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					                    OTAGO DISTRICT HEALTH BOARD JOB DESCRIPTION
                                              XXX
                                           Specialist
                                     with responsibilities in
                                 INTENSIVE CARE MEDICINE

1.      POSITION PURPOSE
        The Anaesthesia & Intensive Care Services are committed to implementing a team-based
        approach to providing excellence in patient care, and to improving the quality of the service
        while reducing the costs. The specialist will work with other service members to provide
        clinical services within this approach, participating in the appropriate team’s training activities,
        with the objective of providing high standard anaesthesia and intensive care services at Dunedin
        Hospital.

2.      RELATIONSHIPS

        Reports to:               Clinical Leader, Anaesthesia
                                  Clinical leader, Intensive Care
                                  Service Manager, Critical Care

        Supervision of:           Registrars
                                  Intensive Care Unit Staff

        Internal:                 Consultant Staff
                                  Junior medical Staff
                                  Operating Theatre Staff
                                  Administrative Staff

        External:                 Referring Medical Practitioners
                                  St John’s ambulance Service

3.      LOCATION
        The position is based at Dunedin Hospital and all ICU services will be delivered at Dunedin
        Hospital. When you supervise the retrieval service you will be required to attended patients at
        other hospitals and sites throughout Otago and Southland.

4.      TREATY OF WAITANGI
        The Otago District Health Board (ODHB) is committed to its obligations under the Treaty of
        Waitangi. As an employee you are required to give effect to the principles of the Treaty of
        Waitangi - Partnership, Participation and Protection to all New Zealanders.

5.      HEALTH AND SAFETY
        Otago District Health Board is committed to achieving the highest level of health and safety
        for its staff. All employees are expected to take initiative and identify, report and resolve
        issues that may cause harm to themselves or others in the organization. As an employee of
        Otago District Health Board, the health and safety of clients and colleagues, as well as your
        own, are your responsibility. You are expected to work safely at all times, and to actively
        participate in health and safety programs in your area. It is expected that you will report all
        accidents or potential hazards to your manager.



 Job Description XXX                                                  Initials          Employee ______

                                                                                        Employer ______

ODHB 15198 (370) V3              Issued 20/08/2005                           Page 1 of 12
6.      This Job Description is to be read in conjunction with the Collective Employment Contract
        negotiated by the Association of Salaried Medical Specialists (ASMS CEC) with the ODHB.
        Where there is difference between the ASMS CEC and this Job Description then this Job
        Description is definitive.

7.      This is a locum position for 10 months provided;

            there are no adverse reports sufficient to raise doubts as to the suitability of the appointee
             and,
            the requirements of the Medical Council of New Zealand for Provisional General
             Registration as an anaesthetist have been met and,
            work visas have been obtained.


8.      SERVICE PROVISION
         Direct Clinical Service Provision will normally be based on a weekly average of 7 clinical
           sessions nominally 4.5 hours duration Monday to Friday. The other 3 sessions are 2
           administrative and 1 education session. The conditions governing Other Professional Duties
           Time are contained in Annex A
         Service Provision will include full participation in the after-hours rosters maintained by the
           Intensive Care Service at a planned frequency of not more than 1 in 5 for weeknights and
           weekends.
         When 'on call' the Specialist is available to respond and attend to patients requiring care
           within 20 minutes.
         The allocation of the Specialist to clinical duties will be by agreement with colleagues but
           with the final determination by the Clinical Leader, Intensive Care to enable the Intensive
           Care Service to meet its required outputs and also by the Clinical Leader for Anaesthesia to
           allow the Anaesthetic Service to meet its outputs.

9.      CLINICAL DUTIES
        Preoperative - The Specialist will:
         Carry out preoperative review of patient data and assessment of patients.
         Gain informed consent for anaesthesia in accordance with the Health and Disability
           Commissioner’s Code of Practice and the ODHB policy.
         Maintain a high standard of professional care in accordance with the New Zealand Medical
           Association Code of Ethics.
         See and advise promptly on patients referred for a specialist opinion.
         Deliver care on a sessional basis as rostered using allocated time efficiently and effectively
           to meet service goals.

        Operative - In theatre the Specialist will:
         Complete formal patient identification procedures and consent check.
         Carry out appropriate anaesthetic procedures and provide resuscitation and general medical
          care throughout surgery.
         Complete required documentation related to the anaesthetic procedure.

        Post Operative - The Specialist will:
         Ensure safe recovery and liase with ward staff re ongoing analgesic and fluid regiment.
         Carry out post-operative review.


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ODHB 15198 (370) V3              Issued 20/08/2005                           Page 2 of 12
        Intensive Care (when rostered) - The Specialist will:
         Be responsible for the admission and discharge of patients to the Intensive Care Unit in
           accordance with ODHB policy. “Intensive Care Service referral and Responsibility for
           Care”. (Attached)
         Ensure patients are reviewed at least twice daily.
         Manage patents in accordance with Unit policies.
         Co-ordinate, and participate in when appropriate, the patient retrieval operations and
           emergency primary response.
         Participate in the specialist roster providing after hours cover for the Intensive Care Unit

        Acute Services (when rostered) - The Specialist will:
         Provide cover for in-theatre and recovery acute calls.
         Participate in the Surgical Emergency Admission Team response.
         Provide anaesthetic services to other locations - for example, x-ray, obstetrics, emergency
          department, and fracture clinic.
         Provide consultations as requested by other medical staff

PERFORMANCE MEASURES
      Gives patients a full explanation of all procedures and treatment.
      Obtains informed consent for all patients in accordance with ODHB's policy for
       undertaking any operation, test or procedure.
      Maintains a high standard of professional care in accordance with the New Zealand Medical
       Association Code of Ethics and in accordance with the Australia and New Zealand College
       of Anaesthetists Guidelines, Protocols and Standards documents, statutory and regulatory
       requirements and Otago District Health Board policies.
      Delivers care on a sessional basis in intensive care unit and operating theatres in a timely
       and cost effective manner. When providing clinical anaesthesia the Specialist will be
       present by the agreed start time for the list.
      When 'on call' the Specialist is available to respond and attend to patients requiring care
       promptly (immediately for telephone consultation, within twenty minutes if required on
       site).

10.     ADMINISTRATION
        Otago District Health Board is committed developing Self Managing Teams and Clinical Care
        Pathways. The Specialist will participate in developing these philosophies to meet Service and
        Organisational objectives.
        Administrative responsibilities - The Specialist will:
         Attend review sessions, budgetary meetings and other service meetings as appropriate.
         Work as part of the allocated Team(s) to meet the throughput and budget targets for that
           team as contained in the operating plan.
         Maintain quality clinical records by
               a) ensuring recording of Anaesthetic Service data.
               b) ensuring necessary documentation is completed and correct - for example, clinic
                   notes, laboratory forms, audit.
               c) Completion of Intensive Care Unit data collection (”STATIC”) for the patients the
                   Specialist is responsible for in a timely fashion.
         Prepare reports for outside agencies as required - for example, Accident Compensation
           Corporation, Department of Social Welfare. Where this task is carried out in scheduled
           work time, payment should be arranged through The Otago District Health Board.


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ODHB 15198 (370) V3              Issued 20/08/2005                          Page 3 of 12
         Prepare reports for management as required.
         Document and update all relevant procedures and policies as part of the Team
          responsibilities

        PERFORMANCE MEASURES
         Demonstrates personal commitment to meeting Otago District Health Board, Service and
           Team objectives
         Comprehensive, accurate and up to date records are maintained for all patients seen.
         Reports are completed and dispatched in a timely manner or by due date.
         Procedure and policy documents that you are responsible for are updated when necessary.

11.     CONTINUOUS QUALITY IMPROVEMENT AND REVIEW RESPONSIBILITIES
        Otago District Health Board is committed to the concept of quality improvement. As an
        employee you are required to actively participate in quality improvement and risk
        management, both at a professional level and service level. You are also required to
        participate in CQI and risk programmes as an integral part of your position.

        The Specialist will:
         Research and investigate areas relevant to speciality and service, as decided in conjunction
           with the Clinical Leader.
         Attend and participate in regular clinical audit.
         Implement systems for monitoring and reporting on quality
         Participate in clinical research where appropriate and actively promote research activities
         Promulgate research results to other staff in the service, and present or publish as
           appropriate

        PERFORMANCE MEASURES
         Carries out review of drugs, equipment and methods of clinical management as decided by
           the service.
         Participates in CQI Projects undertaken by the service.
         Participates in audit of anaesthetic and intensive care related morbidity / mortality and
           critical incidents.
         Demonstrates willingness to achieve service and organisational objectives in a innovative
           manner

12.     COMMUNICATION
        All Otago District Health Board staff are bound by the provisions of the Privacy Act and Health
        Code, Otago District Health Board policies and contractual provisions when they are
        communicating with patients, relatives and other members of the public, and other health
        professionals.

        The Specialist will:
         Provide services in a sensitive way to users of the service and to be culturally sensitive in all
          personal decisions and actions.
         Ensure that areas that may give rise to patient complaint are identified and where practical
          take steps to ensure that complaints do not arise. If complaints do arise, ODHB's procedures
          on such matters shall be followed.
         Ensure that patients receive an appropriate level of information regarding their condition and
          its management.



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ODHB 15198 (370) V3              Issued 20/08/2005                          Page 4 of 12
         Communicate with next of kin, in particular where patients or minors are unable to
          comprehend fully the implications of management options.
         Communicate with general practitioners to facilitate follow up care of patients.
         Communicate with other medical teams who previously or subsequently have responsibility
          for patient care to ensure appropriate patient hand over

        PERFORMANCE MEASURES
         Maintains effective interpersonal relationships with multidisciplinary staff, patients and
           relatives.
         Handles problems and complaints sensitively, following Otago District Health Board
           protocols for dealing with complaints.

13.     STAFF TRAINING/TEACHING and SUPERVISION
         Each employee has a responsibility as part of their normal work activities to provide other
            staff with ongoing training, including informed instruction during routine clinical activities.
         The Specialist has a professional responsibility to participate in the Service training
            programmes, including as appropriate the undergraduate teaching and postgraduate training
            programmes. Unless on leave, attending to clinical matters that cannot be postponed or at
            alternative requested meetings the Specialist is expected to attend all Anaesthesia and
            Intensive Care clinical and management meetings.
         The Specialist is responsible for the direct supervision of Resident Medical Staff,
            Anaesthetics Technicians, and nursing staff assisting with anaesthetics.
         The Specialist is expected to participate in the evaluation of staff he/she has direct
            supervisory responsibility for, including immediate feedback relating to performance as
            appropriate. Evaluation includes assessment of staff performance in relation to
                  clinical competence
                  adherence to service protocols
                  timely and accurate documentation
                  communication with patients, relatives, peers, other staff and GPs
                  participation in orientation of new staff as appropriate
        Where the Specialist has direct supervisory responsibility for staff he will provide immediate
        feedback relating to performance as appropriate.

14.     SELF LEARNING - It is expected the Specialist will:
         Participate in the re-accreditation program of the Australasian College of Anaesthetist
           and/or the Joint Faculty of Intensive Care Medicine as appropriate.
         Participate in professional continuing education activities, regular performance review, and
           have a commitment to maintaining and updating his own knowledge and skills.
         Maintain involvement in professional organisations in order to:
                Fulfil CME and recertification requirements.
                Contribute to maintenance of high professional and ethical standards in
                    anaesthetics.
                Contribute to professional education and assessment programmes.

        PERFORMANCE MEASURES
         Provides certificate of Participation in MOPS program yearly to CPG management.
         Attends 75% of Departmental CME sessions is available for as documented in attendance
           book(s).
         Attends 75% of Departmental QA sessions is available for as documented in attendance
           book(s).


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ODHB 15198 (370) V3              Issued 20/08/2005                          Page 5 of 12
            Provides formal debrief of out-of-Dunedin CME meetings to colleagues as documented in
             attendance book(s).
            Provides an aspect of personal practice for peer review by colleagues at least once a year.

        Otago District Health Board encourages its Specialists to participate in these activities, and in
        the activities of other relevant learned societies, as well as the publishing of reports and papers,
        the organising of conferences, invitation of experts, and membership of national committees, in
        that these activities also reflect well on the Organisation and Service, and on the calibre of its
        staff.

15.     Person Specification
        The Specialist will:

        1. Hold a University Degree in Medicine recognised by the Medical Council of New Zealand
           and hold provisional registration as a medical practitioner under the Medical Practitioners
           Act 1995.
        2. Should the option of taking up permanent employment with ODHB be agreed then the
           specialist will obtain full vocational registration as a specialist anaesthetist with the
           Medical Council of New Zealand the by YYY.
        3. Take out medical indemnity insurance in respect of alleged professional negligence or
           unskilled treatment of patients, in accordance with degree of responsibility involved in
           this appointment.
        4. Demonstrate maintenance of crisis management competency by completing an Emergency
           Management of Anaesthetic Crisis (EMAC) or equivalent at least every 3 years.


EMPLOYEE ACCEPTANCE

Employee                                             Employer
Signature:       _______________________             Signature:      _______________________
                   XXX


Date:            _______________________             Date:           _______________________




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                                                                                        Employer ______

ODHB 15198 (370) V3              Issued 20/08/2005                           Page 6 of 12
Intensive Care Service Referral and Responsibility for
Care
This policy defines the criteria for referring patients to the Intensive Care Service; the control
of the ICU admission process; and the responsibilities of care for those patients admitted to
the Intensive Care Unit (ICU).

        Policy Applies To            Global

        Policy Summary

        Associated                                     Minimum Standards for Intensive Care Units.
        Documents                                IC – 1 (2003), Joint Faculty of Intensive Care
                                                 Medicine, Australia and New Zealand College of
                                                 Anaesthetists, Royal Australasian College of
                                                 Physicians.

                                                       Comprehensive Critical Care: A Review of
                                                 Adult Critical Care Services. (2000). Department of
                                                 Health, United Kingdom

                                                       Do Not Resuscitate Orders Policy. (12861)


Definitions

        Intensivist                  Medical Specialist qualified in Intensive Care Medicine, or
                                     the Medical Specialist, responsible for patient care in the
                                     ICU at the time.

        Unit Manager                 Person appointed as Unit Manager, or the Senior Nurse,
                                     responsible for the resource management of the ICU at the
                                     time.


Philosophy

        Purpose of ICU               The ICU is specially staffed and equipped to provide 24
                                     hour care which enables patients with life-threatening
                                     conditions to survive where they otherwise might not. This
                                     is done in the expectation that they may recover to a
                                     quality of life acceptable to the patient.

                                     In general:

                                                       The best judge of acceptable quality of life is
                                                 the patient, their current caregivers, or the referring
                                                 team.

                                                       The best judge of possibility of recovery is

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ODHB 15198 (370) V3          Issued 20/08/2005                          Page 7 of 12
                                                   the Intensivist.

                                       Patients may be admitted with limitations placed upon their
                                       therapy.

        Continuity of Care             In the ICU continuity of care is important and seamless
                                       transition from one set of clinical staff to the next at all
                                       levels (as on-duty staff change) is the objective.


Admission Criteria

        Basic Principle for            The Intensivist at the time the patient is admitted must
        ICU Admission                  believe that the patient's acute problem is compatible with
                                       recovery and there is the potential for a quality of life
                                       acceptable to the patient.

                                       The best judge of acceptable quality of life is the patient.
                                       When the patient cannot communicate, guidance can be
                                       given by their caregivers, family, friends and, in the case of
                                       acute complications in the setting of a chronic illness, the
                                       General Practitioner or the patient's Specialist.

                                       The only exception to this shall be where the patient cannot
                                       be managed elsewhere within the hospital while formal
                                       evaluation for termination of support can be made —
                                       specifically a possibly brain-dead patient on respiratory
                                       support.

                                       It is acceptable practice to admit a desperately ill patient
                                       for resuscitation; and then subsequently evaluate as to the
                                       appropriateness of continued stay in the ICU.

        Specific Indications           Specific indications for admission are:
        for Admission
                                                         Patients with any illness that results in a life-
                                                   threatening disturbance of their cardiovascular or
                                                   respiratory systems.

                                                        Patients with septicaemia or other major
                                                   metabolic disturbance.

                                                         Patients who require treatment or prevention
                                                   of shock from any cause. In general a (non-
                                                   therapeutic) blood pressure less than 90 systolic in
                                                   an adult is sufficient reason for admission.

                                                         Patients who require, or may suddenly need,
                                                   supervision of their airway.

                                                         Patients who, after trauma or major surgery,

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ODHB 15198 (370) V3            Issued 20/08/2005                          Page 8 of 12
                                                  require constant monitoring to maintain their status
                                                  or may require rapid therapeutic intervention.

                                                          Patients whose medical management is such
                                                  that it is beyond the capability of other facilities in
                                                  the hospital.

        Contraindication to           Contraindications to admissions are:
        Admission
                                                        The reversal of the acute problem
                                                  threatening the patient is not likely.

                                                         Where clinical evaluation and experience
                                                  indicate that the patient's brain is damaged such
                                                  that recovery to a quality of life acceptable to the
                                                  patient is not likely. The exception to this is for a
                                                  patient with probable brain death and positive
                                                  indication that they wished to donate their organs

                                                         Admission of a patient with a poor prognosis
                                                  that, in the opinion of the Intensivist, would result
                                                  in diversion of effort, thereby compromising patients
                                                  with a better prognosis.


Admission Control

        Consultation                  The admission of any patient, emergency or elective, can
                                      only occur with the agreement of the Intensivist. In making
                                      this decision the Intensivist will consult with the Unit
                                      Manager. If the admission is in any way contentious the
                                      Intensivist should discuss the case directly with the
                                      Specialist requesting the patient's admission.

        Admission Triage              Caring for critically ill patients requires efficient use of
                                      scarce expertise and resources. The Intensivist has the
                                      ultimate responsibility for allocating the ICU resource to the
                                      best advantage of the patients already in the ICU, and
                                      those for whom admission is requested.

                                      The guiding principle is allocation of ICU resource to
                                      patients who can benefit from the efforts of the ICU. Issues
                                      such as the insistence of the referring consultant or
                                      emotive factors should not over-ride the principle of
                                      allocating a limited resource to those who can most benefit.

                                                        In making this decision the Intensivist must
                                                  consider the nursing resource and its allocation with
                                                  the Unit Manager.



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ODHB 15198 (370) V3           Issued 20/08/2005                          Page 9 of 12
                                                        Patients in ICU do not have automatic right
                                                 of tenure. Where there is insufficient resource able
                                                 to be found to care for another patient, ICU therapy
                                                 may have to be withdrawn from a patient already in
                                                 ICU who has a more limited prognosis.

                                                        In extreme circumstances patients with a
                                                 realistic chance of good survival may have to be
                                                 transferred to another ICU if a bed is available
                                                 there.

                                                       It is acceptable practice to take the patient to
                                                 ICU and, after assessment, to decline the admission
                                                 and return the patient to their ward for appropriate
                                                 care there.

                                                       Where contention arises the Intensivist
                                                 should consult the Director ICU or another ICU
                                                 Consultant if the Director is unavailable.

                                     In all situations where ICU admission is declined the
                                     decision and the reasons for refusal should be clearly
                                     recorded in the case notes.

        Therapy Limitation           When discussing the proposed admission the Intensivist
                                     may decide that therapy limitation is appropriate and
                                     accept the admission conditional to limitations on therapies
                                     or time in ICU. If this is being considered the Intensivist
                                     should directly contact the referring Consultant to agree
                                     the limitations.

                                     Therapy limitations are to be communicated to the ICU
                                     Registrar and Unit Manager and written into the case notes
                                     by the Intensivist.

                                     Examples of such limitations are:

                                     '24 hours full ICU care then review.'

                                     'Not for more than NN units of blood / Litres of
                                     resuscitation fluids.'

                                     'Not for intubation or ventilation.'

                                     'Not for CPR.'

                                     It is acceptable practice to make a formal Do Not
                                     Resuscitate order for a patient in the ICU and for that
                                     patient to remain in ICU. See the Do Not Resuscitate
                                     Orders Policy (12861)


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ODHB 15198 (370) V3          Issued 20/08/2005                          Page 10 of 12
Responsibility for Patients

        Joint Patient                 All patients requiring Intensive Care management are
        Responsibility                admitted jointly under the name of the Intensivist and the
                                      appropriate primary admitting Specialist(s). The
                                      responsibilities for the differing aspects of the patient's
                                      management are shared according to each other's expertise
                                      in a collegial relationship.

                                      The other Specialist or the Specialist covering for them
                                      must be made aware of the admission as soon as possible.

        Intensivist Patient           Admitting ICU / Primary Specialist:
        Responsibility
                                      During the week (0800 -1800 Mon – Fri) a Specialist is
                                      rostered as Admitting or Primary Specialist for ICU.
                                      Patients are admitted under this Specialist and the other
                                      appropriate Specialist. The name of these two specialists
                                      will be written on the name card above the bed.

                                      The Admitting ICU Specialist has the final responsibility for
                                      determining the written patient management plan. Other
                                      Specialists, when covering the ICU, or acting in urgent
                                      situations, manage the patient in keeping with this plan
                                      according to the circumstances.

                                      Emergency ICU Specialist:

                                      During the week a Specialist is rostered as Emergency
                                      Specialist for ICU. The Admitting and Emergency
                                      Specialists are the Specialists who work as a team to
                                      manage the ICU. The Emergency Specialist is responsible
                                      for responding to emergencies and consultations outside
                                      the ICU and for supervising patient retrievals or emergency
                                      transports.

                                      The Emergency Specialist should be aware of the patient
                                      management plan and, if required by the absence of the
                                      Admitting Specialist, manage the patient in accordance
                                      with this plan.

                                      Out of Hours Specialist Cover ICU:

                                      Outside of 0800-1800 Mon – Fri on normal weekdays, a
                                      Specialist is rostered to on Call for the Unit. During long
                                      weekends, Easter and the Christmas/New Year periods a
                                      second Specialist will usually be rostered as Emergency
                                      cover as well.


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ODHB 15198 (370) V3           Issued 20/08/2005                     Page 11 of 12
                                  Long Term Specialist:

                                  When the Admitting ICU Specialist changes (usually on a
                                  Monday), those patients remaining in the ICU who are not
                                  about to be discharged are transferred to the care of an
                                  Intensivist for long-term continuity.

                                  This will usually be one of the Specialists who was either
                                  Admitting or Emergency Specialist in the preceding week.

                                  The acceptance of this responsibility is by collegial
                                  agreement and availability. The Long-term Specialist is
                                  ultimately responsible for the long term care of the patient
                                  and provides written direction on long term care. If
                                  changes to the management plan appear necessary they
                                  should be made in consultation with him/her if available, or
                                  be consistent with the long-term plan.

        Nursing Patient           Critically ill ventilated patients should be supervised by a
        Responsibility            registered nurse at all times.




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ODHB 15198 (370) V3       Issued 20/08/2005                      Page 12 of 12

				
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