Owen Roodenburg discusses how the Alfred Hospital educates and supports JMOs to run MET calls. Presented at the ANZICS S&Q Conference 2014 on Rapid Response Teams.

1. The Alfred Intensive Care Unit, Melbourne, Australia
Educating and supporting
JMOs
Owen Roodenburg

2. The PATIENT

3. The NURSE

4. The IDEAL doctor

5. Junior Doctors

7. DESKILLING the DOCTOR
• By improving the patient care
• Question is about sustainability for a system

8. becoming SKILLED
Unconscious Incompetence
Conscious Incompetence
Conscious Competence
Unconscious Competence
Noel Burch 1970s

9. becoming SKILLED
Unconscious Incompetence
Conscious Incompetence
Conscious Competence
Unconscious Competence
Noel Burch 1970s

10. Experience as a Teacher

11. The 10%
• BASIC
• BLS
• ALS
• Escalation protocols (CRC, MET )
• Ward cover tasks…

12. Nightly, on average:
No. tasks Requested = 151.8
No. tasks Completed = 144.6 (95.3%)
No. tasks Cancelled = 6.5 (4.3%)
No. tasks Handed Over = 0.7 (<0.4%)
No. tasks Reallocated = 21.3 (14%)

13. Teaching the Leaders
• Certificate course
• Mentoring Program
Consultant- Senior- Junior
• ALS
• Simulation
• formal ICU teaching
– bronchoscopy, echo, research,
procedural accreditation, basic and
advanced ICU content: delivered in
person, and online.

14. Formal or not
Cross, J. (2007) ‘All or nothing’. Informal Learning

15. Why will they learn

16. Cognitive Dissonance
Leon Festinger 1956

17. Challenge & Support is needed
Regression Growth
Stasis Confirmation
SUPPORT
Challenge
Nevitt Sanford, 1967

18. Challenge & Support is needed
Regression Growth
Stasis Confirmation
SUPPORT with understanding
Challenge
Nevitt Sanford, 1967
Tension
Dissonance
Empathy

19. JMS EDUCATION and SUPPORT
cognitive dissonance
• Be Involved with the difficult patients
• Be Supported by People who understand

20. MET calls are
Not simply EARLIER ICU referrals

21. CONCLUSION:
Whilst providing safer, higher quality care for patients
RRT give senior ICU clinicians the opportunity to
radically improve the Education and support for
JMS
RRT members must believe in the process
(or risk JMS receiving from you
Support without a challenge, or a
Challenge without support)

22. Your role in JMS education
• Hospital Managers: Staff the system You want
• Consultants: Embrace the responsibility and role model
• Senior Trainees: Challenge with Support, develop leadership
• Junior JMS: Learn, work, escalate with a plan, demand feedback
• Nurses: Collaborate, and escalate the unconscious incompetent