1) Critical care units can do without information technology failures, communication failures, and unevidenced practices. 2) Early pioneers like Florence Nightingale were able to significantly reduce mortality rates in the Crimean War through simple measures like improved hygiene, nutrition, and staffing levels. 3) Modern ICUs should embrace technologies but address challenges, improve communication across units through multidisciplinary teams, and generate more evidence through research to continually improve patient care.

1. What can ICU do without?
Dr David Hutchins
ICS State Of The Art 07/12/2015

2. We can do without these…

3. Or…what can ICU do with?

4. Critical Care: complex or not?
So, lets make it simples……

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

8. Information technology failure
C
U
Infrastructure challenges
Behavioural & human factors
Advantages: accuracy, error
reduction, audit & research facilitation

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

14. I
C
Un-evidence-based practice
The trouble is ….. there is not a lot out there.
ICU specialty is still relatively embryonic

15. I
C
Un-evidence-based practice
22 internationally recognised ICU journals
Am J Resp Crit Care impact factor 12.9 (Lancet 39.2)

16. So what can we do?

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