivists support the daily running of the unit. During normal working hours, the “consultant of the week” is supported by a second consultant intensivist. Out of hours, the critical care unit is staffed by one senior tier doctor and one junior tier doctor supported by a consultant intensivist on call. Critical care doctors work alongside RCoA trainees, anaesthetic clinical fellows and specialty doctors working on call for theatres and obstetrics.

There are two tiers of junior doctors working in critical care. 8 doctors with airway skills work on a rolling rota comprised of anaesthetic trainees (CT2 to ST7 level), clinical fellows with at least 1 year anaesthetic experience, as well as two dedicated echocardiography fellows. The junior tier rota is comprised of 8 doctors who are not proficient with advanced airway management – this consists of two dedicated echocardiography/ultrasound fellows and 4 core medical trainees and 2 foundation year one doctors.

There are twice weekly multidisciplinary team meetings and alternate day microbiology ward rounds. We have monthly senior staff meetings, frequent M&M meetings and regular joint anaesthetic-ICM clinical governance meetings. The service is part of the Surrey Wide Critical Care Network and takes an active part in its activities.

EASY-CCRG (EAst SurreY Critical Care Research Group) has developed during recent times. Our active weekly journal club has inspired trainees to submit letters for publication in Thorax and Anaesthesia, and also to carry out various research and quality improvement projects on the intensive care unit (abstracts published in Critical Care and Intensive Care Medicine).

Clinical opportunities on the unit for all doctors include:

Procedures regularly performed on intensive care (eg tracheostomy, bronchoscopy, chest drain insertion)
Echocardiography – there is ample support for non-fellows wishing to learn or improve their echo / ultrasound skills including learning FICE.
Ultrasound – regular chest, abdominal and vascular ultrasound is performed on the unit. Enthusiastic trainees may wish to aim to complete CUSIC accreditation.
Resuscitation and stabilisation skills – a large proportion of our admissions are emergency medical admissions requiring resuscitation and advanced ventilatory, cardiovascular and renal support.
Advanced respiratory techniques – we regularly use prone positioning and APRV

Education and Clinical Teams

Dr Alice Myers

Faculty Tutor of Intensive Care Management

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Dr Alice Myers MBBS BA(Hons) MRCP FRCA EDIC FFICM Alice Myers is a consultant in anaesthesia and intensive care medicine with an interest in education and research. Appointed in 2017, she completed training in London and South East England (mainly at St Georges, Kings College and the Royal Free Hospitals). Prior to training in medicine, she studied English Literature and Language at Birmingham University and spent two years as the marketing manager at a design graphics publishing company.

She is faculty tutor for intensive care medicine, co-lead for research in critical care, FICE mentor (Focussed Intensive Care Echo) and course director for the EASY Final FRCA SOE course.

In critical care, her interests include ventilation and echocardiography. She also has a clinical interest in anaesthesia for major upper and lower gastro-intestinal surgery.

She has multiple publications and prizes, including the BMA Book Awards prize for Best Book in Paediatrics 2009 (Paediatrics: Clinical Cases Uncovered, ISBN 9781405159845).

You can contact Dr Myers at: [email protected]

Dr Claire Mearns

Clinical Lead

Dr Theo Samuels

Lead for ECHO

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Mr Ian Maheswaran

Chief of Surgery

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Prior to joining Surrey and Sussex Healthcare NHS Trust Mr Maheswaran undertook a National Bariatric Surgical Fellowship at St. Richard’s Hospital, Chichester, a Centre of Excellence in Bariatric and Metabolic Surgery where he now holds an honorary contract. Working alongside the St.Richard’s multi- disciplinary team he provides a full Obesity Service. His other specialities include endoscopy, gall bladder disease, pancreatitis, anti-reflux and hernia surgery. He collaborates with colleague’s to provide a Laparoscopic Adrenalectomy, Complex Hernia Repair and Abdominal Wall Reconstruction Service. Both elective and emergency operations are undertaken.

Mr Maheswaran is particularly interested in Medical Education having undertaken two Master’s Degrees and a London Deanery Fellowship in Education where he set up and delivered simulation training in order to improve patient safety and outcomes and is the Training Programme Director for Core Surgery Trainees in Kent, Surrey and Sussex. He is also Clinical Lead for the Trust Cost Improvement Program.

Mr Maheswaran is driven to deliver high quality, safe, patient centred care to the local community being born and raised in Redhill where his parents had combined over 50 years of service within the Trust. He very much regards the community as his friends and family.

Professional memberships include the Association of Upper GI Surgeons (AUGIS), British Obesity and Metabolic Surgery Society (BOMSS), Society of American Gastroenterology and Endoscopic Surgeons (SAGES).