Mastering Intensive Care

Andrew Davies

This podcast is designed to inspire intensive care clinicians to become the very best they can be at delivering care to their critically ill patients.

Episodes

Mentioned books

Mar 8, 2018 • 1h 15min

27 - John Santamaria - Genuine care for patients both during and after the ICU stay

How well do you understand what happens to your patients after they leave the ICU? Do you find out how they go and feed this back to your ICU team? Most of you give excellent care to your patients whilst they are in the intensive care unit. No doubt this will be compassionate, appropriate, diligent, information-driven, holistic, team-based and communicative care. But when they leave the ICU, do you know what happens to them? Do you know if they actually leave the hospital? Do you know how they sleep, how long they remain confused for? What their final diagnosis on hospital discharge was? This is what A/Prof John Santamaria genuinely cares about. This is what he endeavours to find out. He is curious. John wants to know these things so he can better inform his patients before they leave the ICU and so he can keep his team up to date with what happened. Of course much of it is straightforward. The lady with pneumonia gradually got better and went home. The old man who had the laparotomy remained confused for 10 days, and then gradually became well enough to go off to rehabilitation. But sometimes there are surprises. The woman you thought had a simple urinary tract infection actually developed a secondary pneumonia in the ward and died after the treating team deemed another round of ICU to be inappropriate. The man with the acute pulmonary oedema who rapidly responded to CPAP but then developed a pulmonary embolism out on the ward. I know I could do better at understanding these things. It's not that I'm not curious, it's more that I get busy with the new patients, or the other jobs I have. Or recording the next podcast! I think after listening to this episode of Mastering Intensive Care with John Santamaria, you might think a bit about following up your ex-ICU patients more carefully. John is Director of Intensive Care at St Vincent's Hospital in Melbourne, Australia. He trained both at St Vincent's and Royal Melbourne Hospitals, in respiratory and intensive care medicine. After completing a doctorate of medicine on the control of breathing and postdoctoral studies in Vancouver, Canada, he returned to St Vincent's in 1985. John has been a past chair of the Victorian branch of ANZICS and President of ANZICS. He currently chairs the Victorian Intensive Care Data Review Committee. His interests include mechanical ventilation, performance monitoring, clinical outcomes and clinical informatics. John is the current longest-serving Director of Intensive Care in Melbourne and anyone who works at St Vincent's speaks so highly of his clinical care and his departmental leadership. He willingly let me interview him and we talked about a range of topics including: How he came to intensive care from respiratory medicine His appointment as ICU director at age 28 How some of his early career mentors influenced him The importance of close examination of patients How he balances teaching and clinical work on a ward round His perspectives on an electronic medical record and how the data from it can improve the quality of practice The need for intensivists to be open to suggestions from other team members The regular offer he makes to his nurses to call him when he is on call His take on end of life care and the family conversations involved How he collects data on his ICU's patients on a daily basis (now over 30,000 patients) The use of technology like list managers, automatic reminders and SMS notifications of abnormal results His love of exercise, particularly early in the morning John's advice on how to have a medical literature reading program Some thoughts about sleep, sleep deprivation and alerting medications And a few regrets he has... My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

Feb 22, 2018 • 1h 15min

26 - Peter Kruger - Does anecdotal experience help you provide better intensive care?

How do you balance the use of your clinical experience with the literature-based evidence? Are you a good enough listener? Is the clinical handover in your ICU the best it could be? I've been reflecting on these questions since I talked to A/Prof Peter Kruger for this week's Mastering Intensive Care podcast. Peter is Deputy Director of Intensive Care at the Princess Alexandra Hospital in Brisbane, Australia and an Associate Professor at both the University of Queensland and Monash University in Melbourne. He holds specialist qualifications in both Anaesthesia and Intensive Care and has experience in both laboratory and clinical research. He is the immediate past chair and a senior examiner for the first part examination of the College of Intensive Care Medicine of Australia and New Zealand and a primary examiner for the Australian and New Zealand College of Anaesthetists. He is a board member of the College of Intensive Care Medicine and of The Intensive Care Foundation. In addition to his clinical and teaching roles his active research interests include clinical trial design, utilising clinical information systems to facilitate research, weaning patients from mechanical ventilation and the management of severe sepsis. Peter is one of those doctors who mixes research, teaching and clinical care really well. So he is perfectly placed to speak on a bunch of topics in this episode, like: How the people and the variety keeps him coming back to work in the ICU Why he enjoys working in a "strong" ICU and what that means Some of the habits he noticed in his mentors The importance of not being in a rush when on clinical duties The varying style of his clinical ward rounds The value of making brief contact with families during bedside handovers What he talked about when he recently gave a presentation entitled "Does what I think I know matter anymore?" How anecdotal experience does impact on our clinical practice Following up those who survive as patients in the ICU (and their families too) can help prevent a series of future problems The value of eye contact, listening, deliberate use of words and pauses in good communication Peter's change in thinking about shift handover after reading a paper 10 years ago How talking to families is the highlight of his job The value he sees in sailing yachts to help mind, body and soul His thoughts on aging and working as an intensivist Some vital tips for the less experienced My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening on the journey towards mastering intensive care. Andrew Davies -------------------- Show notes (people, organisations, resources or links mentioned in the episode) MANIC Course: https://www.baxterprofessional.com.au/manic/ Princess Alexandra Hospital: https://metrosouth.health.qld.gov.au/princess-alexandra-hospital University of Queensland: https://www.uq.edu.au/ Monash University: https://www.monash.edu/ CICM: https://www.cicm.org.au/ ANZCA: http://www.anzca.edu.au/ Intensive Care Foundation: http://www.intensivecarefoundation.org.au/ ANZICS CTG: http://www.anzics.com.au/Pages/CTG/CTG-home.aspx ANZICS/ACCCN annual conference: http://intensivecareasm2017.com.au/ Journal article on "Patient Care, Square-Rigger Sailing, and Safety": https://www.ncbi.nlm.nih.gov/pubmed/18840843 Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/ Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

Feb 1, 2018 • 1h 22min

21 - Martin Bromiley - Turning tragedy into safer healthcare with attention to human factors (DasSMACC special episode)

Are we truly making healthcare safer? Do we adequately understand human factors in how we work in hospitals? How would you respond if your partner died from a "routine operation"? These are just 3 of the questions you are likely to ponder as you listen to this interview with Martin Bromiley OBE from the United Kingdom on the Mastering Intensive Care podcast. Whilst many people that we care for in our Intensive Care Units receive excellent care, sadly there are some who end up in our ICUs after something goes unexpectedly wrong during a routine operation. Tragically some of these people die. Not due to anything they did, but from medical error. In the final DasSMACC special episode, I speak to Martin Bromiley, who became a widower when his wife, Elaine, died in such circumstances 12 years ago. In what has been described as "the direct result of human factors and failings in non-technical skills, created by systemic failings in the healthcare system". Martin didn't blame, shame or complain. He did his best to move forward by researching the culture in healthcare around safety and human factors. And he recognised that although there were pockets of excellence the UK's National Health Service was culturally a long way behind most other high risk industries. As a result of his experiences Martin supported the making of a DVD entitled "Just a routine operation" which explored the lessons of his late wife's death, as well as a BBC Horizon programme about human factors called "How to avoid mistakes in surgery". Professionally Martin works in aviation where he is a pilot for a major UK airline and where he has a background specialising in human factors. Therefore, Martin founded the Clinical Human Factors Group, a non profit-making charitable trust which aims to advise and promote best practice around human factors. Since then the Group has promoted human factors at the highest levels in healthcare, making a significant contribution to current thinking. More significantly though, the terms human factors and system safety are becoming much more commonly understood in healthcare, much of which is due to Martin's efforts and leadership. His work has been recognised through awards from the Royal College of Anaesthetists, the Difficult Airway Society, and the patient support group "Action Against Medical Accidents". In the 2016 New Year Honours list Martin was awarded an OBE for his work to further patient safety. Martin was a speaker at the DasSMACC conference in Berlin back in June, and after delivering an enthralling talk entitled "How To Fail", we went to a quiet room to record an interview. We had an important conversation and touched on: The tragic case of Elaine and her death after a routine operation How Martin dealt with it What support Martin received in and out of the hospital What Martin has been doing to try to improve safety in healthcare What healthcare can and cannot learn from the aviation industry His 3 key messages about human factors How he uses mental rehearsal to be the best airline pilot he can be This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at andrew@masteringintensivecare.com. Please also consider making a donation to the Clinical Human Factors Group here. Thanks for listening. Please do the very best you can for your patients. Andrew Davies -------------------- Links related to Martin Bromiley Martin Bromiley Martin Bromiley on Twitter: @MartinBromiley Martin Bromiley on LinkedIn Clinical Human Factors Group Donations to Clinical Human Factors Group Video "Just a routine operation" Video "How to Fail…Part Two" (a talk by Martin Bromiley at DasSMACC conference) Video "Martin Bromiley, a Patient's Perspective" (talk by Martin Bromiley at Patient Safety Movement) Anonymous version of an Independent Report on the death of Elaine Bromiley Article "The husbands story: from tragedy to learning and action" (authored by Martin Bromiley) Article "Clinical Human Factors" (co-authored by Martin Bromiley) Article 1 on Martin Bromiley Article 2 on Martin Bromiley Article 3 on Martin Bromiley Article "Lessons from the Bromiley Case" (by Mike Cadogan on Life In The Fast Lane) Links to other resources (in order of mentioning) SMACC TED Book "Black Box Thinking" (by Matthew Syed) Paper on the Safety 1 and Safety 2 model Second paper on the Safety 1 and Safety 2 model Third article on the Safety 1 and Safety 2 model Jim Harlow on Twitter Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care page on Facebook Mastering Intensive Care at Life In The Fast Lane Andrew Davies on Twitter: @andrewdavies66 Andrew Davies on Instagram: @andrewdavies66 Andrew Davies on LinkedIn Email Andrew Davies

Nov 10, 2017 • 1h 9min

20 - Jack Iwashyna - ICU adventure camp, time-limited life support trials and regular talks with families (DasSMACC special episode)

Do you play the role of the exemplary leader in the ICU? Are you charming, funny, friendly and extroverted – even when these aren't your natural personality characteristics? Do you throw yourself into your series of consecutive days in the ICU like you are going away to adventure camp? Do you outline specific objectives that a patient should meet over a timeframe of a few days to decide whether treatment should continue? And how regularly do you talk to your patient's family when you are pretty sure the patient is dying? These are some of the questions you may ask yourself after listening to this episode of the Mastering Intensive Care podcast with American intensivist Jack Iwashyna. This is the fifth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Jack is Associate Professor of Pulmonary and Critical Care Medicine at the University of Michigan where he is a practicing medical intensivist at both the University of Michigan and the VA Ann Arbor Health System. He also devotes significant energy to training clinician scientists and is best known for his work defining the concept of "survivorship" after ICU and measuring aspects of the post-intensive care syndrome. Jack's keynote talk at DasSMACC was entitled "Persistent Critical Illness" and as you'll hear in this podcast he is the perfect person to talk about this given he does 14 day blocks in his ICU allowing him ample opportunity to understand what happens in the evolution of a patient's critical illness. Despite Jack self-proclaiming he is introverted, this episode of the podcast reveals him to be a diverse conversationalist with well-matured thoughts, views and reflections on his own experience about how a consultant intensivist should act, whether that be in throwing ourselves 100% into our clinical service, playing a specifically crafted leader's role, wisely mentoring less experienced clinicians, regularly communicating to patient's families, simply having fun doing our job with our colleagues and respecting our spouses and families for supporting the work that we do. We cover a myriad of topics including: Jack's powerful answer as to why he loves his job How invigorating it can be to talk to people he has only just met How he has previously done 30 day stretches of continual clinical service As a researcher he tries not to study his own ICUs too closely Our fixation on short-term survival is inadequate for most patient families His use and the benefits of time-limited trials of life support How he uses a school-like A-F range grading to mark patient's progress The benefits of taking his children away on academic trips His somewhat raw reflections about not feeling as good a father and husband as he is a doctor The difference between mentoring in research and in clinical practice Our role is to try to help all trainees to improve, however good we perceive them to be Burnout is a systems issue – where the system is being run too hard The importance of sleep and afternoon naps This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast. Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies Show notes (people, organisations, resources or links mentioned in the episode): Jack Iwashyna at University of Michigan: http://ihpi.umich.edu/our-experts/tiwashyn Jack Iwashyna on Twitter: @iwashyna DasSMACC: www.smacc.net.au

Oct 26, 2017 • 1h 5min

19 - Alex Psirides - Doing everything at the end of life (DasSMACC special episode)

Are you receiving elderly intubated patients where someone else says they want "everything" done? Are the doctors who refer patients to intensive care finding out what their patients really want towards the end of life? Does this frustrate you on a daily basis? This is a huge topic in intensive care. Finding out the wishes of our patients before they end up on a ventilator with no one to speak for them is vital if we wish to deliver optimal healthcare. Yet so often we intensivists are left to deal with this situation. And whilst in most cases we do this very well, many of us like Dr Alex Psirides, a UK, New Zealand and Australian-trained intensivist, feel the despair as we hold another lengthy meeting with a patient's family. In this episode I spoke with Alex about this topic, which he had just delivered a brilliant TED-like talk on at the DasSMACC international conference in June. Alex has a great perspective to share as two of his specific clinical interests are managing dying patients and rapid response systems for deteriorating patients. This is the fourth in a series of DasSMACC special episodes, where I interviewed speakers from the recent DasSMACC conference held in Berlin. Alex is an Intensive Care specialist at Wellington Regional Hospital in Wellington, New Zealand. His work and research in the area of rapid response systems has led to an appointment as the clinical lead for the New Zealand Health Quality & Safety Commission's 5-year national 'Deteriorating Patient' programme. He is also the clinical lead for Wellington's aeromedical retrieval service, which covers the lower North and upper South Islands of New Zealand. In his spare time, when not walking his dog or children, he builds websites & designs logos for Wellington ICU's prodigious research department, as well as sending a few tweets via Twitter handle @psirides. Given Alex has been an ICU consultant for less time than most of my other guests, I had to talk him into doing an interview, but I'm really glad he agreed. There is so much to like about this conversation. Alex is honest and humble enough to say he's not so sure he's that good at predicting patient outcomes, at least in neurosurgical patients, which is the precise reason he has something to teach us on the podcast. We also cover topics including: Why Alex loves intensive care (with a great answer) How his consultant team work so cohesively The need to respect co-worker's opinions and to avoid tribalism How a team of intensivists meeting with a team of neurosurgeons away from the patients can make practice more consistent and evidence-based How his team uses simulation to reduce rudeness and lack of respect How efficiently his hospital ran when there was a 3 day doctors strike A good ward round requires asking for and addressing the nurse's concerns but also finishes with a clear plan to move the patient forwards Bringing his best self to work requires feeling loved at home and having a great team to work with Some of the non-textbook medical books Alex has been enjoying reading Hobbies allow him to escape from work and to use his creativity How far away he feels right now from burnout What he can get better at over the next 5 years How palliative care physicians can be helpful in teaching us and our trainees about end of life discussions This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues or posting on social media. Feel free to leave a comment or a question. I hope we can build community through Mastering Intensive Care so colleagues can share their thoughts and tell us how they are mastering their own skills. Leave a comment on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at andrew@masteringintensivecare.com. Thanks for listening. Please do the very best you can for your patients. Andrew Davies Show notes (people, organisations, resources or links mentioned in the episode): Wellington Intensive Care medical team: http://www.wellingtonicu.com/AboutUs/Staff/SMO/ DasSMACC: www.smacc.net.au Alex Psirides talk on "Doing everything at end of life": http://wellingtonicu.com/Data/Doing%20Everything%20DasSMACC.pdf Book "Being Mortal" by Atul Gawande: http://atulgawande.com/book/being-mortal/ Book "Do No Harm" by Henry Marsh: https://henrymarshdonoharm.wordpress.com/reviews/ Alex Psirides on Twitter: @psirides

Oct 11, 2017 • 1h 8min

18 - John Marshall - Getting patients out of the ICU as soon as we can

Are your ICU patients ever in a holding pattern? Do you aim to liberate your patients from ICU as soon as possible? Is your caution about moving things forward harmful to our patients? I don't think we talk often enough about the dangers of conservatism in intensive care. About how if we are cautious in thinking the patient is not quite ready to be extubated, or have the sedation turned off, or stop the antibiotics, then we sometimes don't realize the harm our inaction may cause. A topic you will enjoy hearing about in this interview with Professor John Marshall on the Mastering Intensive Care podcast. John is a Professor of Surgery at the University of Toronto, and a trauma surgeon and intensivist at St. Michael's Hospital in Toronto, Canada. John has an active clinical research interest in sepsis and ICU-acquired infection, and in the design of clinical trials and outcome measures. He has published more than 325 manuscripts, and 85 book chapters, and is the editor of 2 books. He is the founding chair of the International Forum of Acute Care Trialists (InFACT) – a global network of investigator-led critical care clinical research groups, he is Secretary-General of the World Federation of Societies of Intensive and Critical Care Medicine, and vice-chair of the International Severe Acute Respiratory and Emerging Infections Consortium. He is also past-chair of the International Sepsis Forum, past-President of the Surgical Infection Society, and past-chair of the Canadian Critical Care Trials Group. He has given invited lectures at more than 470 meetings around the world, is a member of seven journal editorial boards, and an Associate Editor of Critical Care Medicine and Critical Care. In this conversation we also cover topics including: Being both a surgeon and an intensivist – and why ICU might be more fun Humility and curiosity as the two most important habits for intensivists That surgeons seem to own their complications more than intensivists The benefits of family member presence on the ICU ward round Why we should question everything we do in a provocative dialogue How research helps us at the bedside The value of collaborative research networks The observations that some ICUs can feel joyless Withdrawing interventions may not always lead to death The time when John was involved in a 4 hour CPR If we can't define what an intervention can or cannot do, perhaps we shouldn't do it The privilege John feelsto be able to make mistakes that might cost people their lives His artistic pursuits outside of medicine (including the story of a rock band) The constant feeling of rejection in academia The skills required to give a good talk How developing academic capital might be the best way to get a job With this podcast please help me in my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. It would be much appreciated if you could help to spread the word by simply emailing your colleagues or posting on social media. If you have a comment or a question, let's engage. Whilst my primary goal is to improve patient outcomes by helping us all get better thanks to the inspiring messages of my guests, I also have the goal of building community through Mastering Intensive Care, so people can share their thoughts and their own skills. So leave a comment (on the LITFL episode page or on twitter using #masteringintensivecare), send me an email at andrew@masteringintensivecare.com or engage in the facebook page Mastering Intensive Care. Thanks for listening. Please go out and do the best you can for your patients. Andrew Davies

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