5. The original pioneer
* The ICS will not provide complimentary drinks for a correct answer
6. Nurse Nightingale
Crimean War 1853.
Set up Monitoring Unit for Critically Unwell.
Mortality fell from 40% to 2% with simple measures
Believed deaths due to poor nutrition, poor hygiene,
overworked staff & soldiers
Collected evidence to present to Army
7. Q: What can ICU do without?
Answer = the three “failures”……..
Information technology failures
Communication failures
Un-evidenced practice
9. Information technology failure
C
U
Advantages Disadvantages / challenges
Accuracy & legibility Cost
Reduced clinical error Infrastructural
MDT communication Medico-legal data collection issues
Clinical detail Clinician skepticism
Data collection
10. IT failure and Critical Care today
C
U
Busier units
Patients suffer greater morbidity and healthcare burden
Aim is time & clinical efficiency – got to work but must be
simple
Fear of medico-legal data collection issues
The future of healthcare certainly involves technology with
integrated patient management system
11. I
Communication failures
U
Discussion – action or process of talking about something
in order to reach a decision or exchange ideas
“Discussion is always better than argument. Argue to find
out who is right. Discuss to find out what is right.”
12. I
Communication failures
U
GMC “duties of a doctor”
85% industry errors due to communication failures
Why do people sue doctors? Lancet (1994)
• Clinical pathology management
• Insensitivity and communication
<15% explanations were “satisfactory”
13. I
Communication: intra and inter
U
“Single unit mentality”
Increasingly linked
Major Trauma Centre and Units
Paediatric, Vascular, CardioThoracic, Neuro
17. Learn from the past – simple
strategies are often effective
18. So what can we do about
it?
Start simples & do what Nurse Nightingale
did…..
I Embrace new technology (honestly)
C Talk to people & work as a team
U use evidence & get involved in producing
more evidence to improve quality patient care
19. So what can we do about
it?…. And do without superbugs, , negative media, ignorant
managers and bad coffee also!
20. Thank you for listening
References
Vincent C, Young M, Phillips A. Why do people sue doctors? A study of
patients and relatives taking legal action. Lancet 1994; 343: 1609 – 13
Duties of a doctor. General Medical Council. 2013
Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C.
Improving communication in the ICU using daily goals. J Crit Care 2003;
18: 71–5
Journal impact factors from ISI web of knowledge. 2010.
Information technology in Anaesthesia & Critical Care. Contin Educ
Anaesth Crit Care Pain (2011) 11 (3): 104-107. doi:
10.1093/bjaceaccp/mkr004. First published online: April 28, 2011
Communication skills in critical care. Contin Educ Anaesth Crit Care Pain
(2008) 8 (4): 121-124. doi: 10.1093/bjaceaccp/mkn024
Editor's Notes
Florence Nightingale. Crimean War 1853. She set up Monitoring Unit for Critically Unwell. Mortality fell from 40% to 2% with SIMPLE measures
Believed deaths due to poor nutrition, poor hygiene, overworked staff & soldiers (Mr Jeremy Hunt please pay attention).
Collected evidence to present to Army
(Mr J Hunt please pay attention).
We always are interested in avoiding failures of organs…..maybe we also need to turn our attention to avoiding the failures of “ICU”
Behavioural & human factors
Network down”, “battery failure”, “access denied”
UK slow on IT introduction
Drug development and latest equipment often take centre stage in an ICU. Non technical skills are often relatively neglected.
Critically important on a daily basis. Advanced skills required to partake/lead meetings with family, manage clinical challenges and crises, and information share with colleagues within the MDT.
