ICU Management & Practice, Volume 18 - Issue 2, 2018

Highlights from the I-I-I Blog

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Rana Awdish

Director of the Pulmonary Hypertension
Program, Henry Ford Hospital; Medical
Director of Care Experience, Henry Ford
Health System; Faculty member, Wayne
State University School of Medicine, Detroit,
USA; Author of In Shock

Changing the culture of medicine -

one conversation at a time

“As a physician in my own institution I was, at least in theory, an empowered minority. I had a voice, some measure of authority and personal agency. Yet, as a patient, I didn’t feel at all empowered to be vocal about my needs or fears. I thought about how voiceless you become in many ways just through illness. And, perhaps more importantly, I realised that, if I felt that way, then the experience was far more common than Ihad understood it to be. Once I framed it that way for myself, I felt a responsibility to admit the ways in which my own system had in many ways failed me because, if it was failing me, then it was bound to be failing others.”
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Sarah Wickenden

CT3 Anaesthetics - Royal
United Hospital, Bath, UK

Tea trolley teaching: the what, why and benefits

“'Bath tea trolley training' is a novel method of training that we have developed in Bath, UK over the past 3 years, and which we have used extremely successfully to provide multidisciplinary training in the workplace in our intensive care unit (ICU). It involves loading up a trolley with educational material on the top, and a pot of tea on the bottom: this trolley then travels around the ICU, with 1-2 trainers, providing 5-10 minute teaching sessions to ICU staff in their workplace during their usual working day (or even night shift!), followed by a cup of tea!”
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Bruno Tomazini

Attending Physician, Intensive Care Unit - Sirio Libanês Hospital and Hospital das Clinicas da Universidade de São Paulo, Brazil

Time goes by and antibiotics linger on

“Antibiotics don’t replace good doctors. Indiscriminate antibiotic use is a reckless attitude that not only dramatically increases healthcare costs, but also puts our patients' lives in danger. This is not an “I’ll deal with it tomorrow” or “what difference one more day will do” type of thing. We already missed the bus.

“We can rely on evidence-based knowledge and
self-discipline all doctors have, and with a pinch of
goodwill and time, things will settle. Of course, this is a lie. Changes like this only come from the top down. Butthere is a light at the end of a vancomycin bottle. Antibiotic Stewardship Programmes might be the answer we were looking for.”
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Christine Schulman

Critical Care Clinical Nurse Specialist -
Legacy Health, Portland, Oregon, USA;
President, American Association of Critical-
Care Nurses Board of Directors (2017-2018)

If you had a magic wand, what is one thing you would change about healthcare and why?

“The one thing I would change to improve our healthcare system won’t take magic—it’s achievable today. I would empower all direct care nurses as bedside leaders, innovators and catalysts for change. Why? Because empowering our clinicians at the front line of care results in better patient outcomes, satisfaction and cost containment—all key ingredients to thriving in these uncertain times for healthcare.”

“Imagine decreasing infections, delirium and other adverse events, and shortening patient lengths of stay and ventilator days, just by having the care providers closest to the patient devise solutions. I don’t have to
imagine it—I’ve seen it and know it works.”
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Jan Bakker

Professor, Columbia University; New York
University, USA; Erasmus MC, Erasmus
University, Rotterdam, The Netherlands

Burn till you're out

“In a point prevalence survey study in 2013 (46% response rate), we found a very low rate of burnout
(4.4%) in Dutch intensivists, where their medical
directors reported an incidence of 7.4% in that year.

These numbers are strikingly different from any other study in critical care, even when corrected for differences in scoring methods. What could be the key differences between the ICU care in the Netherlands and the U.S. that make up for this difference? In my perception, the significant organisational differences in the critical care systems, the differences in the judicial systems and the culture of claims between the U.S. and the Netherlands make up, for a large part, for the major difference in burnout between the systems. Current organisation of critical care in the U.S. drains the fuel of nurses, doctors, residents and fellows. Changing the organisation of care and improving the integration of hospital management in the process of care are key to solving a problem that endangers patients, doctors, nurses, residents and fellows alike.”
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Arun Radhakrishnan

Latrobe Regional Hospital,
Traralgon, Australia

What does it mean to be an intensivist? A philosophical view of intensive care

“Intensive care is about saving lives and should also be about saving quality of life—they must necessarily be mentioned in the same breath. What we do must be beneficial to the patient—in other words, it is wise to question interventions that are offered or performed in  the absence of a clear benefit to the patient, and also to society.

“It is, most importantly, making the patients feel they are being treated as human beings at all stages of their illness, including during the dying process. “
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Eoin Kelleher

Specialist Anaesthesia Trainee 2, Connolly Hospital, Dublin, Ireland

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