The Registrars Page!
Welcome
Welcome to the position of an Anaesthetic Registrar at the Wangaratta Base Hospital. Six out of the eight anaesthetists you will work under are part of the Wangaratta Anaesthetic Group or WAG, as we are known around town. This means WAG is intimately involved in your rostering and supervision. This information web page is to help with getting the most out of the term as easily as possible by giving you information about us and the basic structure of the term here.
Rather than existing as a public hospital anesthetic department, the Wangaratta Anaesthetic Group exists as a practice that provides anaesthetic services to a community (rural population 70,000) of which Wangaratta Base Hospital is one site (although the largest). As such our interests tend to be across several sites rather than strictly centered at the Base. These interests generally overlap, and we try to provide an equality of service across all sites if possible.
We provide anaesthesia services for General surgery, Orthopaedics, ENT, obstetric and gynecology, urology, as well as occasional lists in paediatric, and dental. Our off the floor commitments include input into ICU/CCU, anaesthesia for radiology and medical procedures and the acute pain service (APS).
We have regular Friday morning group meetings, and have strong enthusiasm for participation in local QA and CME activities. We have a very active social component to the practice, which is probably a major factor in the group’s success.
WAG anaesthetists
Unfortunately, you will have know who they are and what the surgeons do;
Surgeons and Physicians
Supervisor of Anaesthesia Training: Dr Andrew J Haughton (Andrew)
Ultimately your level of supervision is between you and your consultant. Generally, we stick to the guidelines outlined by the college. If in doubt please refer to the college guidelines.
If you are a 1st year trainee or part of the GP program you may not have been assessed for your 'beyond level 1". Please find attached the guidelines for this from the college (beyond L1).
Similarly, if you have started doing epidurals you need to fullfil the requirement of 10 supervised epidurals. You will need to fill out the "Epidural Assessment Form".
The philosophy of this service is the provision of quality service across the multidisciplinary health team to provide excellence in health care to patients utilizing the skills and knowledge of both the anaesthetic department and the specialized nursing members. This team becomes a vital resource for many members of the health team.
Every patient whom in theatre received a spinal, epidural, nerve block, drug infusion or PCA or has acute pain management on the ward, including any of the above has a APS follow-up form filled in. This is placed in the green "pain folder" in recovery. The green folder is the reference used by the pain nurse or registrar on the pain round.
Currently we only have a part time pain nurse, Lisa Gephart. Lisa is now on maternity leave, however her position is being filled very capably by Libby. She will see, on her days on, every active patient in the green folder. Reviewing all patients who have undergone surgery and require post-operative analgesia via epidural, PCA, intrathecal or other delivery modes. She will usually sort out the mundane stuff herself and seek advice from the registrar on, for anything more complex.
Once a week, Thursday morning, a grand pain round occurs with a consultant anaesthetist. This generally starts at 0900, which acts as both quality assurance and an educational forum. All registrars who are present at work that day are expected to attend.
All data is collated on computer and presented to WAG on a six monthly basis for review and planning.
Libby, Pain Nurse, pager 122
Lisa is on maternity leave.
As an anaesthetic registrar (ARSP or MMC based), there are in hours and out of hours commitment but we also want to make your country experience as enjoyable as possible. Usually the on call works out to about 1 in 3 and this can be managed in a number of ways. In each week, you are allocated half a day study leave and an afternoon off. Before you arrive, Andrew will have emailed you a copy of the master weekend roster to allow planning for time off and to ensure all weekends are covered. A monthly roster will be circulated for the following month that will have important dates, days when you will be working and teaching etc. A weekly planner is generated each week that has the specifics of what lists you will be actually doing based on your needs, the hospitals needs and what actually ends up being booked on the lists. Please if you have specific special dates you need off, weddings, meetings etc, let us know as soon as possible, preferably before you start your term! You may swap days between each other if need be but these must be cleared through Andrew or Joan.
Overall we try to get the most exposure for you to the areas you identify as you interest or weakness and also to the lists that occur less frequently e.g. paediatric surgery. The job is busy at times during the day as often the off the floor jobs are done by the registrar if they are free.
Below is a summary of a weekly routine:
1. Check out the weekly planner and the daily list for that day. The planner has all your list, consultants, and on-call for that week. The planner, at the moment, is not available on the website. At the moment the daily list for the registrars is available from theatre reception, usually by late afternoon the day before;
2. Theatre times are from 0800 - 1630.
3. Most patients are in from 0700 and on the main are in the day procedure unit opposite the main theatres. Most cases are day of surgery admission, however the theatre list will indicate if they are on the ward or not
DSU = Day Surgery Unit
1 E is the main surgical ward
1 W is the CCU or HDU
GW is the main medical ward
Paeds ward is on the ground floor and all Paeds are seen here.
4. On-call duties, include Labour Ward and epidurals, acute pain service, code blue, intubations and ventilation of patients in CCU/HDU, ED and Radiology. You will be occasionally asked to help out with central venous access, arterial lines and anything else people think an anaesthetist should do.
Your consultants are often at home and need at least 10 minutes notice if you need them to come in. It is worth discussing with each one what they want to know about cases and how to contact them. If in doubt, stick to the college guidelines on supervision.
On call is from 0800 - 0800 weekdays, however if you are on for the weekend it is from Friday 0800 until Monday 0800. Don't worry, it sounds onerous, however it is usually less busy than your city job, and you can expect to get some sleep and breaks during the day. You always get the next morning off and depending on workload usually the day. You can also do the on call from your accommodation and can also be within the confines of Wangaratta. Note the consultants on call is from 0700 - 0700;
5. CCU/HDU - best not to ask, however to tell you that it is an "Open" unit and inpatient units manage their own patients. You will be asked about the mundane tasks as outlined under 4.
6. Friday Morning Meetings - at the moment we generally have a meeting scheduled for 0700 every Friday morning. You will be asked to present at least one of these meeting during your stay. They are very informal and are attended by WAG members, registrars etc. They are at the WAG rooms, unless stated otherwise. The meeting is usually listed at the bottom of the weekly planner.
Your contact with WAG will not only be with the consultants. In fact your best resource in Wangaratta may be our staff. Currently we are located in the Wangaratta Private Hospital, 134 Templeton Street, however this will changing very soon, how soon, can't tell you.
Joan Wales is our practice manager, and along with Leanne and Kay, is responsible for publishing the rosters, daily theatre lists as well as all the mundane tasks associated with running a specialist practice. We would be lost without them. Really we would!