Daredevils take flight
Just what have those daring young(ish) things in the Southern Region Committee been up to? A joint venture? What’s so daring about that?
Some years ago, the Southern Region Committee imploded as a consequence of a failed joint venture with the RCN critical care forum, so it was no mean feat to see ‘BACCUMUP 09’ come off on 15 May. It was a joint conference day with STICUMUP (South Thames ICU Managers groUP), complete with 28 exhibitor stands and concurrent sessions at Gatwick Hilton on the subject ‘Critical Care Outcomes – Can YOU make a difference?’
As STICUMUP is not a charity (whereas BACCN of course, is) and the aims, customs and practices of the two organisations differed, we needed National Board approval to go ahead, then go we really did.
Delegates came from all corners of the UK and the event sold out well in advance. The inimitable Kathy Rowan from ICNARC talked in detail about survival outcomes for the bulk of ICUs in England, Wales and Northern Ireland. Did you know that the average general ICU mortality is now 17.5%? That’s less than it was a few years ago, but sadly, we’re not getting any better, just admitting more ‘HDU’ patients. The Case Mix Programme will give your ICU its own mortality results, but we must interpret them by dividing into elective, emergency and non-surgical groupings before comparing nationally or with other units. Otherwise, the figures will be skewed by the case mix of your particular unit.
There were great discussions of what other outcome measures were valid – infection rates, pressure sore rates, patient falls, patient experience measures? If we don’t measure them, then we can’t show what difference we do make or argue for sufficient staffing levels, argued Ursula Clarke. What can we do that really does make a difference? We heard from some of the big multicentre trials that early tracheostomy is not better than late (and may cause many a needless scar), that a popular model of follow up does not make any difference to patients’ physical or emotional recovery, nor to economic productivity and were reminded that organ donation does make a difference to grieving families as well as to grateful recipients.
We learned that pre-op assessment of elective surgical patient with CPX (Cardio-Pulmonary eXercise testing) may significantly impact outcomes by selecting the correct patients for surgery and predicting need for ICU or HDU post op. We were challenged by Deborah Dawson about the outcome benefit of outreach in the muddy waters of everyone doing something different and we were struck by BACCN and STICUMUP that it is OUR business to make a difference to patients and their relatives.
Up and coming trials to look out for and get involved in include:
- FIRE – fungal infection risk evaluation (who needs prophylaxis?)
- RAIN – recovery from traumatic brain injury
- IVIg – immunoglobulin in severe sepsis
- OPTIMISE – post-operative goal directed therapy
- ProMISE – more early goal directed therapy for sepsis in the emergency dept
The day was challenging, inspiring and fun (as well as exhausting) and Southern Region BACCN are delighted to have pulled it off!
