Intensive Care Unit (ICU) at The Queen Elizabeth Hospital

The Queen Elizabeth Hospital (TQEH) Intensive Care Unit (ICU) is a C12 accredited unit with the College of Intensive Care Medicine of Australia and New Zealand. It has 14 beds which are used to care for a mix of high and low acuity critically ill patients. The unit admits between 1200 and 1300 patients annually of which roughly 60% require high level intensive care. The medical/surgical patient case mix is evenly split. Of the medical patient pathologies the most common admission diagnoses are respiratory (31%), metabolic (16%), sepsis (15%), cardiovascular (11%) and gastrointestinal (11%). Surgical patients are a mix of upper and lower GI, endocrine, urological, respiratory, plastics, ENT and gynaecological.

The unit’s technical capabilities include cardiac output monitoring, echocardiography, bronchoscopy, intra-aortic balloon pump insertion, percutaneous tracheostomy insertion, renal replacement therapy and temporary transvenous pacemaker insertion. TQEH has busy interventional radiological, cardiac, hepatic and gastric services which often involve ICU patients.

TQEH is also part of the MedStar South Australia state-wide retrieval service and regularly receives critically unwell patients from across the state. TQEH has an active Medical Emergency Response system which receives roughly 1000 calls per annum and equates to about 10% of ICU registrar time during both day and night shifts.

ICU consultants

  • Professor Sandra Peake (Director) BM BS BSc (Hons) FCICM PhD  
    Director of TQEH ICU and Professor of Critical Care Medicine, School of Medicine, University of Adelaide and Adjunct Professor, School of Public Health and Preventive Medicine, Monash University. Professor Peake's PhD in Medicine is in the field of sepsis and her research specialises in the design and conduct of large-scale, randomised, clinical trials in critical care. She is Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) and member of the ANZICS Board, the Australian and New Zealand Intensive Care Research Centre Board and the National COVID-19 Clinical Evidence Taskforce. Professor Peake was the first author of the Australian Resuscitation in Sepsis Evaluation (ARISE) trial and co-first author of The Augmented versus Routine Approach to Giving Energy Trial (TARGET). She was an examiner with the College of Intensive Care Medicine for 12 years and was the SA Chair of the College of Intensive Care Medicine, ANZICS (Chair) and member of the Intensive Care Foundation.
  • Associate Professor John Moran MBBS FFARACS FRACP FCICM MD 
    TQEH ICU consultant and Associate Professor in the Faculty of Medicine at the University of Adelaide. Dr Moran specialises in critical care medicine statistics, teaching intensive care, anesthesia and physician trainees, as well as bio-statistical research; specifically survival analysis, cost analysis, Bayesian approaches and statistical aspects of clinical trial conduct, and frequently reviews for multiple medical journals.
  • Dr John Raj (Supervisor of Training) MB BS MS (Gen Surg) FCICM Grad Dip Clin Ed
    TQEH ICU consutant and supervisor of training, Dr Raj contributes to research projects within the South Australian ICU community and is a Senior Lecturer with the University of Adelaide. He has developed and runs an interprofessional simulation program, runs the Medical Emergency Team program and is a member of the Safety and Quality Committee for the Central Adelaide Local Health Network.
  • Dr Jacob Abraham MBBS MD (Gen Med) FCICM GCClinUS
    TQEH ICU consultant 
    including critical care echocardiography and administration. Dr Abraham has extensive teaching experience including on FCICM primary and fellowship courses. He is involved in TQEH redevelopment program and manages the Unit's Safety and Quality. Dr Abraham's research specialty is anaemia in the critically ill.
  • Dr James Malycha MBBS FCICM
    TQEH medical, surgical and advanced ICU consultant. Dr Malycha's PHD studies include health systems analysis and rapid response systems. He is currently coordinating the registrar rosters and assisting the SA Health Medical Information Office to coordinate statewide data management to enhance management of clinical deterioration.
  • Dr Nikki Yeo MBChB FCICM GCClinUS
    TQEH Clinical Fellow in cardiothoracic intensive care, neurosciences and trauma intensive care. Dr Yeo's PhD is on end-of-life care in the critically ill patients, including simulation based teaching.

ICU registrar positions

There are between 5 and 7 active full time ICU registrar positions at any one time. The registrars work alongside the resident medical officers (RMOs) rotating through the ICU and are supervised by the ICU ward consultant (who rotates each week). Whilst caring for the patients admitted to the unit, the registrars also provide an outreach service, attending code blues and consulting on deteriorating ward patients.

There are excellent opportunities for procedural skill acquisition for junior registrars, with adequate volume of practice, as well as a varied case mix and autonomy for senior registrars. Teaching is strongly encouraged within the unit and registrars are given the chance to supervise both RMOs and medical students on clinical placements. On-call consultants are always available and provide a supportive working and learning environment.

Contact information

For more information regarding positions and availability, please contact Dr John Raj or Dr James Malycha.
Telephone: (08) 8222 6000.

Teaching

Formal teaching takes place each week with all registrars, RMOs and consultants.

Registrars are given the opportunity to present and analyse new research and its potential impact on department practice. RMOs present unique cases or basic sciences to provide background for the weekly sessions. The consultants discuss their special areas of interest and emerging research.

There is regular bedside teaching from the ward consultant, targeted at both registrar and RMO level, and exam-specific teaching is available for trainees sitting both the CICM and ANZCA exams. Primary teaching for these candidates is run in either group or individual sessions and can be completed outside of rostered hours as required.

Simulation

Weekly simulation sessions are run in the ICU for the >RMOs on their three month rotation. They are given opportunities to practice leading ALS scenarios, and receive regular feedback.

Regular simulation sessions are also run for the registrars and hospital wide code blue team. Simulations are run on the hospital ward, with emphasis on communication, team function and leadership, as well as management decisions.

Mentorship

Each registrar and RMO is mentored during their time in the unit.

Rostering

The roster is divided into registrar and RMO sections. Opportunities are provided for continuity of care with a basic rolling pattern that involves 4 days then 2 nights followed by a 6 day break. Study and annual leave are usually managed in accordance with trainee wishes. An example roster is available upon request.

Research

South Australian ICU Affiliations

SA ICU Trainee Network

TQEH is part of the SA ICU Trainee Network which was established in 2019, and encompasses the RAH, Flinders Medical Centre, Lyell McEwin Hospital and TQEH. The aim of the network is to provide a state-wide approach to trainee education, networking and welfare. The network's first state-wide educational evening, was held in conjunction with the SA ICU Fellows Committee, in December 2019.

The supervisors of training at TQEH are committed to providing high quality teaching for both TQEH-based, and SA-based trainees. Intensive Care Association (SAICA) The SAICA is a not-for-profit organisation, formed in 2009.

The aims of the organisation are to:

  • facilitate the organisation and running of various ICU training courses in South Australia (including the BASIC, Primary and Fellowship courses)
  • promote registrar teaching and research
  • provide funds to assist medical students and ICU trainees in conducting research, including presenting at national and international meetings.


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