Mastering Intensive Care

In this week's episode you'll hear an invigorating conversation with Francesca Rubulotta. This power-packed, enthusiastic, passionate, water polo-playing, Italian doctor, now living and working in London, UK, is seriously ambitious to help patients other than those in her ICU, mostly by advancing education using technological innovation.

Francesca is a Consultant and Honorary Senior Clinical Lecturer in Anaesthesia and Intensive Care Medicine at Imperial College Medical School. She studied medicine and anaesthesia in Italy and intensive care in Belgium, but also worked in the USA and the Netherlands on a journey that arrived in London 10 years ago. Francesca has been the Chair of the past division of professional development of the European Society of Intensive Care Medicine (ESICM) and is currently the Chair of the ESICM's CoBaTrICE project. She leads and has led many other committees and organisations, and is presently the first ever female Presidential candidate in the ESICM general election (with the ballot open until June 11).

Francesca has diverse clinical interests including end of life care, ethical aspects of intensive care, rapid response systems, and clinical research. She speaks 5 European languages, travels and speaks around the globe and has won masters world championships as a waterpolo player.

In this conversation, Francesca demonstrates a deep understanding of, a strong passion for and substantial experience in running educational programs and courses in an innovative way using digital technology. She also tells of her desire to maximize the reach of education to less-developed areas of the world and her hope for more balance between the genders in intensive care. We also cover:

• The story of her multinational career so far
• How she obtained her current job in the United Kingdom
• How her intensive care career began by translating her intensivist father's slides into English as a high school student
• How both she and her sister are now intensivists
• The benefits of training under some of the superstars of intensive care
• Her observation that the best intensivists keep it simple
• A story about how her change in demeanour helped her team understand how a clinical situation had turned serious
• The importance of empowering junior staff to make decisions
• Her fundamental desire to have daily physical contact with each patient
• How she took an ex-long-term ICU patient to the pub
• Raised expectations that educators should now deliver TED-like talks
• The honour of standing as an election candidate to be ESICM President
• The possibility of a global intensive care society one day
• Her passion for waterpolo and the vital importance of following our passions outside of medicine
• How yoga helps her look after her mind
• Learning from the mistakes she has made along the way
• And some thoughts about gender inequality in intensive care.

My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to work and to adopt some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast.

Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

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Show notes (people, organisations, resources or links mentioned in the episode):

Link to Francesca Rubulotta's ESICM President campaign: https://mailchi.mp/b3364cf0ed73/francesca-rubulotta-esicm?utm_source=mailchimp&utm_campaign=030026c6e1f0&utm_medium=page

Francesca Rubulotta's logo, suggesting representation (globe), education (eye) and innovation (light):

Twitter handle for Francesca Rubulotta: @frubulotta

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care

Twitter handle for Andrew Davies: @andrewdavies66

Email Andrew Davies: [email protected]

This week is International Nurses Week culminating in International Nurses Day on Saturday May 12th, the date on which Florence Nightingale was born. To celebrate this, my special guest this week is an intensive care nurse, Claire Davies.

Claire is my wife. To me, she is intelligent, caring, kind and compassionate, as both a nurse and a person. So after struggling for a while with the choice of who I should have as my first nurse guest on the podcast, it gradually became obvious that it should be Claire.

Claire began as an intensive care nurse back in 1999 as a Critical Care Course student at the Alfred Hospital's Intensive Care Unit in Melbourne. After rising to become an Associate Nurse Unit Manager there a few years later, Claire took time off to rear our 2 beautiful daughters before reestablishing herself as a Critical Care Liaison Nurse at the Epworth Hospital, also in Melbourne.

Whilst Claire is definitely an excellent nurse, with a keen focus on developing healthy and valuable nurse-doctor relationships which place the patient's needs above anything else, she is also the long-suffering partner of an intensivist, me. This gives Claire the perfect perspective to talk about being an intensivist's partner, something we do towards the end of this conversation. We also talk about:

• Her career journey
• What is it like being an intensive care nurse
• The dynamic and challenging environment of an ICU
• The characteristics of good intensive care doctors
• An instance where she confronted an intensivist about how she felt intimidated by him
• The aim to bring everything back to being about the patient
• Communication between ICU doctors and nurses
• How nurses are good at pattern recognition
• How important decisiveness is
• Respecting and not unfairly judging prior clinical decisions
• Drug and other types of errors
• An interesting tale of one of her patients falling out of bed
• How Claire felt in the period afterwards and how she dealt with it
• Communicating in family meetings, including the use of silence
• Prioritising rest to bring her best self to work
• Some other wellness habits including eating well, exercise and yoga
• Seeing the drinking of water as an important goal during a shift
• The "funny jokes" intensivists often tell on their ward rounds
• Her thoughts to help intensivists be more connected to their partners and families
• Her interest in a more focused acknowledgement of death in the ICU when it happens

My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast.

Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

--------------------

Show notes (people, organisations, resources or links mentioned in the episode):

Twitter handle for Claire Davies: @cldavies22

Instagram handle for Claire Davies: @clairedavies22

New Normal Project podcast: http://newnormalproject.libsyn.com/

Insight Timer app: https://insighttimer.com/

Dr Craig Hassed: https://www.monash.edu/medicine/spahc/general-practice/about/staff-students/hassed

Study focusing on the "Sacred Pause": https://www.ncbi.nlm.nih.gov/pubmed/29618221

5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care

Email Andrew Davies: [email protected]

Twitter handle for Andrew Davies: @andrewdavies66

Does each bedside decision you make actually help your patient to feel, function or survive?

Have you considered how frightening and intimidating the Intensive Care Unit environment is to your patients and their families?

Do you feel empowered by the people you work with and the culture in your ICU?

Simon Finfer loves telling a tale. In this episode you'll hear the story of the serendipitous and multi-national route Simon took to end up working for 25 years in one of Australia's premiere Intensive Care Units. An Intensive Care Department where his colleagues and the culture they developed has fostered him to become one of Australia's prominent intensive care researchers. You'll also hear how he teaches his junior colleagues to question everything they do at the bedside to ensure their decisions truly help the patient.

Simon is a Professorial Fellow in the Critical Care and Trauma Division at The George Institute for Global Health, a Senior Intensivist at Royal North Shore Hospital and Director of Intensive Care at the Sydney Adventist Hospital in Sydney, Australia. He is an Adjunct Professor at the University of New South Wales, a Clinical Professor at the University of Sydney and is a past-Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Simon is a world leader in Sepsis and is an international expert in the design and conduct of large scale randomised controlled trials in Intensive Care.

Simon has collaborated with me (and many others) through the ANZICS Clinical Trials Group, so we caught up at the Group's recent 20th Annual Meeting on Clinical Trials in Intensive Care at Noosa Heads in Queensland. We had a fascinating conversation in which Simon talked about:

• His early career in London where he was simply working too hard
• The circuitous route he took to Royal North Shore Hospital in Sydney
• The magnificent people-oriented culture inspired by Malcolm Fisher
• His early collaboration with the George Institute for Global Health
• How showing you care is what matters most in an end of life discussion
• His thoughts on having family at the bedside for ward rounds
• How the golf course is the only place he doesn't think about patients
• How moving to a property with animals has brought relaxation and peace
• The rekindling of his passion for motorbike riding
• Why he got a Twitter account and how social media is both a force for good and an echo chamber
• How it's almost "too easy" to write a paper in modern times
• The unlikelihood of a magic bullet arriving anytime soon
• His advice to look after our selves, to embrace uncertainty and to maintain our humanity

My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

--------------------

Show notes (people, organisations, resources or links mentioned in the episode)

5th SG-ANZICS Asia Pacific Intensive Care Forum: www.sg-anzics.com

ANZICS Clinical Trials Group: http://www.anzicsctg.org/

More information about Simon Finfer: https://www.georgeinstitute.org/people/simon-finfer

Twitter handle for Simon Finfer: @icuresearch

SAFE study: https://www.ncbi.nlm.nih.gov/pubmed/15163774

NICE-SUGAR study: https://www.ncbi.nlm.nih.gov/pubmed/19318384

SMACC: https://www.smacc.net.au/

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

Email Andrew Davies: [email protected]

Twitter handle for Andrew Davies: @andrewdavies66

How well do you understand what happens to your patients after they leave the ICU?

Do you find out how they go and feed this back to your ICU team?

Most of you give excellent care to your patients whilst they are in the intensive care unit. No doubt this will be compassionate, appropriate, diligent, information-driven, holistic, team-based and communicative care.

But when they leave the ICU, do you know what happens to them? Do you know if they actually leave the hospital? Do you know how they sleep, how long they remain confused for? What their final diagnosis on hospital discharge was?

This is what A/Prof John Santamaria genuinely cares about. This is what he endeavours to find out. He is curious. John wants to know these things so he can better inform his patients before they leave the ICU and so he can keep his team up to date with what happened. Of course much of it is straightforward. The lady with pneumonia gradually got better and went home. The old man who had the laparotomy remained confused for 10 days, and then gradually became well enough to go off to rehabilitation. But sometimes there are surprises. The woman you thought had a simple urinary tract infection actually developed a secondary pneumonia in the ward and died after the treating team deemed another round of ICU to be inappropriate. The man with the acute pulmonary oedema who rapidly responded to CPAP but then developed a pulmonary embolism out on the ward.

I know I could do better at understanding these things. It's not that I'm not curious, it's more that I get busy with the new patients, or the other jobs I have. Or recording the next podcast! I think after listening to this episode of Mastering Intensive Care with John Santamaria, you might think a bit about following up your ex-ICU patients more carefully.

John is Director of Intensive Care at St Vincent's Hospital in Melbourne, Australia. He trained both at St Vincent's and Royal Melbourne Hospitals, in respiratory and intensive care medicine. After completing a doctorate of medicine on the control of breathing and postdoctoral studies in Vancouver, Canada, he returned to St Vincent's in 1985. John has been a past chair of the Victorian branch of ANZICS and President of ANZICS. He currently chairs the Victorian Intensive Care Data Review Committee. His interests include mechanical ventilation, performance monitoring, clinical outcomes and clinical informatics.

John is the current longest-serving Director of Intensive Care in Melbourne and anyone who works at St Vincent's speaks so highly of his clinical care and his departmental leadership. He willingly let me interview him and we talked about a range of topics including:

• How he came to intensive care from respiratory medicine
• His appointment as ICU director at age 28
• How some of his early career mentors influenced him
• The importance of close examination of patients
• How he balances teaching and clinical work on a ward round
• His perspectives on an electronic medical record and how the data from it can improve the quality of practice
• The need for intensivists to be open to suggestions from other team members
• The regular offer he makes to his nurses to call him when he is on call
• His take on end of life care and the family conversations involved
• How he collects data on his ICU's patients on a daily basis (now over 30,000 patients)
• The use of technology like list managers, automatic reminders and SMS notifications of abnormal results
• His love of exercise, particularly early in the morning
• John's advice on how to have a medical literature reading program
• Some thoughts about sleep, sleep deprivation and alerting medications
• And a few regrets he has...

My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to consider adopting some of the habits and behaviours my guests give their perspectives on, with the ultimate purpose of improving outcomes for all of our patients. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment on the Facebook "mastering intensive care" page, on the LITFL episode page, on twitter using #masteringintensivecare, or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

--------------------

Show notes (people, organisations, resources or links mentioned in the episode)

MANIC Course: https://www.baxterprofessional.com.au/manic/

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

How do you balance the use of your clinical experience with the literature-based evidence?

Are you a good enough listener?

Is the clinical handover in your ICU the best it could be?

I've been reflecting on these questions since I talked to A/Prof Peter Kruger for this week's Mastering Intensive Care podcast.

Peter is Deputy Director of Intensive Care at the Princess Alexandra Hospital in Brisbane, Australia and an Associate Professor at both the University of Queensland and Monash University in Melbourne. He holds specialist qualifications in both Anaesthesia and Intensive Care and has experience in both laboratory and clinical research. He is the immediate past chair and a senior examiner for the first part examination of the College of Intensive Care Medicine of Australia and New Zealand and a primary examiner for the Australian and New Zealand College of Anaesthetists. He is a board member of the College of Intensive Care Medicine and of The Intensive Care Foundation. In addition to his clinical and teaching roles his active research interests include clinical trial design, utilising clinical information systems to facilitate research, weaning patients from mechanical ventilation and the management of severe sepsis.

Peter is one of those doctors who mixes research, teaching and clinical care really well. So he is perfectly placed to speak on a bunch of topics in this episode, like:

• How the people and the variety keeps him coming back to work in the ICU
• Why he enjoys working in a "strong" ICU and what that means
• Some of the habits he noticed in his mentors
• The importance of not being in a rush when on clinical duties
• The varying style of his clinical ward rounds
• The value of making brief contact with families during bedside handovers
• What he talked about when he recently gave a presentation entitled "Does what I think I know matter anymore?"
• How anecdotal experience does impact on our clinical practice
• Following up those who survive as patients in the ICU (and their families too) can help prevent a series of future problems
• The value of eye contact, listening, deliberate use of words and pauses in good communication
• Peter's change in thinking about shift handover after reading a paper 10 years ago
• How talking to families is the highlight of his job
• The value he sees in sailing yachts to help mind, body and soul
• His thoughts on aging and working as an intensivist
• Some vital tips for the less experienced

My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

--------------------

Show notes (people, organisations, resources or links mentioned in the episode)

MANIC Course: https://www.baxterprofessional.com.au/manic/

Princess Alexandra Hospital: https://metrosouth.health.qld.gov.au/princess-alexandra-hospital

University of Queensland: https://www.uq.edu.au/

Monash University: https://www.monash.edu/

CICM: https://www.cicm.org.au/

ANZCA: http://www.anzca.edu.au/

Intensive Care Foundation: http://www.intensivecarefoundation.org.au/

ANZICS CTG: http://www.anzics.com.au/Pages/CTG/CTG-home.aspx

ANZICS/ACCCN annual conference: http://intensivecareasm2017.com.au/

Journal article on "Patient Care, Square-Rigger Sailing, and Safety": https://www.ncbi.nlm.nih.gov/pubmed/18840843

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

What are the biggest challenges when beginning as a fully-fledged intensive care clinician?

How do you best use your senior colleagues when your experience bank is still small?

What can you do to help achieve gender equity in intensive care medicine?

These are some of the questions you'll ponder as you listen to the latest Mastering Intensive Care podcast guest Dr Sarah Yong from Melbourne.

Having started off 2018 with two "Best of 2017" episodes on the podcast, today allows you the opportunity to hear a new interview. I am enthusiastic and passionate about bringing you some further valuable perspectives on improving how we do our jobs in intensive care units around the world. And this year I'm hoping to branch out a bit and try some new things and some new types of guests. Mastering Intensive Care is not just about interviewing older and experienced intensivists. It's also about hearing some of the challenges from less experienced intensivists as they traverse the early days of their careers. So in this episode you'll hear from Sarah who is right in the middle of this phase working at the Alfred Hospital in Melbourne, Australia.

After graduating from The University of Melbourne, she completed training in general medicine before obtaining her fellowship of intensive care medicine. Along with critical care, she has a strong interest in education, simulation and the free open-access medical education (FOAMed) revolution. She is currently completing a Masters in Clinical Education in non-technical skills in intensive care. Sarah is a strong advocate for her peers including convening the Victorian Primary Exam Course, chairing the Trainee Committee and being the New Fellows' Representative for the College of Intensive Care Medicine here in Australia and New Zealand. She is a founding convenor of the Women in Intensive Care Medicine Network, which is dedicated to improving the gender balance in Australasian Intensive Care Medicine through advocacy, research and networking.

I really enjoyed talking with Sarah. She is eloquent, mature, humble and honest; and she has a great perspective on how we can all take action to achieve improved gender balance in intensive care. In the episode we talk about many things, including:

• What attracted Sarah to intensive care
• The rewards of delivering end of life conversations
• Whether she can sustain a lifelong career in the specialty
• How she dealt with the transition between trainee and fully fledged specialist
• Her utilization of other colleagues to support her ever-improving experience base
• The characteristics of the senior specialists who stood out to her
• What habits she is concentrating on to develop professionally
• How she has learnt and developed her communication skills
• Her excellent approach to a family conversation
• Dealing with the demands of an intensive care career
• Preparing at home for a busy clinical week
• Blending family and career
• The main gender-related issues women face in intensive care
• Sarah's work with the Women In Intensive Care network
• Her advice for current trainees

My genuine hope with this podcast is to inspire and empower you to bring your best self to work and to adopt improved habits and behaviours at work, so you can more masterfully interact with and care for your patients, their families and your colleagues. Thanks for joining me on a quest to improve outcomes both in your intensive care and in mine. Please help me to spread the message by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at [email protected].

Thanks for listening on the journey towards mastering intensive care.

Andrew Davies

Show notes (people, organisations, resources or links mentioned in the episode):

CICM: https://www.cicm.org.au/

Sarah Yong on Twitter: @drsarahyong

Women In Intensive Care Medicine Network: http://www.womenintensive.org/

Women In Intensive Care Medicine Network on Twitter: @womenintensive

Women In Intensive Care Medicine Network on Facebook: womenintensive

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

A year ago there was no such thing as the Mastering Intensive Care podcast. Now there are 21 separate interviews, each of which have helped me and seem to have helped many of you to make improvements at delivering more compassionate, thoughtful and patient-centred intensive care.

Without fail my guests throughout 2017 were excellent and I really enjoyed doing the interviews. And I promise to bring you the best content I can over 2018 too.

Here are the final five of the best 2017 guests, to follow on from the first five in the last episode. This has been difficult as I have seriously enjoyed every one of my guests. I will upset some guests by not including them and I will upset some of you for not including your favourite guest. But nevertheless I have taken the five most downloaded episodes and mixed them with the five I enjoyed the most. Then I took what I considered the best excerpt of the conversation and put them in no particular order over two episodes.

So enjoy listening to the best excerpts of the best episodes over the first year of Mastering Intensive Care. I hope it will inspire you to a fresh start in 2018 with some great perspectives for bringing your best self to work. If you've missed a few episodes over the year here is a chance to catch up with them and if you are totally new to the podcast here is a glimpse of what Mastering Intensive Care is all about.

Andrew Davies

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Resources from people, organisations and things mentioned in this episode:

MIC Episode 9 with John Myburgh: http://masteringintensivecare.libsyn.com/episode-9-john-myburgh-the-importance-of-the-intensive-care-clinical-ward-round

MIC Episode 12 with Julia Wendon: http://masteringintensivecare.libsyn.com/episode-12-julia-wendon-making-the-patient-the-centre-of-everything

MIC Episode 20 with Jack Iwashyna: http://masteringintensivecare.libsyn.com/episode-20-jack-iwashyna-icu-adventure-camp-time-limited-life-support-trials-and-regular-talks-with-families-dassmacc-special-episode

MIC Episode 10 with Imogen Mitchell: http://masteringintensivecare.libsyn.com/episode-10-imogen-mitchell-an-intensivist-and-dean-of-medicine-focused-on-communication-and-clinical-decision-making

MIC Episode 2 with John Botha: http://masteringintensivecare.libsyn.com/episode-2-john-botha-exemplary-leadership-in-the-icu

Mastering Intensive Care podcast on Libsyn: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care podcast on Life In The Fast Lane: https://lifeinthefastlane.com/?s=mastering+intensive+care

Mastering Intensive Care on Facebook: https://www.facebook.com/masteringintensivecare/

Andrew Davies on Twitter: @andrewdavies66

Email Andrew Davies: [email protected]

A year ago there was no such thing as the Mastering Intensive Care podcast. Now there are 22 episodes with 21 separate interviews, each of which have helped me and seem to have helped many of you to make improvements at delivering more compassionate, thoughtful and patient-centred intensive care.

Without fail my guests throughout 2017 were excellent and I really enjoyed doing the interviews. And I promise to bring you the best content I can over 2018 too.

Given the Christmas/New Year break is a time for reflection, I thought this was the time to slow down and relive the best of what was heard on Mastering Intensive Care in 2017.

Here are the first five of the best 2017 guests, with a further five to follow next episode. This has been difficult as I have seriously enjoyed every one of my guests. I will upset some guests by not including them and I will upset some of you for not including your favourite guest. But nevertheless I have taken the five most downloaded episodes and mixed them with the five I enjoyed the most. Then I took what I considered the best excerpt of the conversation and put them in no particular order over two episodes.

So enjoy listening to the best excerpts of the best episodes over the first year of Mastering Intensive Care. I hope it will inspire you to a fresh start in 2018 with some great perspectives for bringing your best self to work. If you've missed a few episodes over the year here is a chance to catch up with them and if you are totally new to the podcast here is a glimpse of what Mastering Intensive Care is all about.

Andrew Davies

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Resources from people, organisations and things mentioned in this episode:

MIC Episode 3 with Rinaldo Bellomo: http://masteringintensivecare.libsyn.com/episode-3-rinaldo-bellomo-compassionate-care-with-continuous-enquiry

MIC Episode 8 with Dianne Stephens: http://masteringintensivecare.libsyn.com/episode-8-dianne-stephens-developing-a-happy-work-environment-by-respecting-and-valuing-everyone-in-the-intensive-care-team

MIC Episode 4 with Neil Orford: http://masteringintensivecare.libsyn.com/episode-4-neil-orford-seeking-optimal-communication-leadership-and-balance

MIC Episode 13 with Sara Gray: http://masteringintensivecare.libsyn.com/episode-13-sara-gray-voices-in-my-head-dassmacc-special-episode

MIC Episode 21 with Martin Bromiley: http://masteringintensivecare.libsyn.com/episode-21-martin-bromiley-turning-tragedy-into-safer-healthcare-by-attention-to-human-factors-dassmacc-special-episode

Rich Roll podcast: http://www.richroll.com/category/podcast/

Mastering Intensive Care podcast on Libsyn: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care podcast on Life In The Fast Lane: https://lifeinthefastlane.com/?s=mastering+intensive+care

Mastering Intensive Care on Facebook: https://www.facebook.com/masteringintensivecare/

Andrew Davies on Twitter: @andrewdavies66

Email Andrew Davies: [email protected]

This week's Mastering Intensive Care podcast features Dr Felicity Hawker who is one of the true female pioneers of Intensive Care in Australia and New Zealand.

I had the privilege of working with Felicity for over a decade from when I began as a brand new intensive care consultant over 20 years ago and I came to admire her greatly. Mainly because I witnessed first hand someone who was a master clinician – astute, careful, diligent, systematic, thoughtful, compassionate and knowledgeable. Felicity always handed over the patients in a considered and packaged patient-focused manner. She was a pleasure to work with and I learnt so much from such a high quality role model.

Felicity grew up and went to medical school in the Australian state of Tasmania, before completing specialist training in Melbourne, Glasgow and Sydney. She became the Co-director of the ICU at Royal Prince Alfred Hospital in 1985 before moving to Melbourne to be the Director of the Cabrini Hospital ICU from 1995 until 2008, during which time she also worked as a part time intensive care specialist at the Alfred Hospital. She continues to work at Cabrini as the Chair of the Deteriorating Patient Committee.

None of this spells out well enough that in the late 1970s and early 1980s, when Felicity was doing her specialist training, intensive care was an almost totally male-dominated specialty (certainly in Australia and New Zealand). Many more women have joined her and us over the years but surely the path she forged can't have been easy. Nevertheless, Felicity has published extensively, written a book on the liver in critical illness, spoken at many scientific meetings and been highly respected in our community.

Felicity's other major contribution has been her committee work at every level of education and training in the various Australian and New Zealand intensive care training institutions since the early 1990s. With other colleagues she was instrumental in bringing together the anaesthetic and the physician training programs through several iterations to ultimately become what is now a stand-alone College of Intensive Care Medicine (CICM), and where she is now the Director of Professional Affairs. Felicity was the inaugural Dean of the then Joint Faculty of Intensive Care Medicine (JFICM) from 2000-2002 and was awarded the JFICM medal in 2009. Since 2005 she has been honoured with the annual presentation of the prestigious Felicity Hawker Medal to the best research presentation by a trainee at the Annual Scientific Meeting of the CICM.

I am extremely grateful to have had the opportunity to talk with Felicity, as in my eyes she has been a brilliant clinician at the bedside, a female pioneer in our specialty and a person who has strived to ensure proficient, knowledgeable and professional intensive care specialists are developed over the course of specialty training in Australia and New Zealand. In the episode we talk about many things, including:

• The early course of her career and what attracted her to intensive care
• The enjoyable relationships she has made with intensive care trainees
• The importance of diagnosis and the need to remain curious and sceptical
• Her time spent training in Glasgow as a Shock Team registrar
• The influence of a dynamic female consultant during her own training
• How attitudes and outcomes have changed since when she was one of 2 consultants at what is now one of the biggest ICUs in Sydney
• The characteristics she thinks good intensivists require
• Communicating with colleagues and patient's families
• Her highly valuable published survey of the issues female intensivists face
• How research has changed since her early career
• Her views on winding down an active intensive care career
• Her earlier successful horse riding career
• Her current role as a doctor at professional horse racing meetings
• How she has dealt with the stress of an intensive care career
• Her observation that many intensivists want to be educationalists
• Her enjoyment of family, cryptic crosswords, reading and travel
• And some valuable advice to 35 year old intensive care doctors

This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, our fellow healthcare professionals and indeed ourselves so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at [email protected].

Thanks for listening. Please do the very best you can for your patients.

Andrew Davies

Show notes (people, organisations, resources or links mentioned in the episode)

CICM: https://www.cicm.org.au/

CICM honours: https://www.cicm.org.au/About/Honours-Awards

Felicity Hawker medal: https://www.cicm.org.au/Trainees/Assessments-and-Examinations/Formal-Projects#FelicityHawkerMedal

Published paper on survey of female specialists in intensive care medicine: https://www.ncbi.nlm.nih.gov/pubmed/27242111

Felicity Hawker on LinkedIn: https://www.linkedin.com/in/felicity-hawker-728a3025/

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com/

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care/

Are we truly making healthcare safer?

Do we adequately understand human factors in how we work in hospitals?

How would you respond if your partner died from a "routine operation"?

These are just 3 of the questions you are likely to ponder as you listen to this interview with Martin Bromiley OBE from the United Kingdom on the Mastering Intensive Care podcast.

Whilst many people that we care for in our Intensive Care Units receive excellent care, sadly there are some who end up in our ICUs after something goes unexpectedly wrong during a routine operation. Tragically some of these people die. Not due to anything they did, but from medical error.

In the final DasSMACC special episode, I speak to Martin Bromiley, who became a widower when his wife, Elaine, died in such circumstances 12 years ago. In what has been described as "the direct result of human factors and failings in non-technical skills, created by systemic failings in the healthcare system". Martin didn't blame, shame or complain. He did his best to move forward by researching the culture in healthcare around safety and human factors. And he recognised that although there were pockets of excellence the UK's National Health Service was culturally a long way behind most other high risk industries. As a result of his experiences Martin supported the making of a DVD entitled "Just a routine operation" which explored the lessons of his late wife's death, as well as a BBC Horizon programme about human factors called "How to avoid mistakes in surgery".

Professionally Martin works in aviation where he is a pilot for a major UK airline and where he has a background specialising in human factors. Therefore, Martin founded the Clinical Human Factors Group, a non profit-making charitable trust which aims to advise and promote best practice around human factors. Since then the Group has promoted human factors at the highest levels in healthcare, making a significant contribution to current thinking. More significantly though, the terms human factors and system safety are becoming much more commonly understood in healthcare, much of which is due to Martin's efforts and leadership. His work has been recognised through awards from the Royal College of Anaesthetists, the Difficult Airway Society, and the patient support group "Action Against Medical Accidents". In the 2016 New Year Honours list Martin was awarded an OBE for his work to further patient safety.

Martin was a speaker at the DasSMACC conference in Berlin back in June, and after delivering an enthralling talk entitled "How To Fail", we went to a quiet room to record an interview. We had an important conversation and touched on:

• The tragic case of Elaine and her death after a routine operation
• How Martin dealt with it
• What support Martin received in and out of the hospital
• What Martin has been doing to try to improve safety in healthcare
• What healthcare can and cannot learn from the aviation industry
• His 3 key messages about human factors
• How he uses mental rehearsal to be the best airline pilot he can be

This podcast is my quest to improve patient care, in ICUs all round the world, by inspiring all of us to bring our best selves to work to more masterfully interact with our patients, their families, ourselves and our fellow healthcare professionals so that we can achieve the most satisfactory outcomes for all. Please help me to spread the word by simply emailing your colleagues, posting on social media or rating and reviewing the podcast.

Feel free to leave a comment or a question on the LITFL episode page, on twitter using #masteringintensivecare, on the Facebook "mastering intensive care" page or by sending me an email at [email protected].

Please also consider making a donation to the Clinical Human Factors Group here.

Thanks for listening. Please do the very best you can for your patients.

Andrew Davies

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Links related to Martin Bromiley

Martin Bromiley

Martin Bromiley on Twitter: @MartinBromiley

Martin Bromiley on LinkedIn

Clinical Human Factors Group

Donations to Clinical Human Factors Group

Video "Just a routine operation"

Video "How to Fail…Part Two" (a talk by Martin Bromiley at DasSMACC conference)

Video "Martin Bromiley, a Patient's Perspective" (talk by Martin Bromiley at Patient Safety Movement)

Anonymous version of an Independent Report on the death of Elaine Bromiley

Article "The husbands story: from tragedy to learning and action" (authored by Martin Bromiley)

Article "Clinical Human Factors" (co-authored by Martin Bromiley)

Article 1 on Martin Bromiley

Article 2 on Martin Bromiley

Article 3 on Martin Bromiley

Article "Lessons from the Bromiley Case" (by Mike Cadogan on Life In The Fast Lane)

Links to other resources (in order of mentioning)

SMACC

TED

Book "Black Box Thinking" (by Matthew Syed)

Paper on the Safety 1 and Safety 2 model

Second paper on the Safety 1 and Safety 2 model

Third article on the Safety 1 and Safety 2 model

Jim Harlow on Twitter

Links related to Mastering Intensive Care podcast

Mastering Intensive Care podcast

Mastering Intensive Care page on Facebook

Mastering Intensive Care at Life In The Fast Lane

Andrew Davies on Twitter: @andrewdavies66

Andrew Davies on Instagram: @andrewdavies66

Andrew Davies on LinkedIn

Email Andrew Davies