0. Diabetes and Endocrinology. Specialty Induction Guide. OPD2. Royal Infirmary
of Edinburgh. 51, Little France Crescent. Edinburgh EH16 4SU. Metabolic Unit.
Diabetes and Endocrinology Specialty Induction Guide
OPD2 Royal Infirmary of Edinburgh 51, Little France Crescent Edinburgh EH16 4SU Metabolic Unit Anne Ferguson Building Western General Hospital Crewe Road Edinburgh EH4 2XU
January 2011
0
ENDOCRINOLOGY AND DIABETES IN EDINBURGH CONTENTS Page 1
Contents ……………………………………………...
Introduction ………………………………………….. Page 2
RIE Page 3-4
Who’s Who …………………………………..
Unit meetings ………………………………... Page 4 Clinic timetable ……………………………… Page 4-5 OPD2 information …………………………… Page 6 Clinical Outcoming ………………………….. Page 7 Information for SpR/ST trainees…..…………. Page 7 GP placement information …………………...
Page 9
Who’s Who …………………………………..
Page 10
WGH
Unit meetings ………………………………... Page 11 Clinic timetable ……………………………… Page 11-12 Clinical Outcoming ………………………….. Page 13 Information for SpR/ST trainees……………..
Page 13
GP placement information …………………...
Page 15
FY1/2 information …………………………...
Page 15
Protocols ……………………………………………..
Page 16
1
INTRODUCTION Welcome to the departments of endocrinology and diabetes in Edinburgh. Training for SpRs and ST doctors takes place mainly in the Royal Infirmary (RIE) and the Western General Hospitals (WGH) in Edinburgh, but you will rotate to St John’s Hospital, Victoria Infirmary in Kirkcaldy or the Borders General Hospital for general medicine placements. If you are doing an FY2 placement you will be based at the metabolic unit at WGH. GP placements in diabetes lasting 3 months take place at both RIE and WGH. There are agreed management protocols for diabetes and endocrinology that are used in both RIE and WGH. These
are
all
available
on
the
intranet
under
the
Metabolic
Unit
Handbook
http://intranet.lothian.scot.nhs.uk/NHSLothian/Healthcare/A-Z/Diabetes/DiabInfoforHealthProf/MetabolicUnitHandbook/Pages/MetabolicUnitHandbook.aspx.
at A
list of protocols is included in this induction information but you should have a look at the full range of protocols on the intranet. As part of the strategy to streamline endocrine services in Edinburgh, the endocrine units at RIE and WGH have amalgamated to function as a single unit: the Edinburgh Centre for Endocrinology (ECE). There is a shared administrative structure and integration of clinical services across the two sites. Regular meetings involving both sites are held to facilitate discussion of clinical cases and regular review of unified protocols for investigation and management. This regular cycle of meetings also incorporates multidisciplinary team meetings and liaison meetings with allied specialties.
ECE weekly meetings take place every Monday from 4 to 5pm in the Blackford room at the RIE postgraduate education centre and the seminar room at the WGH Metabolic Unit, using the video-link.
The pituitary MRI conference runs separately on Friday lunchtimes at 1.30pm at the Western General.
The thyroid/endocrine pathology MDT runs monthly (generally 3rd Monday of the month).
Other topics take place approximately every 10 weeks. The topics covered and the appropriate lead clinicians are given in the table below.
The lead clinician for each topic generates an agenda.
ECE meetings are coordinated by Dr Nicola Zammitt.
Topic
Lead clinician
Thyroid/pathology MDT
Mark Strachan/Ted Duvall
Case presentations
Nicola Zammitt/Stuart Ritchie
Protocol review
Roger Brown
Lab liaison
Geoff Beckett/Cathy Shearing
Rep endo liaison
Richard Anderson
Paeds liaison
Louise Bath
Morbidity and mortality
Nicola Zammitt 2
ROYAL INFIRMARY OF EDINBURGH (RIE) WHO’S WHO AT RIE You will find a list of permanent staff in OPD2 below. Margaret Turnbull, who is head of A&C, will be able to organise passwords to log onto SCI-DC (diabetes IT system) as well as general passwords to log onto the computers if you do not already have one. Dr Nicola Zammitt coordinates the clinic rota. Annual and study leave requests need to be approved by Dr Alan Patrick and then passed on to Margaret Turnbull. Leave needs to be authorised with at least 6 weeks notice. CONSULTANTS – (D) = Diabetes (E) = Endocrinology Clinical Staff Dr Alan Patrick (D+E) (Clinical Lead) Prof Brian Frier (D) Dr Matthew Young (D) Dr Alan Jaap (D+E) Dr Nicola Zammitt (D+E)
Academic Staff Prof Jonathan Seckl (E) Prof Brian Walker (E) Dr Rebecca Reynolds (D+E) Dr Roger W Brown (E) Dr Moffat J Nyirenda (E) Dr Shareen Forbes (D+E)
CLINICAL ASSISTANTS Dr Trisha McPhail Dr Frances Soutter Dr Linda Rainey
RESEARCH NURSES Alison Sudworth Margaret Boyd
CLINIC NURSING STAFF Staff nurses Val Stone (C/N) Tara Wilson (S/N) Jane Glass (S/N)
Clinical Support Workers Christina Johnston Denise Watson Margaret Craig
DIABETES SPECIALIST NURSES Name Joan Allwinkle Joan Grant Janet Barclay Vida Heaney Mike Richards Lindsay Aniello Lynn Gourlay Kay Malloch Margaret Boyd (Roodlands)
Specialty area (if applicable) Community Pregnancy, insulin pumps In-patient diabetes Adolescent diabetes, GLP-1 analogues GLP-1 analogues GLP-1 analogues Erectile dysfunction
ALLIED HEALTH CARE PROFESSIONALS Dietetic staff Debbie Anderson Alison Hutchison
Podiatrists Emma Brewin Joanne McCardle Nasrin Khosravi 3
A&C STAFF Secretaries Margaret Turnbull (Head of A&C) Fiona Craik (AWP) Margaret Milne (BMF) Louise Hanlon (MJY) Elaine Dowding (AJJ) Janey Anderson (NNZ) Debbie Higgins (Endo/gen med)
Clerical Officers Madge Ritchie (Diabetes) Yvonne Dickson (Diabetes) Kathy Cockerell (Diabetes) Isa Mack (Diabetes) Catherine Clark (Endo) Donna Rennie (GM) Karen Robson (GM)
UNIT MEETINGS
Monday 4-5pm ECE meetings Blackford room in Postgrad suite, RIE.
SpR/ST teaching (“morning prayers”) 08.30-09.15 Mon-Thurs, OPD2 seminar room (except July-Aug)
Wednesday 12.30-13.30 hospital grand rounds in Chancellor’s building.
Friday 08.30-09.15: unit meeting for discussion of clinical cases seminar room OPD2.
Friday 13.00-14.00: unit meeting with lunch included seminar room OPD2.
CLINICS The clinic timetable is given overleaf. Most of the clinics run weekly with the following exceptions: Diabetes/renal clinic: 2nd and 4th Monday of the month Thyroid eye clinic PAEP: 1st Tues of the month Roodlands endocrine and adolescent diabetes: periodically on Thursday afternoons (see monthly timetable) RIE adolescent diabetes clinic: Every 6 weeks on a Friday afternoon Insulin pump clinic: On most Wednesday afternoons as listed on monthly timetable.
Registrars will be allocated to clinics depending on their training needs and service requirements. This includes the subspecialty diabetes renal, adolescent and antenatal clinics. While registrars are at RIE, they should arrange to attend foot clinics with Dr Matthew Young, diabetes retinopathy clinics at the Princess Alexandra Eye Pavilion and paediatric diabetes clinics with Dr Louise Bath at the Royal Hospital for Sick Children (all contactable on luht.scot.nhs.uk Email addresses).
As optional extras, registrars can attend the islet cell clinic on Monday mornings with Dr Shareen Forbes, the metabolic antenatal clinic on Tues afternoons with Dr Shareen Forbes (
[email protected]) and Dr Rebecca
Reynolds
(
[email protected]),
(
[email protected])
and
the
the
thyroid insulin
eye pump
clinic clinic
with with
Dr
Nicola Dr
Zammitt
Alan
Jaap
(
[email protected]). You are supernumerary and attendance, which should be pre-arranged with the relevant consultant, is for educational purposes. There is also a pharmacist-led (Juliette Paton) cardiovascular risk clinic and a nurse-led (Margaret Boyd) erectile dysfunction clinic on Wednesday mornings. 4
RIE WEEKLY DIABETES/ENDOCRINOLOGY TIMETABLE Monday Week 1
4th AJJ/AWP
AM
DM AJJ/AWP FS LR Reg Islet cells SF (OPD1) ANC AJJ/AWP Reg Thyroid Ca MWJS (OPD 4) ECE meeting 4pm
DM BMF FS PM NZ/Reg
AM
PM
Week 4
Registrar on call – XX th 5 NZ 6th JRS/RWB
3rd BRW/MN
Date
Week 3
Wednesday
Date PM
Week 2
Tuesday
10th BRW/MN DM FS LR Reg Renal AJJ/AWP Reg Islet cells SF (OPD1) ANC AJJ/AWP Reg Thyroid Ca MWJS (OPD4) ECE meeting 4pm th
Date
17
BRW/MN
AM PM
DM AJJ/AWP FS LR Reg Islet cells SF (OPD1) ANC AJJ/AWP Reg Thyroid Ca MWJS (OPD4) Thyroid MDT 4pm
Date
24th BRW/MN
Thursday DM BMF MJY AJJ NZ Reg Rood AWP AXJ
Metabolic ANC RR/SF (SMMP) Endo JRS AWP MN PM Reg Thyroid eyes NZ (PAEP)
Endo AWP BRW AJJ Reg CVR (JP) & ED (MB) DM BMF/AJJ Reg x 2 Pump clinic AJJ DA JG WGH DM NZ
11th AJJ/AWP
Registrar on call – XX 12th NZ 13th JRS/RWB
DM BMF FS PM NZ/Reg
Endo AWP BRW AJJ Reg CVR (JP) & ED (MB)
Metabolic ANC RR/SF (SMMP) Endo JRS AWP MN PM Reg
DM BMF/AJJ Reg x 2 Pump clinic AJJ DA JG WGH DM NZ
18
th
AJJ/AWP
DM BMF FS PM NZ/Reg Metabolic ANC RR/SF (SMMP) Endo JRS AWP MN PM Reg
25th AJJ/AWP
DM BMF MJY AJJ NZ Reg Rood AWP AXJ
DM FS LR Reg DM BMF FS PM NZ/Reg Endo AWP BRW AJJ Reg Renal AWP/AJJ CVR (JP) & ED (MB) Islet cells SF (OPD1) ANC AJJ/AWP Reg Metabolic ANC RR/SF (SMMP) DM BMF/AJJ Reg x 2 PM Thyroid Ca MWJS (OPD4) Endo JRS AWP MN PM Reg Pump clinic AJJ DA JG ECE meeting 4pm WGH DM NZ AJJ – Alan Jaap AXJ – Andrew Jamieson MJY – Matthew Young AWP – Alan Patrick FS – Frances Soutter MN – Moffat Nyirenda BRW – Brian Walker JRS – Jonathan Seckl NZ - Nicola Zammitt BMF – Brian Frier LR – Linda Rainey PM – Patricia McPhail
5
DM MJY SF (alt wk) LR FS Reg
14th Unit meeting DM MJY SF (alt wk) LR FS Reg
Endo JRS/BRW RWB RR/SF NZ Reg
DM BMF MJY AJJ NZ Reg Rood AWP AXJ
21st Unit meeting DM MJY SF (alt wk) LR FS Reg Endo JRS/BRW RWB RR/SF NZ Reg
Registrar on call – XX 26th NZ 27th JRS/RWB
AM
7th Unit meeting Endo JRS/BRW RWB RR/SF NZ Reg
Registrar on call – XX 19th NZ 20th JRS/RWB Endo AWP BRW AJJ Reg CVR (JP) & ED (MB) DM BMF/AJJ Reg x 2 Pump clinic AJJ DA JG WGH DM NZ
Friday
DM BMF MJY AJJ NZ Reg Rood AWP AXJ Rood Endo & adolescent DM AWP (Variable dates for these clinics) RR – Rebecca Reynolds RWB – Roger Brown SF – Shareen Forbes
28th Unit meeting DM MJY SF (alt wk) LR FS Reg
Endo JRS/BRW RWB RR/SF NZ Reg Adol DM (every 6/52) AJJ NZ RHSCx2 occasional reg DA – Debbie Anderson JG – Joan Grant JP – Juliette Paton MB – Margaret Boyd
OUT_PATIENT DEPARTMENT 2 (OPD2) Diabetes and endocrine clinics take place in OPD2, along with clinics in haematology, neurology, general medicine and hypertension. Diabetes has a designated entrance and reception area while the north entrance via the mall is the reception area for all other clinics. Clinic folders with useful paperwork are kept in the desk drawers in each consultation room. Please inform clinic nurses if paperwork is missing. Diabetes clinics Clinic nurses and support workers will check weight and BP and take clinic bloods on patients. Blood tests either consist of full annual review venous bloods or a capillary sample for glucose and HbA1c. Results for glucose and HbA1c will be attached to the front of the notes. Other blood samples are routinely processed in the hospital labs. Patients are asked to bring a urine sample to all clinic visits. You should retrieve this from the nurses after it has been dipped and send to the lab along with any venous bloods. Blood tests should be requested electronically on Trak With over 9,000 patients currently attending the clinic, we can generally only offer 7 month or annual review appointments as clinics are booked up for many months in advance. Patients requiring a review in a shorter time frame can be referred to the DSNs or dieticians via the blue referral forms kept in the clinic folders. Insulintreated patients usually attend every 7 months while other patients may be suitable for shared care with their GP and only require an annual review appointment in hospital. Endocrine clinics Patients will be weighed by nurses on arrival. Blood tests should be undertaken by doctors in clinic and requested on Trak. For short synacthen tests (SST), take baseline bloods but do not seal the blood form.
Prescribe 250mcg synacthen im on a
prescription sheet from the clinic folder and give this to one of the clinic nurses along with the baseline blood samples and a patient sticker. They will do the synacthen injection and 30 minute blood sample. Special containers for renin samples can be obtained from clinic nurses.
Patients can be brought back to OPD2 for SSTs,
acromegaly GTTs and routine bloods (eg early morning testosterone). More complex tests and procedures (eg water deprivation tests, annual iv zoledronate infusions) should be arranged at the WGH metabolic unit by writing to Sister April Robertson.
6
CLINICAL OUTCOMING A patient’s journey can be broken down (in time) into a number of steps:
Referral received to triage
Triage to booking appointment
Time from booking appointment to actual attendance in OPD
Wait for diagnostics
Diagnostic to review appointment (to discuss results and plan treatment)
Review appointment to treatment (outpatient, inpatient or day case)
The sum total of all these steps needs to be less than 18 weeks. It is necessary to “outcome” every patient when they attend clinic appointments in order to facilitate monitoring of these processes. If patients on this pathway take longer than the predetermined trigger points, Trak will automatically flag them.
By creating these
trigger points, it is hoped that any problems can be identified at an early stage and not as the patient is about to breach their 18 week guarantee. Clinical outcomes are crucial to monitoring the patient’s journey on Trak.
In the endocrine clinic, an outcome sheet is attached to the front of all clinic notes. This should be completed to allow secretarial staff to update Trak. In the diabetes clinic, outcomes are completed automatically by reception staff as appointments are rebooked.
INFORMATION FOR SPR/ST TRAINEES During your time at RIE, you will be allocated a clinical/educational supervisor whom you should meet with at the start, end and midway point of your placement. You need to ensure that specialty clinics and general medicine blocks are arranged in good time. The Training Programme Director for diabetes and endocrinology is Dr Alan Patrick. The Assistant Training Programme Director is Dr Mark Strachan based at WGH and he organises trainee rotations.
There is a post-clinic discussion after all endocrine clinics. In diabetes clinics, you are encouraged to discuss any complex cases as you see them with the consultant in clinic. Cases can also be discussed at the Friday morning unit meeting.
7
Each week, there is a registrar on call for diabetes and endocrinology as indicated on the monthly rota. The registrar carries the pager (#6800) from 09.00-17.00 and takes call from GPs and other specialties within the hospital. Close liaison is advised with Janet Barclay, diabetes specialist nurse with a remit for in-patient liaison. Complex cases should be discussed with a consultant. Diabetes cases can be discussed at the Friday morning meeting while endocrine cases can be brought up at any of the postclinic discussions. If you are seeing any new referrals urgently within the department (eg newly diagnosed type 1 diabetes) please inform A&C staff so notes can be made up. You should also liaise with dietetic and specialist nursing staff as needed.
There is a separate out of hours cross-city on call rota currently coordinated by Dr Jo George (
[email protected]). Specialty on call cover runs from 5-8pm Mon-Fri and 9am – 5pm Saturday and Sunday, using the #6800 pager. While much of the specialty on call consists of phone advice, it is expected that you would attend to review patients in either hospital if needed, particularly any pregnant diabetic patients or any neurosurgical patients with endocrine issues. There is a consultant on-call rota so that specialist advice is always available to you. When handing over patient information, it is important that this is done in an appropriate manner, either in person, over the telephone or using a secure Email account. Whilst it is secure and permissible to send patient specific information between e-mail addresses within the NHS Lothian system or on nhs.net Emails, exchange of such information with an email address outwith this system is forbidden (including University of Edinburgh accounts) and monitoring systems are in place to pick up any security breaches. It is worth bearing this in mind if multiple handovers are anticipated outside of normal working hours eg if on call over Christmas is divided up between several registrars.
You will also be expected to contribute to Hospital At Night (HAN) on call. There is one pool of registrars to cover St John’s, Western General and Royal Infirmary of Edinburgh rotas, with shifts being allocated by Dr Tim Morse at WGH (
[email protected])
8
INFORMATION FOR GP PLACEMENTS (DIABETES) During your 3 month placement at RIE, you will do one clinic a week. This is usually the Friday morning clinic, alongside our 3 regular GP clinical assistants and 1-2 consultants. The Friday clinic is preceded by a unit meeting for case discussion from 8.30-9.15 and there is a further unit meeting at Friday lunchtime. Compared to other clinics, the Friday clinic has the most appropriate case mix for GPs. If Friday mornings do not fit in with your other commitments, arrangements can be made to attend a clinic on a different day. The clinic rota is coordinated by Dr Nicola Zammitt (
[email protected]) and she should be informed of any annual or study leave requirements with at least 6 weeks notice.
Arrangements will be made for you to sit in on at least one clinic before you start seeing your own patients. On this first visit, you should see Margaret Turnbull, head of A&C, to organize computer passwords. You should also ask the consultant you sit in with to show you how our diabetes IT system, SCI-DC, works.
Any other logistical issues, such as arranging reimbursements for locums to cover your work at your practice, are dealt with by Bonnie Crichton (Executive Assistant, Lothian diabetes network) at WGH (
[email protected]).
9
WESTERN GENERAL HOSPITAL (WGH) WHO’S WHO IN THE METABOLIC UNIT (MU) AT WGH Consultants – (D) = Diabetes (E) = Endocrinology Dr John A McKnight (D) Prof Paul Padfield (E) Dr Mark W J Strachan (D) + (E) Dr Rebecca Reynolds (D) + (E) Dr Peter Rae (D) Dr Roger W Brown (E) Dr Nicola Zammitt (D) Clinical Assistants Dr Colin Cackette Dr Gavin Boyd Dr Mike Cash Dr David Jolliffe MU Nursing Staff April Robertson (C/N) Helen Fraser (S/N) Anne Main (S/N) Rosie Sanderson (S/N) Lesley McCleod (S/N)
Diabetes Liaison Nurses Liz MacKay Jacqui Charlton Jill Little Lesley Barrow Susan Johnston Suzanne Dillon
Secretaries Cathy McDonald (JMK) June Tonks (RR) Helen Mitchell (RWB) Jan Martin (PLP, SRM, DJW) Pat Stewart (MWJS)
Clerical Officers Josie Stirling Fiona Gilchrist Gillian Mathieson Manjula Bhatnagar
Pharmacists Lubna Kerr Alison Cockburn Dietitian Sheena Douglas Podiatrists Lorna Jarrett Stephanie McGill
10
UNIT MEETINGS
Monday 4-5pm ECE meetings in the seminar room at the Metabolic Unit (MU) with video-link to RIE.
SpR/ST teaching (“morning prayers”) 08.30-9.15 Mon-Thurs, MU seminar room.
Tuesday 1-2pm journal club in the MU seminar room. Registrars and FY doctors take it in turns to present papers for discussion.
Wednesday 1-2pm hospital grand round 4th floor lecture theatre, Out-patient building.
Thursday 1-2pm: unit meeting MU seminar room. The on-call registrar for the week should present all of the pituitary in-patients for that week along with any other complex patients.
CLINICS The clinic rota is made up by Dr McKnight’s secretary, Cathy McDonald (
[email protected]) and she should be informed of any annual or study leave requirements with at least 6 weeks notice. The clinic timetable is given overleaf. Most of the clinics run weekly with the following exceptions: Neuro-endocrine oncology clinic: On Mondays every 2 months. Tues morning diabetes renal clinic and Dr Zammitt’s diabetes clinic: alternate weeks Tuesday morning MODY clinic every 2 months. Wednesday afternoon CF clinic every 3 months Diabetes young persons late clinic (15.45-18.00): 2nd Tues of each month Adolescent diabetes clinic: Every 6-8 weeks on a Friday afternoon Registrars will be allocated to clinics depending on their training needs and service requirements. This includes the subspecialty diabetes renal, adolescent diabetes and hypertension clinics, the neuro-endocrine oncology clinic and Dr Strachan’s thyroid nodule clinic at RIE. While registrars are at WGH, they should arrange to undertake reproductive
endocrinology
clinics
with
Prof
Richard
Anderson
(
[email protected]) and paediatric endocrinology clinics with Dr Louise Bath at the Royal Hospital for Sick Children (
[email protected]). As an optional extra, registrars can attend the CF clinic with Dr John McKnight (
[email protected]) and the MODY clinic with Dr Mark Strachan (
[email protected]). Attendance is for educational purposes and should be prearranged with the relevant consultant. 11
WGH WEEKLY DIABETES/ENDOCRINOLOGY TIMETABLE
AM 09.0012.30
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
ENDOCRINE NEW/RETURN PATIENTS Prof Padfield Dr Brown + 1 Registrar
DIABETES NEW/RETURN Dr Reynolds + 2 Registrars Dr Zammitt* (* every 2/52)
CARDIOVASCULAR RISK CLINIC Prof Padfield Dr Brown Prof Webb Prof Simon Maxwell +/- 1 Registrar
DIABETES NEW/RETURN Dr McKnight Dr Strachan + 2 Clinical Assistants + 1 Registrar
ENDO/ONCOLOGY JOINT CLINIC Dr Strachan/Dr Wall every 3 months
DIABETES/RENAL CLINIC *every 2/52 Dr King + 1Spr/Dr McKnight*
FRIDAY
PHARMACIST LED DIABETES CARDIOVASCULAR RISK CLINIC Lubna Kerr
MODY Dr Strachan – every 2months PHARMACIST LED DIABETES CARDIOVASCULAR RISK CLINIC Alison Cockburn
PM 13.3017.00
DIABETES NEW/RETURN Dr Nyirenda Dr Rae + 2 Registrars
ANTENATAL/DIABETES Dr Strachan 1330-1700** DIABETES RETURN Dr McKnight + 2 Clinical Assistants + 1 Registrar
DIABETES/CF CLINIC EVERY 2 MONTHS Dr McKnight
**1545-1800 2ND TUESDAY OF EACH MONTH
12
ENDOCRINE NEW/RETURN Prof Padfield Dr Strachan + 2 Registrars
ADOLESCENT DIABETES 1400-1700 EVERY 2 MONTHS (Check with secretary) Dr McKnight Dr Bath Prof Kelnar + 2 Registrars
CLINICAL OUTCOMING A patient’s journey can be broken down (in time) into a number of steps:
Referral received to triage
Triage to booking appointment
Time from booking appointment to actual attendance in OPD
Wait for diagnostics
Diagnostic to review appointment (to discuss results and plan treatment)
Review appointment to treatment (outpatient, inpatient or day case)
The sum total of all these steps needs to be less than 18 weeks. It is necessary to “outcome” every patient when they attend clinic appointments in order to facilitate monitoring of these processes. If patients on this pathway take longer than the predetermined trigger points, Trak will automatically flag them.
By creating these
trigger points, it is hoped that any problems can be identified at an early stage and not as the patient is about to breach their 18 week guarantee. Clinical outcomes are crucial to monitoring the patient’s journey on Trak.
In the endocrine clinic, an outcome sheet is attached to the front of all clinic notes. This should be completed to allow secretarial staff to update Trak. In the diabetes clinic, outcomes are completed automatically by reception staff as appointments are rebooked.
INFORMATION FOR SPR/ST TRAINEES During your time at WGH, you will be allocated a clinical/education supervisor whom you should meet with at the start, end and midway point of your placement. You need to ensure that specialty clinics and general medicine blocks are arranged in good time. The Training Programme Director for diabetes and endocrinology is Dr Alan Patrick based at RIE. The Assistant Training Programme Director is Dr Mark Strachan based at WGH and he organises trainee rotations.
There is a post-clinic
discussion after all clinics.
Each week, there is a registrar on call for diabetes and endocrinology and this is indicated on the monthly rota. The registrar carries the pager from 09.00-17.00 and takes call from GPs and other specialties within the hospital. Close liaison is advised 13
with Suzanne Dillon, diabetes specialist nurse with a remit for in-patient liaison. Complex cases, including all pituitary in-patients, should be discussed with a consultant and/or be brought to the Thursday unit meeting. Throughout the week, patients will be admitted to the day-bed area of the Metabolic Unit for dynamic endocrine tests. You may be asked by the nurses to administer some of the drugs required for these tests and determine when tests should be terminated eg water deprivation tests.
Please consult the metabolic unit protocols or discuss with a
consultant if in doubt about what to do.
There is a separate out of hours cross-city on call rota currently coordinated by Dr Jo George (
[email protected]). Specialty on call cover runs from 5-8pm Mon-Fri and 9am – 5pm Saturday and Sunday, using radiopager #6800. This pager is used from 9-5 for daytime on call at RIE so should not be switched on till 5pm. While much of the specialty on call consists of phone advice, it is expected that you would attend and review patients in either hospital if needed, particularly any pregnant diabetes patients or any neurosurgical patients with endocrine issues. There is a consultant specialty on call rota available via switchboard so that advice is always available to you. When handing over patient information, it is important that this is done in an appropriate manner, either in person, over the telephone or using a secure Email account.
Whilst it is secure and permissible to send patient specific
information between e-mail addresses within the NHS Lothian system or on nhs.net Emails, exchange of such information with an e-mail address outwith this system is forbidden (including University of Edinburgh accounts) and monitoring systems are in place to pick up any security breaches. It is worth bearing this in mind if multiple handovers are anticipated outside of normal working hours eg if on call over Christmas is divided up between several registrars.
You will also be expected to contribute to Hospital At Night (HAN) on call. There is one pool of registrars to cover St John’s, Western General and Royal Infirmary of Edinburgh rotas, with shifts being allocated by Dr Tim Morse at WGH (
[email protected])
14
INFORMATION FOR GP PLACEMENTS (DIABETES) During your 3 month placement at WGH, you will do one clinic a week on either a Tues or Thurs morning or a Wednesday afternoon. The day will be arranged to fit in with your practice commitments and should be negotiated with Cathy McDonald and Bonnie Crichton (details below). The clinic rota is made up by Dr McKnight’s secretary, Cathy McDonald (
[email protected]) and she should be informed of any annual or study leave requirements with at least 6 weeks notice.
Arrangements will be made for you to sit in on two clinics before you start seeing your own patients. On your first visit, you should see Cathy McDonald to organize computer passwords. You should also ask the consultant you sit in with to show you how our diabetes IT system, SCI-DC, works.
Any other logistical issues, such as arranging reimbursements for locums to cover your work at the practice, are dealt with by Bonnie Crichton at WGH (
[email protected]).
INFORMATION FOR FY2 DOCTORS During your placement at WGH, you will do a range of diabetes and endocrine clinics. Cathy McDonald will issue you with a SCI-DC password for WGH. Your annual leave requests should go to Kelly Black, Dr McKnight’s medical secretary. Although you will not be required to formally take the on-call bleep on a regular basis, it will be useful training to assist the on call registrar with in-patient reviews under supervision. You will be expected to contribute to the journal club rota and attend “morning prayers” with the registrars.
15
PROTOCOLS Endocrine Management protocols 001
Pituitary disorder management on neurosurgery wards
002
Guidelines for investigation of mineralocorticoid excess
003
Cushing’s syndrome
004
Von Hippel Lindau Syndrome screening protocol
005
MEN1 screening protocol
006
MEN2 screening protocol
007
British Thyroid Association guidelines on the management of thyroid cancer
008
Local protocol for management of thyroid nodules and thyroid cancer
009
Ablative radioiodine in thyroid cancer 2009
010
Radioactive iodine – inpatient leaflet
010a
Outpatient radioiodine guidance
011
Whole body scanning in thyroid cancer 2009
012
Outpatient radioiodine administration
013
Thyroid function testing in primary care pregnancy guidance
014
Thyroid function testing primary care guidance
015
Amiodarone induced thyroid dysfunction
016
European Guidelines on the mamangement of dysthyroid eye disease 2009
017
Dysthyroid eye disease – Sumary protocol TO 2009
018
Dysthyroid eye disease – Who to refer to ophthalmologists
019
Dysthyroid eye disease severity guide
020
Interferon and thyroid dysfunction
021
Hypercalcaemia
022
Hypocalcaemia
023
Investigation of suspected familial hypocalciuric hypocalcaemia
024
Osteoporosis
025
Glucocorticoid-induced osteoporosis
026
Growth hormone replacement therapy for adult hypopituitarism
027
Growth hormone shared care protocol for GPs
028
Adult Growth Hormone Deficiency Assessment AGHDA quality of life questionnaire
029
Follow-up for adults with Turner’s syndrome
030
Maple Syrup Urine Disease (MSUD) protocol Jan 2009
031
Management of Paget’s disease of bone
032
Criteria for surgery in asymptomatic primary hyperparathyroidism
033
Incidental adrenal mass – investigation and follow-up
034
Protocol for management of patients with carcinoid syndrome undergoing surgery or chemoembolisation
16
Cardiovascular risk clinic protocols 001
Secondary hypertension
002
Protocol for minoxidil therapy in resistant hypertension
Diabetes protocols 001
Management of pregnancy for diabetes inpatients RIE
002
Guide to diabetes antenatal care and clinics for SpRs
003
Management of diabetes on surgical wards
004
Integrated care pathway for the management of adult diabetes in the peri-operative period
005
Multidisciplinary care pathway for DKA
006
Management of diabetic ketoacidosis
007
Management of acute hypoglycaemia
008
Management of Diabetic Hyperosmolar Non-Ketotic syndrome – guidelines
009
Aetiology guidelines for diabetes in young adults
010
Diabetes liaison nurses (DSN) referral sheet (WGH)
011
Diabetes clinic new patient referral form (WGH)
012
Administrative procedure for urgent patients with diabetes (WGH)
013
Algorithm for suboptimal control of type 2 diabetes
Endocrine test protocols and patient information 001
Water deprivation test
002
Ammonium chloride test
003
Arginine infusion test protocol
004
Combined calcium and pentagastrin stimulation test
005
Insulin tolerance test (ITT)
006
Acromegaly glucose tolerance test
007
Glucagon test for Growth hormone
008
Corticoptrophin releasing hormone (CRH) test
009
Radioactive iodine treatment for overactive thyroid patient information sheet
010
Patient consent for radioactive iodine treatment
011
RIE patient information for radioactive iodine treatment
012
WGH patient information for radioactive iodine treatment
013
Investigation of spontaneous hypoglycaemia – 72 hour fast
014
Investigation of spontaneous hypoglycaemia – 20 hour fast
015
Calcium intake questionnaire
016
Oral glucose tolerance test (OGTT)
017
Subcutaneous octreotide protocol
018
Pregnancy testing in advance of radioiodine administration form
17
