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The Intensivist: August 2018

August 31, 2018
 

 

 

 

 

 

CHOOSING WISELY AUSTRALIA

DR MATTHEW ANSTEY

 

Intensive Care Specialist, Sir Charles Gairdner Hospital
Chair, Choosing Wisely Australia Advisory Group

 

 

 

Choosing Wisely started as part of a professionalism statement from the American Board of Internal Medicine, pointing out that that appropriate resource allocation was a professional and ethical responsibility of physicians. Choosing Wisely has since spread worldwide, and Australia is one of more than 20 participating countries. It has become a worldwide movement, seeking to identify areas of waste or unnecessary treatments which may be associated with evidence of harm or simply confer no benefit, and start conversations between clinicians and with patients about these low value areas.

In 2016, in a collaborative effort, and as member organisations of Choosing Wisely Australia, ANZICS and CICM jointly produced their list of 5 tests, treatments and procedures that clinicians and consumers should question. The 5 items include:

  1. Have goals of care discussions with patients who are at high risk of death or severely impaired functional recovery,
  2. Remove invasive devices as soon as possible,
  3. Only transfuse if the haemoglobin concentration is < 70g/L or the patient is unstable,
  4. Have daily attempts to lighten sedation,
  5. Consider antibiotic de-escalation daily


These items are a good starting point, but the benefits of Choosing Wisely comes not from the production of the lists themselves but moving to the next step and measuring the prevalence of these low value and changing behaviour where necessary. This has been most marked through the Choosing Wisely Australia Champion Sites – 18 health services that have committed to measuring and improving practice on Choosing Wisely items. In Victoria, 10 health services have just received funding from Better Care Victoria to start working on Choosing Wisely projects, and Western Australia and Queensland also have multiple hospitals involved. From the Intensive Care point of view, there are increasing numbers of hospitals working on projects, with some examples in Table 1.

Site Item
Sir Charles Gairdner Hospital
  • Coagulation testing
  • Appropriate cessation of Stress ulcer prophylaxis
Rockingham Hospital
  • Coagulation testing
Nepean Hospital and NSW Clinical Best Practice Working Group
  • Arterial blood gas ordering
Prince of Wales
Hospital
  • Sensible Test Ordering Project (STOP) reducing routine blood tests (ABG, coags, LFTs)
Gold Coast Hospital
  • Pathology testing (ABG, coagulation, blood cultures)
Eastern Health
  • Reduction in daily CXRs

* Contacts for site coordinators available on request

For the sites participating in these projects, they have found that while the intensive care medicine literature has well described “bundles of care” and guidelines, compliance with these is not always optimal. Sites have used varying ways of measuring practice, from sophisticated integration of digital medical records, through to resident led manual chart audit.

Moving forward, we hope to create a network of interested clinicians and sites to undertake further Choosing Wisely projects. We are not limited by the items described in the lists, and there are other items described elsewhere. For example, the American societies have two additional items “Do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay” and “Do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions”. By reflecting on our practices and looking for areas of variation and potential improvement we may identify opportunities to improve patient care and conserve resources. We plan to undertake a step-wedge cluster randomised trial, looking to introduce a behaviour change intervention to improve one Choosing Wisely item across a number of Australian and New Zealand Intensive Care Units.

If you are interested in participating, please contact matthew.anstey@health.wa.gov.au

 

 

 

NEW ANZICS WEBSITE

 

 

 

ANZICS is pleased to announce the launch of our new website. Following our recent ANZICS brand refresh, the Society is implementing changes to the way it communicates with our members. As with any project of this scale, the next few days will see the ANZICS office uploading gaps in content to the new site and refining usability for members.

Visit the new website via this link.

With the launch of our new website, the focus will move to the creation of an ANZICS mobile app. It is anticipated that this app will allow members to harness the intensive care community via access to communication forums. Access to simplified content featured on the website will also be available via this app.

Should you have any suggestions for our new website or our proposed mobile app, please contact us via email.

 

 

 

 

Each year ANZICS holds the Intensive Care Global Rising Star Program supported by Pfizer since the inception of the program. The iniative aims to encourage and support innovative and productive early to mid-career clinician/scientists from 3 international regions.

Past recipients of the Fellowships have rapidly become international key opinion leaders in their respective areas e.g. Danny McAuley (Belfast, 2013, ARDS), Christopher Seymour (Pittsburgh, 2013, Sepsis), Kenneth Baillie (Edinburgh, 2013, Viral Pneumonia), Sean Bagshaw (Edmonton, 2014, Acute Kidney Failure), Hallie Prescott (Michigan, 2015, Health Services Research), Joost Wiersinga (Amsterdam, 2015, Infectious Diseases), Hayley Gershengorn (New York, 2016 Health Services Research), Alexander Vlaar (Amsterdam, 2016, Haematology), Rashan Haniffa (Colombo, 2016, Critical Care in Developing Countries), Dr Nathan Brummel (Nashville, 2017, Long-term outcomes), Dr Takeshi Yoshida (Japan, 2017, Ventilation) and Dr Manu Shankar-Hari (London, 2017, Sepsis).Following on from the oustanding presenters from the Gold Coast in 2017, we are pleased to announce the 2018 Rising Stars:

 

 

DR LAUREN FERRANTE
YALE SCHOOL OF MEDICINE (USA)

Dr. Ferrante is an Assistant Professor of Medicine in the Section of Pulmonary, Critical Care, and Sleep Medicine at the Yale School of Medicine in New Haven, CT, USA.  Her research program is centered at the interface of critical care medicine and geriatrics, with the overarching goal of understanding and improving the functional outcomes of critically ill older adults.  She is supported by the National Institutes of Health (NIH) and in 2017 was awarded a Paul B. Beeson Emerging Leaders in Aging Career Development Award.  Her work has been recognized with an AGS/Merck New Investigator Award (2016), the Yale School of Medicine Iva Dostanic Physician-Scientist Award (2016), and an ANZICS Intensive Care Global Rising Star Fellowship (2018).  Dr. Ferrante also co-chairs the Aging in Critical Care Interest Group of the American Thoracic Society (ATS) and the Medical Subspecialties Section of the American Geriatrics Society (AGS).

Dr. Ferrante trained in internal medicine at New York Presbyterian Hospital-Columbia University Medical Center before moving to Yale for postdoctoral fellowship.  At Yale, she concurrently completed a clinical fellowship in Pulmonary & Critical Care Medicine, a research fellowship in Geriatric Clinical Epidemiology, and a Masters of Health Science degree before joining the Yale faculty in 2015.

 

DR JAN HAU LEE
KK WOMEN’S AND CHILDREN’S HOSPITAL (SINGAPORE)

Dr. Jan Hau LEE is a Senior Consultant at the Children’s Intensive Care Unit at KK Women’s and Children’s Hospital, Singapore. He holds the academic rank of Assistant Professor at Duke-NUS Medical School, Singapore. After completing his undergraduate and postgraduate training in Singapore, he completed his advanced fellowship in pediatric critical care at Duke Children’s Hospital, Durham, United States.
Dr. Lee’s clinical and research interest focus on:
1.    Pediatric acute respiratory distress syndrome
2.    Pediatric critical care epidemiology
3.    Pediatric critical care nutrition
DR ANDREW CONWAY-MORRIS
UNIVERSITY OF CAMBRIDGE

Dr Conway Morris undertook undergraduate training in Glasgow, UK before moving to Edinburgh to start his training in Anaesthesia and Intensive Care.  Whilst in Edinburgh he developed an interest in ICU-acquired infections and studied for a PhD in critical care immunology and its impact on nosocomial infections supervised by Professors John Simpson and Timothy Walsh.  He moved to Cambridge to complete his post-graduate training in Anaesthesia and ICM and to undertake post-doctoral research with Professor Edwin Chilvers.  His work continues to focus on immune failure in critical illness and nosocomial infection.

He published the first study identifying C5a as a key mediator of neutrophil dysfunction in critical illness.  This has led to subsequent work developing clinically useable markers for immune dysfunction, a clinical trial of immunomodulatory therapy and exploration of the intracellular signalling pathways which underpin these effects.  He has also developed a number of diagnostics for nosocomial infection, including the host response test recently evaluated in the VAP-RAPID trial, and several pathogen-focussed molecular diagnostic platforms.  He is currently a Wellcome Trust Clinical Research Career Development fellow at the University of Cambridge and Consultant in Intensive Care Medicine in the John V Farman Intensive Care Unit, Addenbrooke’s Hospital, Cambridge, UK.  He is the incoming Deputy Chair of the European Society of Intensive Care Medicine’s Infection section.

 

2017 GLOBAL RISING STAR PRESENTATIONS

 

 

DR MANU SHANKAR-HARI  Kings College (United Kingdom) B Cells, Free Light Chains and Immunoglobin Biology in Sepsis to Inform Trial Design
DR NATHAN BRUMMEL Vanderbilt University (USA) Toward a Better Understanding of the Disabilities After Critical Illness
DR TAKESHI YOSHIDA (Japan)  High PEEP Renders Spontaneous Effort Non Injurious 
 

SAFETY & QUALITY CONFERENCE HIGHLIGHTS

 

 

 

The 2018 ANZICS Safety and Quality Conference took place on July 30 – 31 2018 at the Sofitel Melbourne on Collins.

340 delegates heard inspiring and thought-provoking presentations from nearly 60 medical, nursing and allied health invited speakers. There were also 18 oral and 38 poster presentations from researchers presenting the latest in research and quality improvement projects being undertaken around Australia, New Zealand, Singapore and Qatar.

Thank you to our internationally recognised key note speakers who donated their time, talent and expertise to present at this event. Professor Rinaldo Bellomo, Dr Tony Burrell, Dr Graeme Duke, Professor Simon Finfer, Dr John Gowardman, Mr Malcolm Green, Associate Professor Nerina Harley, Professor Imogen Mitchell, Dr Chris Nickson, Professor Yahya Shehabi, Professor Karin Thursky and Professor Andrew Udy,

It is well recognised that the Australian and New Zealand region has mature Rapid Response Systems, however much work is still being undertaken to optimise the function of the RRS. Delegates heard from leaders in the field of Rapid response systems on measures to reduce afferent limb failure, RRS in the paediatric setting and improving governance.

This year the Organising Committee included more general safety and quality in the ICU, including presentations on strategies to successfully build safety and quality into routine care and the daily ward round, communication, burnout and training for stress, end-of-life care, delirium and sepsis.

Presentations from government representatives and the VMIA, highlighted the work being undertaken to lead the safety and quality agenda, including the Rapid Diagnosis Discussion (RaDD) tool; updates from ACSQHC, including the new NSQHC Comprehensive Care Standard and Standard 8; The Think Sepsis. Act Fast program and using data to audit a state health system.

Doug Wright from willnevergiveup.com shared his inspiring personal story of his journey through the health system following a head on collision in regional Queensland. His presentation highlighted the importance of communication especially with relatives following traumatic incidents.

This year’s event would not have been the success it was without the support of our industry partners, our gold sponsor Masimo; Philips who provided an informative breakfast forum on methods of innovative approaches to earlier detect patients at risk of deterioration and preventing ‘alarm fatigue’; CSL Behring for sponsoring the program handbook and our exhibitors Medtronic and Zoll In keeping with our presentations on preventing burnout and stress delegates were able to enjoy an early morning yogalates session with Lululemon instructor Victoria Brockfield www.holistichq.com.au

And, a special thankyou to the Organising Committee and Conference Convenor, A/Prof Daryl Jones who generously devoted so much time to ensuring the meeting was a success. Finally, as in past years many of the presentations will be uploaded in due course to the ANZICS YouTube Channel https://www.youtube.com/channel/UCVU_LWubvrXrNklrEHcv7jA

 

 

 

Multi-Year Strategic Plan Update

 

 

 

Over the past several months, the Board and staff of ANZICS have progressed the development of a multi-year strategic plan for the society with an ultimate vision of ‘Connecting the Intensive Care Community’. This is an update from our previous vision ‘Advocate for Intensive Care’.

The recent strategic goals have been developed for the next three years, which include:

 

 

 

Specific initiatives to support the delivery of each of these goals are well underway.  We are striving to be the most inclusive society in all the ways we progress the delivery of our strategic goals, so we welcome and encourage your feedback.

We will be delivering our organisational goals with the following values underpinning all of our activities:

INTEGRITY – We are professional in all of our activities and we do what we say we do.

RESPECT – We treat people with fairness, objectivity and courtesy.

INCLUSIVE – We consider and support our members and those involved in the wider intensive care community.

COLLABORATIVE – We promote and foster opportunities and partnerships between members, stakeholders and the community.

EXCELLENCE – We collaborate to deliver high achieving outcomes through our programs internationally.

INNOVATIVE – We are flexible, creative and at the forefront of improving intensive care practices

Please do not hesitate to contact us to share any ideas that you feel will positively contribute to the delivery of our strategic goals.

 

 

 

ANZICS Critical Care Datathon Updates

 

 

 

ANZICS hosted the 2018 Critical Care Datathon at the University of Sydney in April. The successful event bought together over 90 participants ranging from senior clinicians, trainee clinicians, data scientists, statisticians and health professionals to explore large critical care datasets and discover new knowledge.

Sixteen teams had access to de-identified datasets. Over two days teams collaborated, extracted data, analysed and presented their research findings. The dedication and commitment of the attendees showed as the final presentations were of high standard and created discussion amongst the critical care community. The NSW Minister for Health who took time to meet with each team and discuss their research.

ANZICS is pleased to support the Datathon teams who are continuing their research projects, with the hope to see publications in the future. We would like to take the opportunity to thank the following; Philips, NSW Government, Agency for Clinical Innovation, University of Sydney, College of Intensive Care Medicine, Google Cloud, MIT Critical Data and Alfred Health.

Planning has already begun for the 2019 ANZICS Critical Care Datathon – watch this space for more news.For Victorians the Bendigo Datathon is happening on the 8th &  9th September. The focus of this datathon is across the continuum of care with broad linkage across many data sets, ANZICS is contributing data related to ICU for this event.

 

 

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SUBMITTING ARTICLES

Please contact the ANZICS Office if you would like to submit an article for a future version of The Intensivist.

Phone: +61 3 9340 3400
Email: anzics@anzics.com.au

 

 

 

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