The Consultant Microbiology Services to the Hywel Dda Health Board are provided by 4 consultants.
While I am sure we will continue to evolve, not least because the Health Board is evolving, we have developed a pattern of work, which is now reflected formally in our consultant job plans and we hope will ensure consultant availability for our healthcare colleagues.
The “On-Service” Consultant (First-on)
Our planned Consultant Microbiologists work is part of a 1 in 4 “on-service” rota, covering both in hours and out of hours. Currently, we have a consultant vacancy and therefore are working 1 in 3. Our pattern for clinical work however remains the same:
The week begins on Monday morning at 9.00am and runs through to the following Monday. On each Monday morning, between 9.00-10.00am, we hold a clinical handover meeting in Carmarthen for both acute clinical cases which we have been dealing with in the previous week and also any infection control issues. The meeting includes the Carmarthen based antimicrobial pharmacist and infection control team members, who provide a link with the other members of the extended team across the health board area.
This arrangement ensures that the new on-service consultant and other team members are aware of the various cases which are acutely being managed in association with the three laboratories and any more long term patients being carried forward from previous weeks. The out-going consultant will have covered any acute infection control events over the weekend and these are detailed in our discussions. The Carmarthen laboratory pa/clinical assistant uses this opportunity to begin the work of collecting new patients to be added to the weeks ward rounds on each acute hospital site.
In support of our management of cases, we also retain our own clinical notes which are available to us from previous contact with individual patients. In this regard, where we are asked for advice in relation to a longer term patient, we may ask you for contact details so that we can review previous results and notes by our colleagues to understand the microbiological thinking. These notes are available to view by all our BMS staff, our infection control staff and our antimicrobial pharmacists. Records of ward round notes are added by the laboratory pa/clinical assistants in Aberystwyth and Carmarthen.
We seek to operate via a ‘one stop shop’ approach with a single on-service office as the first point of contact. When on-service, we move to the on-service office, which is also staffed by Jane Regan our Laboratory Administrator for the Carmarthen laboratory who also acts as On-service Consultant Assistant. The direct line for this on-service office is ext: 2972. If dialling from outside the Hywel Dda telephone system, the direct telephone number is 01267 227972. For general enquiries, the laboratories in Aberystwyth, Carmarthen and Haverfordwest may be contacted as now and as described in the relevant laboratory user guides.
Each consultant also acts as the principal link to one of the 4 acute hospitals as detailed below in our individual profiles. Currently, with a vacant post, we do not have a named consultant for Glangwili General Hospital. We have opted to do this as the ‘one stop shop’ operates from this central location.
The on-service consultant may not be immediately available as we have increased our presence on the wards in response to specific issues. Jane will therefore ask some basic demographics on individual cases and an outline of the questions you are seeking to answer, which will allow her to trawl some initial information for us and get to the support you require more rapidly. We will seek to provide answers to “Frequently Asked Quesions” via this website and Jane may be able to point enquirers to an appropriate answer.
Each of us has duties as the second-on consultant. This is also undertaken on a 1:4 basis ordinarily but currently 1:3. This takes up every morning (5 sessions per week). The task here is to undertake the authorisation of those laboratory reports that are positive. We recognise the clinical importance of this task, providing interpretive comments to accompany the laboratory findings.
They do not take calls in this role as it is important that the bulk of the laboratory results are authorised and distributed in a timely fashion. By dedicating this time, all three labs will have the bulk of their reports due for authorisation that day distributed electronically to the wards and general practice. Paper reports are also printed for the wards.
Infection/Infection Control/Antibiotic Ward Rounds
Working with our Infection Control and Pharmaceutical colleagues, the other acute clinical work undertaken by us are the clinical rounds of all four acute hospitals. The named principle consultant will do the ward round in their hospital, unless on leave, when it will be covered by a different member of the clinical team (usually the second-on consultant.) The on-service consultant currently does the weekly round in Glangwili as well as their own hospital. We aim to undertake on the nominated day but sometimes have to swap days due to other commitments:
Tuesday – Withybush General Hospital – Dr Emrys Willims
Wednesday – Glangwili General Hospital – on-service consultant
Thursday – Bronglais General Hospital – Dr Mike Simmons
Thursday– Prince Philip Hospital – Dr Nikolaos Makrygiannis
We cannot guarantee absolutely the standard day fixtures because of any acute issues that arise. However, by aiming to set specific days, this allows the clinicians in each hospital to engage with us over particular clinical issues. While the aim will be to have a multi-disciplinary team of microbiologist, infection control nurse, and antibiotic pharmacist we recognise that this may not always be possible and on occasions one or other of the partners may substitute an alternate or be missing from the routine round.
Areas of Interest
When not on-service, each of the consultant microbiologists will be pursuing their other areas or responsibility either locally or nationally.
Dr Nikolaos Makrygiannis
Nikolaos is our newest member of the consultant body, joining the service in early 2015. Having been through a time of orientation having joined us from Greece with his family, he has taken on the task of understanding the increasingly complex field of orthopaedic joint infection. He has been set this task as a way of exploring further how we can support individual clinical disciplines.
Nikolaos is also the primary link Consultant Microbiologist to Prince Philip Hospital. In this role, as well as ward rounds, he supports educational and infection control initiatives.
Dr Emrys Williams
Emrys joined the services we provide to Hywel Dda in September 2014. Emrys has been a consultant with Public Health Wales for over 5 years and joined us from the north Wales service and has done a lot of work on antimicrobial stewardship. He leads this area from the microbiology perspective.
Emrys is the link consultant for Withybush General Hospital and lives in Saundersfoot for his family. In his role, he provides the principle link with Withybush Hospital for local group meetings, teaching and engagement activities.
Dr Harsha Perera
Harsha is our latest recruit to the service and joined us in June 2017. He fills a vacancy that has been present for the past 18 months, much to the relief of the other three consultants. Harsha has considerable experience in virology as well as microbiology and will be a welcome addition to our team.
Dr Mike Simmons
As service lead, I have local responsibility for the overall direction of clinical services we provide as well as providing management support to the Public Health Wales Microbiology Services.
Nationally, I lead the decontamination programme for Wales, which continues to provide advice on decontamination and sterilization to the NHS in Wales and the Welsh Government.
I provide the principal link consultant role to Bronglais General Hospital and will normally be on-site on Wednesdays and Fridays but other days by arrangement as necessary.
With four consultants now in post, we will be reviewing our areas of interest and specific responsibilities through a job planning process. We are always interested to hear from our service users, be they clinical, managerial or indeed our end users, the patients. While we rarely have direct contact with the patients we serve as our services are provided indirectly through the clinicians in direct contact, we do occasionally have opportunities to interact and these can prove very valuable. We are always interested in receiving feedback and to discuss development needs. To this end, we welcome feedback.
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