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GOLDEN JUBILEE NATIONAL HOSPITAL arrhythmia

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					                                AGENDA FOR CHANGE
                             NHS JOB EVALUATION SCHEME


                                          JOB DESCRIPTION


1. JOB IDENTIFICATION

Job Title: Senior Cardiac Physiologist.

Reports to (insert job title): Principal Cardiac Physiologist

Department, Ward or Section: Cardio-Respiratory Department

CHP, Directorate or Corporate Department: Clinical Services – Raigmore Hospital

Job Reference: MEDDRAIGRESP05

No of Job Holders: 4 (3 full-time and 1 part-time)

Last Update (insert date): 12/01/06


2. JOB PURPOSE

To perform and report on an extensive range of unsupervised highly specialised Cardiac Testing and
specialised Respiratory Testing. To provide a service to outlying Hospitals and GP surgeries. To provide
basic education and basic training for qualified and non-qualified staff within and outwith the Department.
To manage own workload. To organize outlying pacemaker clinics, travel and accommodation.




3. DIMENSIONS

1. The range of patients dealt with ranges from paediatric to elderly. Paediatric patients include
   premature babies. Patients can be totally mobile or totally incapacitated, have learning difficulties,
   hard of hearing and/or unable to speak. Some patients have had a tracheotomy and find it difficult to
   communicate or perform test.
2. The post holder deals with inpatients, outpatients and patients from GP surgeries.
3. Provide advice to medical staff, nursing staff, G.Ps, Medical Physics, colleagues in other hospitals,
   patients and relatives.
4. Liaise with medical staff, nursing staff and G.P’s with regards to patients care and follow up.
5. Communicate with multi disciplinary personnel both within and outwith the hospital.
4. ORGANISATIONAL POSITION



                                              Principal
                                              Physiologist




  Chief               Senior                 Senior                Senior
  Physiologists       Physiologist +3        Physiologist +1       Physiologist
                      incremental            Incremental           (This Post)
                      points                 point




             Assistant
             Physiologists



5. ROLE OF DEPARTMENT

To perform highly specialised Cardiology and specialised Respiratory Tests. To analyse and report on
Tests performed. To take decisions on the basis of the results obtained. To give advice on appropriate
testing to Medical Staff. The service is provided mostly to Raigmore Hospital but a service is also
provided for outlying Hospitals and GP surgeries. To maintain a high standard of training of personnel
within the Department. To provide education on basic cardiac testing and analysis to both non-qualified
and qualified nursing staff.




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6. MAIN TASKS, DUTIES AND RESPONSIBILITIES

The post holder has to work within Hospital and departmental policies. The post holder also has to work
within guidelines developed by the Society of Cardiological Science and Technology. The post holder is
expected to work independently as well as part of a team.


Highly specialised Cardiac Testing (unsupervised): (15%)

All pacemaker clinics are physiologist led and involves the performance of detailed pacemaker testing,
interrogation and detailed analysis of stored data, assessment of pacemaker function, reprogramming,
requesting of other cardiac testing. In the event of problems, arising from data or test results, it is the
post holder’s responsibility to reprogram the pacemaker, occasionally after discussion with a more senior
member of staff. If this does not resolve the problem, it is then the post holder’s responsibility to inform
the Cardiologist. Due to geographical pressures the Cardiologist is often not contactable therefore it is
the post holder’s responsibility to take an interim decision, occasionally after discussion with a more
senior member of staff as to the course of action until a Cardiologist can be contacted. Gives advice and
reassurance to the patient. It is the post holder’s responsibility to organize clinics in outlying hospitals,
organize accommodation and organize the transport of equipment and personnel to and from the clinics.


Specialised Cardiac/Respiratory Testing (unsupervised): (65%)

Provides a large range of unsupervised cardiac testing. A detailed analysis is performed on the testing
and a detailed report written. Advice on further testing and/or action is often provided.

1.Supporting Cardiologist:
    a. By performing detailed electrical analysis on the position of the pacemaker leads during
       implantation of pacemakers. Advising the Cardiologist as to the need to reposition a lead.
       Assisting with defibrillation and resuscitation when required.
    b. Detailed monitoring and analysis of heart rate and blood pressure during Tilt table testing.
        Assisting with resuscitation when required.

2.Monitoring the minute changes in blood pressure and ECG during a range of cardiac catheterisation
testing (right heart, left heart, coronary artery, grafts and biopsies). Calculation of cardiac outputs and
cardiac index. Decisions are made autonomously with regards to the resolution of technical problems, as
these have to be resolved quickly and there is no immediate backup. Assisting with defibrillation and
resuscitation when required.

3.Performing analysing and reporting of exercise stress testing. Prior to performing the exercise test,
assess patient symptoms and check for any further ECG changes to decide whether to proceed or
cancel or request alternative or more appropriate testing. Immediate informing of test results to medical
staff, if necessary. If a patient requires to be admitted urgently, informing relevant medical staff and
organizing admission. Decisions made on direct access (from GP surgeries) treadmills as to the
follow up ie. whether to be sent back to the GP with the result of the test, to be seen by a
cardiologist or referred for angiography. Informing and explaining to the patient the course of action
(i.e. further testing and/or admission). If a patient has to refrain from taking specific drugs prior to a test, it
is the post holder’s responsibility to ensure that this is done. If required initiating cardiac resuscitation and
defibrillation. Assisting with advanced life support once the medical staff have arrived.




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4. Performance of ECGs on patients referred by GP surgeries, and the assessment of the ECG results
and patient symptoms. As a result of conclusions drawn, taking the decision to release patient/inform GP
of ECG results or have patient admitted to Hospital. The post holder will inform the patient of the course
of action and the reason why that specific action has been taken.

5. Assessment and correction of automated ECG reports (downloaded from departmental machines),
which are archived on a computer system. These reports are accessible by all areas within the Hospital
(and possibly in the near future by GP surgeries).

6. Performance, detailed analysis and detailed reporting of Intermittent cardiac arrhythmia monitoring
and 24 hour holter monitoring. Advise on any follow up testing required or arrhythmias requiring urgent
attention. In the case of life threatening arrhythmias organize to have the patient admitted.

7. Assists with research and development by performing tests and analysis required. Work as part of a
team usually with doctor or nurse involved with the research.

8. Responsible for assessing, ordering of non-stock, in stock, stationery.

9. Due to the difficulty in recruiting Clinical Physiologists it is a requirement for staff to also be trained in
the specialism of Respiratory Function Testing. Must be fully competent in the performance of flow
volume loop, gas transfer and lung volumes testing.

10. Assisting Cardiologist with Carotid Sinus Massage testing.

11. Reporting on tests.Performance and detailed reporting of Autonomic Function testing.


Basic Cardiac/Respiratory Testing (unsupervised): (5%)

    1. Performing of standard 12 lead ECGs. Fitting of 24-hour blood pressure monitors, 24-hour ECG
       monitors and intermittent cardiac arrhythmia monitors.

    2. Respiratory: basic spirometry and reversibility study testing.


Management Duties: (5%)

    1. The department is sub divided into several areas. It is the post holder’s responsibility to be in total
       charge of one of these areas (the area of responsibility changes after a period of several months).
       Total charge means, ensuring that all stock and equipment required are present, up to date, in
       good working order and that staff required to assist are present and understand their duties.
       Management of staff working within the area is the post holder’s responsibility including
       organizing and delegating to ensure cover when not present e.g during lunch breaks or when
       attending emergency pacemaker implants etc;

    2. In extreme circumstances the post holder can be required to take responsibility for the
       management of the assistant physiologists.




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Education: (5%)

    Involved with the teaching and demonstration of basic ECG testing and rhythm analysis to qualified
    and non-qualified staff (from other disciplines) i.e. Hospital nursing staff, radiographers and GP
    practice nurses. Provides teaching (theoretical and observational) on pacemaker implant and
    exercise stress testing to medical students, nursing staff and students. Provides training and
    practical advice to GP practice nurses with regards to the use of Intermittent Cardiac Event
    Recorders, Ambulatory Blood Pressure monitors and ECG machines.

Administration: (5%)

    Updating pacing data of individual patients after attendance at clinics or implantation of new system.
    Producing letters for patient notes and copies to GP practices.
    Reception duties (in absence of receptionist): putting patients on the waiting list, making
    appointments, responsible for logging and locating patient notes within the hospital. Dealing with
    numerous telephone queries from within the hospital (medicals staff, nursing staff, secretaries etc;)
    and outwith – GP’s, colleagues from other hospitals and patients.
    Responsible for updating the Hospital patient administration system.



7a. EQUIPMENT AND MACHINERY

   1. Highly technological and expensive equipment/machinery is used in all testing. This includes
      small intermittent cardiac arrhythmia, 24 hour ECG and Blood pressure monitors, treadmills,
      sophisticated monitoring systems (e.g. cardiac catheterisation testing equipment), computerized
      analysis systems and patient administration systems.

   2. Highly technological and complex pacemaker programmers and analysers are used. Many
      different programmers are used from different companies. Some companies have 2 or 3 different
      programmers designed to deal with different generations of pacemakers. These programmers
      vary in their set up and style of programming. Different companies have different names for the
      same programmable feature and also have different ways to set up similar functions. Therefore
      the post holder is required to be fully competent with many different methods of programming,
      different terminology relating to similar features and different formats for setting up similar
      functions required by the large range of programmers in use.

   3. The post holder is responsible for the basic maintenance, cleaning, programming and
      troubleshooting of all equipment.

   4. The post holder is also responsible for regular checks on alarm systems and defibrillators.

   5. The post holder is responsible for ensuring that all emergency trolleys are regularly checked and
      stocked.

   6. The post holder is responsible for taking the decision to call in someone from the Medical
      Physics department or the company, if a problem with an item of equipment cannot be resolved.

   7. When equipment is being assessed for purchase, the post holder often has to use various pieces
      of equipment/machinery from different companies. The post holder will then participate in an
      intra departmental discussion as to the most suitable equipment/machinery to purchase.



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7b. SYSTEMS

  1. Updates the hospital patient administration system information.

  2. Updating of patient information on the departmental patient appointment system.

  3. Updating of pacemaker data on the computerized analysis system.

  4. After a pacemaker check the post holder is required to update the patient notes as to the
     programming performed, action taken and length of time until next follow up.

  5. The post holder is responsible for the updating of pacemaker records and the transfer of
     information to other Hospitals when the patient moves.

  6. Responsible for editing, reporting and confirming all clinical results entered into departmental data
     base (MUSE) prior to archiving.

  7. Clinical information is downloaded by Raigmore, Belford and Caithness General and is reported
     on by the post holder.

  8. Medical staff, nurses and secretaries can view all reports generated by the post holder,
     development is underway to allow GP access.



8. ASSIGNMENT AND REVIEW OF WORK

  1. The majority of patients are referred for testing from Consultants within the Hospital and from
     outlying Hospitals. Sometimes the Registrars or Senior House Officers request the tests.

  2. If the inappropriate test has been requested or the criteria for the testing incorrect it is the post
     holders duty to organize the appropriate test, cancel or postpone the test and inform the
     Consultant.

  3. Results of tests are always returned to the requesting Consultant or the Consultant that the
     patient is registered with (not registrar or SHO). If results require an urgent consultation
     /admission or further testing, this will be organized and the relevant Consultant or member of the
     medical team will be notified.

  4. If the requestor has a limited cardiac knowledge it is the post holder’s role to offer advice as to the
     further testing required or to give a more detailed interpretation of results sent to them.

  5. There is also limited direct access to investigations from GP’s. These investigations are ECG’s,
     Intemittent cardiac arrhythmia monitoring, direct access exercise stress testing and the Rapid
     Access Chest Pain Clinic.
         a. Whilst performing an ECG can be considered routine, it is the post holder’s responsibility
             to take detailed history of the patient’s symptoms and together with the interpretation of
             the ECG decide whether the patient requires to be seen by medical staff and / or should
             the GP be informed of the report immediately or should the ECG be put forward for routine
             reporting by the Cardiologist.
         b. With the Rapid Access Chest Pain Clinic, often GP’s phone for advice as to whether their
             patient is suitable for this clinic. It is the post holder’s responsibility to decide on their

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            suitability and advise whether the patient should be sent directly to A&E.
         c. Patients are referred from GP surgeries for Exercise stress testing. On obtaining the
            results it is the post holder’s responsibility to refer them back to the GP, or have them
            assessed by a cardiologist or referred to cardiologist for angiography.

  6. The post holder follows up pacemaker patients. The post holder decides as to which
     programmable parameters are suitable for a patient, and performs the programming without
     supervision. Decisions are taken by the post holder as to when their next appointment should be
     i.e. In 1 week, 1 month, 3 months, 1 year etc or if they should have further investigations, which
     will be organized by the post holder, or if a referral to a medical clinic for further assessment is
     required. A report of the pacemaker follow up and any further investigations is stored in the
     patient’s notes and a copy sent to their GP. If results indicate that further medical intervention is
     required, the results will be sent to the relevant Consultant with an explanation.

  7. It is also the post holder’s responsibility to decide when the patient requires to have their
     pacemaker replaced and to advise the consultant as to which type of pacemaker would benefit
     the patient most. It is necessary to arrange admission of the patient in an appropriate timescale
     i.e urgent or non-urgent.

  8. The post holder is expected to work unsupervised at all times and make independent decisions if
     necessary. The post holder is solely responsible for the analysis and reporting of results, which
     they perform. If a case is particularly problematic then it can be discussed with one of the senior
     Physiology staff / Cardiac consultants.



9. DECISIONS AND JUDGEMENTS

  1. If a policy or protocol in place is failing due to health and safety issues or new research then it is
     the post holder’s responsibility to alert the Head of Department.

  2. Decisions have to be made by the post holder, occasionally after discussion with a more senior
     member of staff, as to whether the patient requires to be admitted at the outlying hospital or
     transferred to Raigmore Hospital or to refer them for further testing as an outpatient. Independent
     decisions are made with regards the appropriate follow up required for direct access GP referred
     exercise stress test patients.

  3. Independent decisions are made as to the routine follow up of pacemaker patients with minor
     problems.

  4. The post holder organizes day to day running of the particular area of charge allocated to the post
     holder. However this may need rescheduled/reorganized when emergency cases occur (i.e. the
     post holder has to attend theatre to assist with an emergency pacemaker implantation) or if they
     have to cover the work of another member due to sick leave etc. This reorganization/rescheduling
     will be left entirely to the post holder to ensure the most efficient use of resources available to
     them.

  5. Provide guidance and answer queries from other healthcare professions.




                                                      7
10. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB

     1. Decisions taken from patient history and results obtained for direct access GP patients, as to
        whether to send report to GP, inform GP of result urgently, have patient reviewed by cardiologist,
        have the patient admitted or directly refer the patient for further testing.

     2. Informing patients and relatives that a particular patient will need to be admitted after test results
        have been obtained. Sometimes patients are unwilling to be admitted; therefore they have to
        persuaded and reassured.

     3. Due to the variety of pacemaker programmers used it is difficult to learn about complex new
        pacing functions, as each company will call it a different name and have different methods of
        setting up of these functions. The companies will also have different methods for testing and
        collating data from these functions. Therefore simple additions to the function of pacemakers are
        complex learning processes.

     4. Keeping up to date with ever advancing technology bearing in mind the pressures on time and
        resources to attend courses, which are mostly held at venues not at a commutable distance.




11. COMMUNICATIONS AND RELATIONSHIPS
Communication takes place on a daily basis and may take the form of face to face, telephone
conversations, emails, written reports and letters.


1.   The post holder presents information (in the form of a tutorial/talk/demonstrations) to students and
     qualified nursing and radiography staff. Presents material to colleagues after attending courses and
     meetings.

2.   Performs teaching sessions outside Raigmore Hospital to groups of nurses in outlying hospitals and
     GP practices with regards to performing routine ECG’s and simple interpretation.

3.   Communicates with patients, patient’s relatives, medical staff of all grades, nursing staff, porters,
     radiographers, GPs, medical physics, stores personnel, medical records and appointments
     personnel, receptionists, sales representatives and engineers from companies and a variety of
     personnel from other Hospitals.

4.   Patients: Explaining the test being performed. Reassuring them before and after tests. Explaining to
     the patient why the test is being performed. Answering any of the patient’s questions with regards to
     the test. If necessary explaining why they need to be admitted or have further follow up. Can be
     difficult if patient does not wish to be admitted.

5.   Patient relatives: Informing them when the patient requires to be admitted. Reassuring them. Can be
     difficult if the relative is distressed.

6.   Medical staff: Communicating of results, discussion of results, advice on further testing and
     requesting the admission of patients.


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7.   Nursing staff: Discussion about patient’s fitness to perform tests/attend department. Information is
     passed on to the nursing staff when a patient is admitted to the ward. Communication as part of a
     team within the Theatre and Cardiac catheterisation laboratory.

8.   Porters: Communicating type of transport required, assisting with the transport of a sick patient to
     the ward.

9.   Radiographers: Communicating with them whilst working together on cases in Theatre and the
     Cardiac catheterisation lab.

10. GPs: Conveying of test results, advise on further testing, and informing them of the reasons behind
    the admission of a patient to the ward.

11. Medical Physics: Informing them of broken equipment, chasing up of equipment to be returned.

12. Stores personnel: Resolving of ordered stock problems e.g. overdue delivery of stock or wrong stock
    delivered etc.

13. Medical records/appointments: Chasing up of sets of notes, appointments that should have been
    made etc.

14. Receptionist: Request the receptionist to organize appointments; obtain notes and any other general
    duties.

15. Personnel from other Hospitals: Mainly with medical records staff to organize outlying pacemaker
    clinics and liaising with colleagues with regards to patient results or requesting them to carry out
    tests on patients or to offer advice on various issues.

12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB

Physical:

Effort:

     1. Prolonged periods sitting in front of computer and /or monitoring screens requiring 100% attention
        and concentration.
     2. Walking between main department area and procedures area. Collecting patients from reception
        area and delivering both patient and result to appropriate clinic. Within department pushing
        wheelchairs to procedure rooms and to clinics and X Ray and Ambulance waiting rooms.
     3. All patient contact is hands on and requires both bending and stretching over the patient to
        ensure accurate placement of electrodes and other essential equipment. Moving of patients from
        wheelchair to bed and vice versa. Helping wheelchair bound patients to use bathroom facilities.
        Moving of patient from trolley to theatre table/bed and vice versa.
     4. Carrying of heavy programmers within the Hospital. Carrying of heavy programmers and heavy
        bags of patient files to and from cars/aeroplanes when attending outlying pacemaker clinics.
     5. As we do not have enough rooms, there is the moving of and setting up of heavy and bulky
        equipment in different rooms.
     6. Working in cramped conditions where there is not enough work surface area for the amount of
        staff in the department and where rooms have excess items due to lack of storage.
     7. Wearing of lead coats for prolonged periods of time i.e. up to 5 hours, during cardiac
        catheterisation testing and pacemaker implants.
     8. Occasional performance of CPR.

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Skill:

    1. Speed and 100% accuracy are required for the analysis and writing of reports with the use of
       computer keyboard.
    2. Concentration is required for prolonged periods at a computer screen (this can be for up to 7
       hours with short breaks).
    3. Manual dexterity and attention to detail are required in order to set up equipment properly and
       safely. As the department does not have enough procedure rooms certain equipment has to be
       frequently and regularly set up and dismantled in order to fully maximize resources. This is also
       mirrored in both theatre and the X Ray angiography suite. As we do not have dedicated theatre
       space, it has to be shared with other disciplines and equipment cannot remain static.
    4. Excellent driving skills are required to drive long distance to outlying clinics, courses and
       meetings. Driving skills should be to a high standard as driving conditions can often be adverse.

Mental:

    1. 100% concentration is required whilst performing and analysing a test.
    2. A week can be planned out, but due to emergencies or people on sick leave the working week
       may have to be rearranged on a day-to-day basis. Therefore work that was planned by the post
       holder could have to be postponed. This happens on a regular basis.
    3. When working there are often frequent interruptions from patients or hospital personnel (from
       within the Hospital or outlying Hospitals) requesting advice, results and information.
    4. As there is a difficulty in the obtaining of qualified staff or locums willing to work in Inverness,
       there are often long periods after a member of staff leaves, during times of prolonged sick leave
       and maternity leave where the workload is excessive. This also extends to reception duties
       where often no cover is provided and time that has been allocated for clinical duties has to be
       spent covering reception.

    5. Due to government targets, waiting lists are required to be kept below certain levels. Therefore it
       is required to add extra appointments and put aside other essential work including administrative,
       teaching and training, auditing and time to fully implement changes and new methodology. This
       results in added stress and anxiety as to when time can be found to do these tasks. To reach
       waiting list targets, extra appointments are made out of hours; (Whilst performing out of hours
       work the post holder is autonomous as there is no technical back up at these times). These
       additional appointments occur over a prolonged period, which can be as long as 12 months.
       Over this length of time it becomes both mentally and physically exhausting.

    6. Decision making on course of action for the patient after the analysis of results has been
       performed.

Emotional:

    1. Conveying to a patient and relatives that the patient requires to be admitted and the reasons for
       this. Patients can get distressed as the doctor sometimes gives the patient distressing news, and
       due to commitments is unable to spend time with the patient. The post holder then has to deal
       with an emotional patient.
    2. Sometimes patients are terminally ill or die during a procedure, which is emotionally distressing.
    3. Dealing with children who are ill, as well their parents and siblings can be upsetting.
    4. Also with patients who attend the department regularly over a long period, particularly pacemaker
       patients, it can be upsetting when they die.
    5. The post holder has to participate in outlying clinics, which often span over 2-3 days. This means
       that the post holder is away from family and dependants for which provision for childcare etc. has
       to be made.

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   6. Working with patients who have barriers to communication and understanding, including those
      who are confused, agitated or aggressive.

Environmental:

   1. Occasionally it is necessary to cancel appointments at short notice – for example due to
      equipment failure, as many of our patients travel a distance to attend, they have often already left
      and cannot be contacted. On arrival the patient has to be informed that we cannot do the test
      and sometimes they can get quite angry. The situation has to be controlled and the patient
      calmed. Patients can get irate because they cannot have an appointment at the date and time,
      which suits them best. These patients have to be calmed and reassured either face to face or by
      phone. Occasionally there is a patient who comes for a test and is irate because they have had a
      long wait, at the clinic, which they are attending, or they are looking for an argument for no
      apparent reason. These patients require calming and persuasion to do the tests. Occasionally
      staff from other departments can get irate because we cannot fit in an appointment, which suits
      the other tests, which the patient is required to have performed.
   2. Patients can have infectious diseases, be infested with parasites, be incontinent, cough up
      phlegm, vomit or be MRSA positive. These patients can be dealt with in both the department and
      the ward.
   3. Dealing with patients who are deaf or, have limited English or who have learning disabilities
      require much more time to explain procedures and to obtain history from.
   4. For cardiac catheterisation tests, pacemaker implants and the occasional radio-nuclear scan at
      which the post holder is present they are exposed to a large amount of radiation.
   5. Whilst travelling to outlying clinics, the weather can be unpredictable e.g. Snow, fog, heavy rain
      etc. This can cause delays and stress from the poor driving conditions.
   6. Accommodation provided for outlying clinics can sometimes be sub-standard e.g. Hospital
      student accommodation or a smoking room for a non-smoker. Sometimes the accommodation
      can be a distance from the Hospital creating problems with transport.




13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB

1. Degree in Clinical physiology (Cardiology) or equivalent training.
2. MSCST or equivalent.
3. In house training and assessment. Expectation that the post holder has gone on courses, which
   have improved their existing skills to a postgraduate level. The many relevant day and residenti al
   courses, which have been attended, have also been assessed.
4. Significant post qualification experience. Be fully competent in all the advanced cardiac testing
   mentioned. Have experience in advanced respiratory testing. Have had an introduction to
   management skills and a high level of computing skills, including word and power point. CPD are
   also required to be up to date and documented, which includes teaching, training and certificated
   updating of skills.




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14. JOB DESCRIPTION AGREEMENT
I agree that the above Job Description is an accurate reflection of my duties and
responsibilities at the date of signing.

Job Holder’s Signature:                                                             Date:

Manager’s Signature:                                                                Date:




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Description: GOLDEN JUBILEE NATIONAL HOSPITAL arrhythmia