Mastering Intensive Care is back after a lengthy break with an episode featuring senior ICU dietitian Dr Emma Ridley. Emma is a Senior Research Fellow and a NHMRC Emerging Leadership Fellow at the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University in Melbourne, where she leads the Nutrition Program. Emma has 16 years of clinical dietetic experience, including as a senior dietitian in the ICU at The Alfred Hospital in Melbourne, and over 13 years of research experience, including the awarding of her PhD. Her research interests include energy requirements across the hospitalisation period, the clinical application of indirect calorimetry and the effect of optimal nutrition delivery on short and long-term outcomes in ICU patients. Emma is a long-time colleague of mine, someone I have huge respect for, and a woman that seems to fit a lot into a busy life and career. I was keen to talk to Emma for the podcast so I could ask about topics such as how she sees dietitians best fitting into the ICU team, what her thoughts are on communication between different ICU staff roles and what is required for a dietitian to be a valuable advocate for ICU patient nutrition. Emma also has some important insights from the difficult experience of having her recently newborn son admitted to the NICU. This episode is not just for dietitians. Emma is such a wise and thoughtful healthcare leader that there are pertinent perspectives in this conversation that will help doctors, nurses and practitioners in any Intensive Care role. The list of topics Emma discussed include: How she became a dietitian in Intensive Care Her reflections on the pace of an ICU The importance of dietitians and doctors understanding each others “language” How she feels dietitians best fit into the ICU team Advocating for ICU patient nutrition at the bedside The importance of dietitians being present at the ICU ward round Working with the different members of the ICU team Optimal communication between colleagues The importance of getting to know your colleagues Talking to patients and their families Why she was fascinated by research and how this has helped her clinical practice Why she feels research allows her to have a greater impact The benefits of embedding nutrition research in an ICU Her interest in nutrition at the time when ICU patients are transitioning out of the ICU The differences between leadership, mentorship and sponsorship The effects of the pandemic on her role Her work to assist nutrition for critically ill patients with COVID Managing personal safety and wellbeing during the pandemic The experience of her newborn son being admitted to the NICU Fitting everything in to a busy life The value of work flexibility and how this affects her clinical work capacity Her closing advice to less experienced ICU practitioners   Thanks for listening to my conversation with Emma Ridley.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the work, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Emma Ridley Dr Emma Ridley at ANZIC RC Emma Ridley on Twitter @ICUnutrition ANZIC Research Centre   Links to other resources (in order of mentioning) ANZICS Clinical Trials Group Mastering Intensive Care podcast - Episode 5 with Jamie Cooper Guideline for Nutritional Management of COVID patients Media and Medicine Program at Harvard Medical School   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 Audio Producer Chris Burke Burke Sound & Media

Mastering Intensive Care

Episode 69: Emma Ridley - Advocacy, communication and leadership as an ICU dietitian

This episode features Professor David Tuxen, a pioneer of Intensive Care in Australia, who recently retired after 38 years at the Alfred Hospital in Melbourne. David trained in both respiratory and intensive care medicine, and became the Alfred’s ICU Director at a young age. He led the development of one of Australia’s first mega-ICUs before standing down after over 20 years as Director to re-energise his passion for teaching and research. David is a Professor at Monash University, still works as an intensivist at Albury Hospital and previously served in leadership roles including President of ANZICS and Chairman of the Australian and New Zealand Intensive Care Foundation. He is globally renowned for his teaching and research on many aspects of mechanical ventilation. David was my first ICU Director, and he rapidly became, and remains, a wise, enthusiastic and long-standing mentor to me. I have particularly admired his excellent clinical skills and specifically his attention to detail so I am thrilled he agreed to appear on the podcast. Given many people in Australia and New Zealand know David by his nickname “Tux” it shouldn’t surprise you to know that David likes to have fun and bring humour to most occasions. In this episode, David’s principle message is not to be serious at all times during a day at work, and to keep up an active social life, including with colleagues, in the periods between work. David delivers a lot of other great advice in this episode, as he talks about topics including: Becoming an ICU Director at a young age The changes he’s witnessed over his career Which patients we sometimes over-treat in our ICUs Resolving differing opinions about patient prognoses The value of thorough physical examination in ICU Building rapport with families, especially for end of life conversations His experience in being filmed for a reality TV series Communicating with patient’s families Ward round teaching Tips for presenting a good talk The differences between working in a tertiary and a regional centre ICU What he thinks best maintains his wellbeing The toll of work on his family life   Tux has led a high-achieving, well-respected and clinically-orientated career. It’s a great privilege to have him on the podcast. I hope you will enjoy listening to David Tuxen.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to this episode David Tuxen on Twitter @TuxenDavid Audio of talk by David Tuxen on the history of the Alfred ICU Australian and New Zealand Intensive Care Society (ANZICS) Australian and New Zealand Intensive Care Foundation 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 Audio Producer Chris Burke Burke Sound & Media

Episode 68: David Tuxen - Making life and work fun (including ward rounds)

In this episode the focus is on our Intensive Care friends in the UK and what they are going through right now with COVID-19. My guest is Rupert Pearse, a Professor and Consultant in Intensive Care Medicine at Barts Health NHS Trust and Queen Mary University of London. He works at the Royal London Hospital, which was at the epicentre of the first wave and now the second COVID wave in East London. Rupert's recent work on Twitter through public health messaging has been outstanding and you can follow him @Rupert_Pearse. Despite being terribly busy in London, Rupert willingly gave his time to talk about: How the cases of COVID-19 are tracking right now How the logistical challenge is being gradually replaced by important reflection What the Royal London Hospital ICU did to deal with the surge The ongoing research they’ve been doing during the pandemic Why the Nightingale hospitals of the first wave seemed to struggle The stress and strain associated with diluting the nurse to patient ratio The difficulty with blending leadership structures during an intense period How they have maintained their ICU culture The struggle of his colleagues caring for themselves as healthcare professionals His advice to less affected areas of the world Why he changed his approach to delivering public health messages for the second wave The principles he follows when speaking to the media How he describes this period of his career.   I hope you will find value from listening to Rupert Pearse.   Andrew Davies   -------------------- About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Rupert Pearse Rupert Pearse Rupert Pearse on Twitter @rupert_pearse Royal London Hospital   Links to other resources (in order of mentioning) Twitter prose posted by Rupert Pearse Recovery trial REMAP-CAP trial   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 Audio Producer Chris Burke Burke Sound & Media

Episode 67: Rupert Pearse - Responding to the stress and the strain of COVID-19 in the UK

This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice. Dr Todd Rice, is an Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. Todd is a clinical intensivist, the Director of the Medical ICU (MICU) and the Medical ECMO Program, and leads VUMC’s MICU strategy for the care of COVID-19 patients. In addition, Todd leads a substantial research program as a clinician scientist, and is co-chair of the Learning Healthcare System at Vanderbilt where the motto is "Learn What We Do and Do What We Learn." Professionally, he is proud of the evidence he has generated to improve the care of critically ill patients and the mentorship he has provided to other physician scientists. He loves ice hockey (watching, not playing) and is completely into enjoying life with his two sons. Todd graduated from the University of Notre Dame and completed Internal Medicine residency at Indiana University School of Medicine. He completed Pulmonary and Critical Care Medicine fellowship training at Vanderbilt University where he obtained a Master’s of Science in Clinical Investigation. Other roles Todd serves in include: President of the American Society of Parenteral and Enteral Nutrition Vice President for Clinical Trial Innovation and Operations in the Vanderbilt Institute for Clinical and Translational Research (VICTR) Critical care principal investigator for the Prevention and Early Treatment of Acute Lung injury (PETAL) clinical center at VUMC Medical Director of VUMC’s Human Research Protections Program Todd and I recorded this conversation in March 2020, just before the COVID-19 impacted fully in our respective countries. I didn’t feel I should put this episode out during the crisis of 2020 so I held it back until now. I also asked Todd if I could interview him a second time now (in February 2021) to freshen up the interview with some perspectives on how COVID-19 has affected he and his colleagues in Nashville. I hope you will gain immense value from what Todd speaks about on this episode, including: Why he’s considered an ICU junkie and how he’s changed over the years The principle of “Don’t just do something, stand there” Understanding the confidence/competence balance His 4 box method of understanding a critically ill patient’s situation The concept of the second victim with mistakes How transparency to families builds substantial trust Why he praises nurses in front of patient’s families The structure of the ward round at his ICU The importance of empowering nurses to ask questions His note-writing practice, and it’s benefits and risks His practice to look after himself during periods of clinical service The benefit of a mix of clinical and research work The importance of pragmatic trials studying things we are already doing His institution’s Learning Healthcare System and how it is used Some overall career tips How COVID-19 has affected his ICU How the ICU team is taking care of each other His ICUs struggle with harsh visitor restrictions and how they relaxed these safely   Please enjoy listening to Todd Rice.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Todd Rice Todd Rice Todd Rice on Twitter @toddrice_icu   Links to other resources (in order of mentioning) ANZICS Clinical Trials Group ARDSnet low tidal volume strategy study EDEN study TARGET study PERMIT study   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 Audio Producer Chris Burke Burke Sound & Media

Episode 66: Todd Rice - Learning and teaching how to “not just do something, stand there”

This first podcast episode of 2021 is my attempt to put into perspective at least some of what has happened over the whirlwind of the last 12 months. We can’t control what happens to us, yet we can control our actions in response to our circumstances and we can learn from our experience. I feel like the whole experience of COVID has delivered a few important lessons for us as an Intensive Care community, so in this episode you’ll hear 5 valuable lessons I have been reflecting on. In line with the theme of the podcast, I’ll concentrate on what Intensive Care has learnt, rather than humanity in general. And although 2020 involved much discussion about various drugs, ventilator settings and other interventions, my curiosity is the human side of things. I’ll therefore concentrate on how the novel coronavirus has affected us - as individual healthcare practitioners, as distinct ICUs, and as a greater intensive care community. I am aware many of you are still struggling with overwhelming situations where you work and I understand there is still much more pandemic in front of us all. In the meantime, I hope you will take some solace from listening as I take you through the biggest lessons I feel COVID-19 has taught us in Intensive Care. None are unique to my thinking. None are rocket science. They are simply worth speaking about if only so you might reflect on what I’ve noticed from my own 2020 professional experience as we move into the next part of this pandemic and eventually beyond it. I hope you’ll listen to the podcast to hear the 5 lessons in full. They relate to: The human resources our ICUs contain The general community’s perception of Intensive Care The downside of harsh visitor restrictions Healthcare worker safety, and The future of Intensive Care education You have likely reflected on other lessons. Please let me hear them. I’d also love to receive any feedback or comments you have. If you use Twitter, include my handle @andrewdavies66 and/or #masteringintensivecare. Or simply email me at andrew@masteringintensivecare.com. I invite you to listen to the 5 valuable lessons COVID-19 taught Intensive Care in 2020.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing. -------------------- Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 60 with Simone Hannah-Clark Mastering Intensive Care podcast - Episode 64 with Roger Harris & Oli Flower 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 Audio Producer Chris Burke Burke Sound & Media

Episode 65: Five valuable lessons COVID-19 taught Intensive Care in 2020

Two inspiring and innovative educationalists, Dr Roger Harris and Dr Oliver Flower, are featured in this episode. Both of these Sydney intensivists are the force behind the recently created educational initiative named Coda, having previously been two members of the successful triumvirate who set up SMACC (Social Media and Critical Care). To my mind Oliver (or Oli) and Roger have led an educational revolution by utilising speakers with high level presentation skills and encouraging community engagement, through a blend of real life events, internet technology and social media, to bring us the type of innovative and entertaining educational platform we haven’t previously seen in intensive or critical care. Dr Roger Harris is a senior staff specialist in the ICU at the Royal North Shore hospital and the Sydney Adventist hospital. He is dual qualified in Emergency Medicine and Intensive Care. He is passionate about education, his five children and especially his wife Georgie. He’s on Twitter @RogerRdharris where his bio states he is “privileged to care for the critically ill.” Dr Oli Flower is also an intensivist at the Royal North Shore Hospital in Sydney. He’s steered the creative side of SMACC & Coda, from the graphic design elements to the style, marketing, website and social platform strategies. He has an interest in neurocritical care and is on Twitter @oliflower where his bio states he is a “believer in the power of the big medical community”. We recorded this in February 2020; just before the COVID-19 pandemic scuppered Oli and Roger’s plans to release nearly 4000 tickets to the inaugural large-scale Coda event. Coda is aimed to be more like a festival than a conference and is not only for critical care practitioners but for a wider healthcare audience. The overall goal of Coda is to cover vital broader healthcare subject themes and to assist the assembled community to take meaningful actions as a result of what is discussed, the climate emergency being one of the first of these. When Coda was one of the earlier healthcare conferences to be postponed in the pandemic, I also held this podcast back until there could be firmer plans about any live Coda events. A meeting named Coda Zero Live has now been announced for 16-18 February 2021. This is an event in Sydney with both a live and a virtual audience. It now seemed appropriate to release this episode to help you know about Coda and to encourage you to attend or tune in to Coda Zero Live. This interview is well worth listening to as, despite no mention of COVID-19, you’ll hear: The career backgrounds of Oli and Roger Roger's humility in training in a second speciality in the same hospital Both of their views on the mature culture and flattened hierarchy in their ICU at Royal North Shore Hospital Perspectives on gender equity as well as diversity and inclusion in an Intensive Care department The story behind the educational initiatives of SMACC and Coda The marginalisation of non-technical topics they noticed in most scientific meetings The growing appetite they were observing for these same topics The value of delegate feedback in directing educational initiatives How SMACC developed such an engaged community The vision for Coda including its initial themes of education, ethics, earth and cure The plans for tackling the climate emergency as a healthcare practitioner community Discussion about how a plant-rich diet is beneficial for both environmental and personal health What Oli and Roger have learnt from all these educational pursuits to help them at the bedside How they both stay balanced Some tips for less experienced clinicians   Please enjoy listening to Roger Harris & Oli Flower.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Roger Harris and Oli Flower Roger Harris Roger Harris on Twitter @RogerRdharris Oli Flower Oli Flower on Twitter @OliFlower Intensive Care Unit at Royal North Shore Hospital Coda Coda on Twitter Coda Zero Live Event - 16-18 February 2021 Intensive Care Network Intensive Care Network podcasts   Links to other resources (in order of mentioning) Chris Nickson SMACC Coda Coda Zero Live Queen Square Sydney HEMS Staff at Royal North Shore Hospital ICU Australasian Trauma Society Australasian College of Emergency Medicine College of Intensive Care Medicine SMACC Berlin Final Day Program Martin Bromiley Life In The Fast Lane Blog Intensive Care Network Simon Carley St Emlyn’s Scott Weingart EMCrit Haney Mallemat Ken Milne SMACC Conference History ANZICS SCCM Rob MacSweeney Critical Care Reviews Conference Jesse Spurr Mary Freer New England Journal of Medicine John Hinds Coda Zero Episode 1: Cure - Pandemic Sepsis Coda Zero Episode 2: Ethics - Gender Video Coda Zero Episode 3: Educate - Communicating in the era of big data, AI and the “infodemic” Coda Zero Episode 4: Earth - A safe and healthy pandemic recovery Coda Zero Live Event - 16-18 February 2021 Safe Airway Society   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 21 with Martin Bromiley Mastering Intensive Care podcast - Episode 28 with Simon Finfer Mastering Intensive Care podcast - Episode 45 with Scott Weingart 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 Audio Producer Chris Burke Burke Sound & Media

Episode 64: Roger Harris & Oliver Flower - The innovative educationalists behind SMACC and CODA

The guest on this episode is Nurse Practitioner Naomi Pratt who describes the lingering and harrowing effects of long COVID. Naomi is a Nurse Practitioner who jointly manages and leads the Critical Care Liaison Nurse service at Peninsula Health. In this role she provides clinical leadership and the Intensive Care response to Medical Emergency Team calls. She has completed post graduate qualifications in Intensive Care and has over 20 years of ICU experience. She completed her Masters in Nursing (Nurse Practitioner) at LaTrobe University and has been an endorsed Nurse Practitioner since 2015. Naomi has a keen interest in providing critical care outreach and supporting clinicians caring for deteriorating patients in ward areas outside of ICU. She is a clinical mentor for advanced practice nurses at Peninsula Health and has undertaken research to understand the factors associated with the care of deteriorating patients. This has resulted in several conference presentations and journal publications. Naomi tries to balance the challenge of work and enjoying time with her family and friends. She is lucky to live on the Mornington Peninsula, outside of Melbourne, where she shares the environment with many local animals including the visiting koalas, birdlife and pobblebonk frogs. Naomi and I work at the same hospital and I started wondering if something was wrong when I hadn’t seen her for over a month during the first wave of the COVID-19 pandemic. Sure enough, Naomi was at home and was unwell with COVID-19. Naomi has experienced a diverse range of significant symptoms over many months, some of which have lingered. She has resumed working with lighter duties than her usual busy role, yet experiences “up and down” periods with a decent level of fatigue. Naomi remains below her normal full health and seems to now have the condition which has become known as long COVID. Naomi is a true expert at keeping sick hospitalised patients out of ICU and, whilst performing that role, appears to have developed COVID-19 from exposure to a patient. I therefore asked her if we could record a conversation about her 2020 experience so it might help others. In this episode, Naomi talks about: Her career background to becoming a Critical Care Liaison Nurse The role she plays in the Liaison Nurse service at Frankston Hospital How she juggles the many different requirements of this position The night shift she was exposed to COVID-19 by helping to intubate a patient The PPE policy at that early period of the pandemic Developing the symptoms of, and being diagnosed with, COVID-19 Why she felt she shouldn’t share this information with other people early in her illness Her personal health experience of COVID-19 Quarantining in her home with her family The severe chest pains she later endured The many additional symptoms she developed as it turned into long COVID How she is feeling now, many months later, in her recovery Some thoughts about keeping healthcare workers safe from COVID-19   Naomi is courageous to tell her personal health story on a podcast. I really hope you find this valuable to listen to.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.   --------------------   Links related to Naomi Pratt Naomi Pratt at Peninsula Health Naomi Pratt on Twitter: @gnome3927   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 Audio Producer Chris Burke Burke Sound & Media

Episode 63: Naomi Pratt - A nurse practitioner’s personal and debilitating experience of long COVID

This episode is a departure from recent conversations about COVID-19 material to cover some very important topics on the human side of what we do in the ICU. My hope is you will glean valuable insights from an intensivist I admire greatly as both an expert practitioner and an esteemed educator of high-level intensive care communication - amongst other things, of course. Dr Steve Philpot is an Intensive Care Specialist at Cabrini Hospital in Melbourne with a special interest in end of life care, organ and tissue donation, communication skills training and empathy in the workplace. He is the National Lead Trainer for the DonateLife Family Donation Conversation Workshops, the Convenor of the College of Intensive Care Medicine communication training program, convenor of the Cabrini Health “Shared Decision Making” and “Advance Care Planning Conversations” workshops and chair of the Cabrini Health End of Life Care Committee. Steve is an Adjunct Senior Lecturer at Monash University and is involved in undergraduate communication training. He is currently completing a Masters of Health and Medical Law at Melbourne University. His other interests include playing guitar, singing, walking his dogs, the Fremantle Football Club (in the Australian Football League), and writing. Steve was once an advanced trainee where I worked as a consultant, and always displayed wisdom beyond his experience, something that comes through in this conversation, even if he is highly experienced now. We recorded this conversation before SARS-COV2 had been described, so there is no discussion of the COVID-19 pandemic, but I guess that makes it a favourable choice to listen to for many of you right now. In this conversation, Steve talks on topics including: The importance of being calm and collaborative His realisation that knowledge is not the most important thing we need The usefulness in giving positive feedback, and being helpful, kind and humble How tribalism damages workplace culture, and how we can deal with this The ways he builds relationships with other team members 3 vital points about, and his number 1 tip for communication The usefulness of having an evolving phrase library Shared decision making, including asking vital questions to learn what a patient really wants His outside work interests, and what his self-care practice is Thoughts on making a transition from a mega ICU to a smaller ICU, and The value of knowing you already know enough   Steve uses story-telling very powerfully in this episode. Please enjoy listening to Dr Steve Philpot.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you to bring your best self to the Intensive Care bedside, through conversations about the human side of what we do, so you can be the most kind, compassionate and effective healthcare practitioner you can be.   --------------------   Links related to Steve Philpot Steve Philpot at Cabrini Health Intensive Care Unit Steve Philpot on LinkedIn Donate Life Family Donation Conversation Workshops (Steve is National Lead Trainer) Article by Steve Philpot on Shared Decision Making   Links to other resources (in order of mentioning) Study on Tribalism CICM Communication Course Article by Steve Philpot on Shared Decision Making Podcast “Dolly Parton’s America” Podcast “13 Minutes To The Moon” Podcast “This American Life” Podcast “Hamish & Andy” Author Jane Harper Book “Sapiens” (by Yuval Noah Harari)   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 Audio Producer Chris Burke Burke Sound & Media

Episode 62: Steve Philpot - Communication, tribalism, shared decision making and the value of knowing you already know enough

2020 has been a roller coaster year and I wish to acknowledge my friends of the Intensive Care world for your outstanding and awe-inspiring efforts as clinicians, researchers, educators, digital content creators, and mostly as human beings, compassionately caring for others in a truly unprecedented global crisis. COVID-19 is far from over yet. Massive numbers of cases are still being reported each day and many countries are re-instituting public health-focused social and business restrictions. So whilst the pandemic continues, unabated, it feels like the right time to reinvigorate the Mastering Intensive Care podcast, after a 6 month break, with an episode where I express my gratitude to each of you individually, thanking you for what you have done so far, and for what you will likely need to continue to do. This isn’t a thank you to one discipline of people who work in the ICU. It’s to every single person, in every role, who has supported either the people admitted to or those who work in any ICU in the world. We need to look after each other as the pandemic is not going away. The promise of a vaccine is really only that. And many of you have done it tough either through the gruelling and onerous work or through the exhausting fatigue, whether that be physical, mental or emotional, you’ve suffered. There have been many patients with COVID-19 admitted to ICUs, there have been many deaths, and sadly there have been many healthcare worker deaths, including Intensive Care professionals. My heart goes out to those who have died, their families and especially you as their colleagues. It has been one of the hardest things you have all had to deal with. The emotional turmoil, let alone the physical toil, many of you have been under has been extreme. And all I can hope for is that things settle down very soon. Thank you and well done. You are true heroes. Please listen to my tribute to the awesome and astonishing Intensive Care community of the world.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The show focuses on the human aspects of what happens at the Intensive Care Unit bedside. The aim is to inspire and support you to bring your best self to work as well as to be the most kind, compassionate and effective Intensive Care professional you can.   --------------------   Links to recent COVID-19 podcasts on Mastering Intensive Care Steve McGloughlin - Preparing for the COVID-19 pandemic (MIC #59) Firsthand COVID-19 patient experience from New York ICU nurse Simone Hannah-Clark (MIC #60)   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 Audio Producer Chris Burke Burke Sound & Media

Episode 61: A tribute to the global Intensive Care community for your COVID-19 efforts

In many parts of the world the COVID-19 pandemic is overburdening Intensive Care Units with huge numbers of critically unwell patients, many of whom are dying. Whilst China, Italy, Spain, France, Germany and the UK have been crisis-ridden over the last few months, one of the most inundated parts of the world right now is the USA and especially the state of New York. In this episode you will hear the firsthand experience of a New York City ICU nurse where things are extremely intense and overwhelming. Simone Hannah-Clark is a critical care nurse in the Medical ICU at the Mount Sinai hospital in Manhattan. Originally a New Zealander, she worked in both New Zealand and Australia before moving to the USA 15 years ago. Simone recently penned an engrossing New York Times opinion piece entitled “An ICU Nurse’s Coronavirus Diary”. In this podcast she delves deeper into her recent reality as a nurse caring for ICU patients with COVID-19. She recounts stories of the hard work, the sense of duty, the intricacies of personal protective equipment, the inspiring camaraderie, her revived passion for her job, and above all the heartbreaking emotion of dying patients with absent relatives. Nurses around the globe are doing extremely arduous jobs and risking their own health as they care for thousands of seriously ill people with COVID-19. They are the true linchpins of the ICU. As you’ll glean in this episode, Simone is a perfect example of the compassion, professionalism and humanity that is so essential in the world right now. Thanks for listening to this conversation with Simone Hannah-Clark.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The show aims to focus on the human aspects of what happens at the Intensive Care Unit bedside. Conversations with thought-provoking guests should hopefully help you to bring your best self to work as an intensive care clinician.   --------------------   Links related to Simone Hannah-Clark Simone Hannah-Clark on Twitter Opinion piece in New York Times “An ICU Nurse’s Coronavirus Diary” (by Simone Hannah-Clark)   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 Audio Producer Chris Burke Burke Sound & Media

Episode 60: Firsthand COVID-19 patient experience from New York ICU nurse Simone Hannah-Clark

In the midst of the global COVID-19 pandemic, this episode focuses on the pandemic planning all ICUs should be doing - if they haven’t already been overwhelmed. This week a Working Group of 30 colleagues released the Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines. This episode features the Chair of that Working Group, A/Prof Steve McGloughlin. Steve is an intensivist, an infectious diseases physician, and the Director of the ICU at the Alfred Hospital in Melbourne, one of the largest Australian ICUs. In this conversation, Steve talks about: How he is “hoping for the best and preparing for the worst” His confidence in the Australian Intensive Care system How and why the ANZICS COVID-19 Guidelines were developed Measures for increasing ICU capacity His belief that intensive care can be offered to all who might benefit in the pandemic The need to communicate more in a crisis to ease anxiety The value of asking “Are you confident we know what we are doing as a team”? PPE being safe as long as the equipment is used properly His ICU developing the role of a PPE monitor The hierarchy for negative pressure room use Splitting teams into 3 so workers are either on, on call, or totally off What the guidelines recommend about high flow nasal oxygen, non-invasive ventilation & ECMO The lack of evidence for medications and COVID-19 Looking after our teams by ensuring a degree of confidence How he will deal with the social isolation The ways we might obtain additional intensive care trained healthcare workers His thoughts on older health care workers and their risks If you are in a place where the number of COVID-19 patients are ramping up, I really think this is a must listen episode.   We are all in this together.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Steve McGloughlin A/Prof Steve McGloughlin A/Prof Steve McGloughlin on LinkedIn Alfred Intensive Care Unit   Links to resources (in order of mentioning) WHO situation reports on COVID-19 ANZICS COVID-19 guidelines (Version 1) ANZICS JAMA Network Video “Coronavirus in Italy - Reports From The Front Lines”   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 47 with Matt Morgan Mastering Intensive Care podcast - Episode 58 on "COVID-19 - We are all in this together" 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 Audio Producer Chris Burke Burke Sound & Media

Episode 59: Steve McGloughlin - Preparing for the COVID-19 pandemic

Our need to bring our best selves to work has become more important in the face of this COVID-19 pandemic sweeping the globe. Many intensive care clinicians are presently overwhelmed by escalating numbers of critically ill COVID-19 patients whilst many others are carefully preparing for seemingly inevitable local outbreaks. There is an eerie feeling where I live and work in Melbourne especially with the online reports and accounts from our heroic colleagues in harder hit places like China, Italy and even parts of the USA. My wife, Claire Davies, and I thought it would be useful to record a conversation about what’s going through our minds, right now in mid-March 2020, as public health officials and healthcare organisations around the world are either managing or preparing for the onslaught of individuals infected with the virus whilst also enacting public health measures such as social distancing and airline travel restrictions. Claire, who was a previous interview guest on episode 29, spent almost 2 decades as an intensive care nurse before retraining in pastoral care and now works in that role at Epworth Hospital in Melbourne. Claire and I fully recognise that colleagues in some parts of the world have significantly more experience with the novel Corona virus than we do but if, like us, you are thinking a lot about this pandemic and fearful of what is about to happen I hope you find some value in this conversation between Claire and I. In it we talk about: Our gratitude for those clinicians working in the overwhelmed areas Claire’s hope they know they are not alone Claire’s own current fears and how this has manifest Balancing the need to manage our fears whilst doing our crucial jobs Claire’s perspective on how we bring our whole selves to work The likely moral distress of making “war time-like” decisions about rationing ventilators The unknowns of providing pastoral/spiritual care in this situation Useful ways to help look after ourselves during the outbreak Recognising that if we don’t transform our personal trauma, we transfer it Trying to eat well, drink less alcohol, sleep well and to get in some exercise Trying to have deep compassion for people making the big decisions The opportunity this pandemic provides to bring us closer together as an intensive care community Being grateful and caring for each other in these times   We are definitely all in this COVID-19 thing together.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to resources (in order of mentioning) WHO situation reports on COVID-19 Robcast Podcast episode “I am calling you to talk about the Coronavirus” (by Rob Bell) Book “The Body Keeps The Score” (by Bessel van der Kolk)   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 29 with Claire Davies 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 Audio Producer Chris Burke Burke Sound & Media

Episode 58: COVID-19 - We are all in this together

Those of you who are consultant intensivists or attendings hopefully remember most of your trainees - especially the ones you met when you were a brand new intensivist. In this episode I speak with Dr Georg Auzinger who in 1997 moved from Austria to Australia to train in intensive care at the same ICU I was beginning my first job as a specialist intensivist. I have fond memories of working with Georg, have enjoyed the friendship we have developed and have been thrilled to see from afar how well his career has progressed. Nowadays Georg has a senior position in the United Kingdom intensive care field where he is Consultant Honorary Senior Lecturer in Intensive Care Medicine, Lead Clinician at the Liver Intensive Care Unit and Director of the Veno Arterial ECMO service at King’s College Hospital NHS Foundation Trust in London. He is PTEeXAM board certified for perioperative transoesophageal echocardiography and also leads on critical care echocardiography training. Georg has played a substantial role in the outstanding international reputation the Liver Intensive Care Unit at King’s has maintained over the last decade. He is member and associate fellow of the UK Intensive Care Society, as well as member of the European Society of Intensive Care Medicine, the Society of Critical Care Medicine, the Austrian Society of Internal Medicine and the International Liver Transplantation Society. In this conversation, Georg and I do some reminiscing, as we talk about: His transition from doing general medicine in Austria to intensive care in Australia How he found his way to Kings College Hospital in London The changes in the last 2 decades in the types of patients being admitted to ICU The current resource constraints in the UK Working in the Clinical Director role in a busy institution How beneficial colleague performance reviews can be for both parties Relationship building between nurses and doctors Communicating with colleagues The importance of keeping the patient at the centre of what we do The difficulties he recognises in balancing his work and life   Please enjoy listening to Dr Georg Auzinger.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Georg Auzinger Dr Georg Auzinger at Kings College Kings College Hospital Liver ICU   Links to other resources (in order of mentioning) Prof Julia Wendon Cleveland Clinic London New Normal Project podcast   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Mastering Intensive Care podcast - Episode 12 with Julia Wendon Mastering Intensive Care podcast - Episode 55 with Mervyn Singer Mastering Intensive Care podcast - Episode 56 - What’s in the Journals to help you care 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 Audio Producer Chris Burke Burke Sound & Media

Episode 57: Georg Auzinger - Remembering to keep the patient at the centre of what we do

In this episode I talk about what’s been recently published in the medical literature to help you master intensive care from a humanity point of view. In a departure from the usual interview episode, and as a trial, I searched the December 2019 issues of 8 well-respected journals and found a large number of articles focused on non-technical aspects of intensive care. Not the drugs, devices, procedures or interventions, but the person-based and human-focused topics I like to concentrate this podcast on. As I’ve transitioned in my own career from being a researcher of interventions to a producer of a podcast focused on being the best all-round intensive care-givers we can be, I’ve realised there is a growing literature on non-technical topics, some of which I’m not well enough aware of on a day to day basis. So in this episode I found numerous articles from December 2019 which I believe can help you and your colleagues humanise the intensive care you give at the bedside. Some are research studies, some are reviews, and others are stories, essays, poems, or simply writings. I focus in some detail on 3 specific journal articles on the topics of (1) family engagement, (2) family support and (3) early palliative care consultation. I then refer you briefly to 10 other articles so you can read these in full if you are interested. There are links to all of these articles below. I really hope you enjoy and value this episode. I learnt a lot from reading these articles myself. Please send any feedback, questions or comments to andrew@masteringintensivecare.com.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links to 3 Journal articles reviewed in detail Kleinpell R, Zimmerman J, Vermoch KL, et al. Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs. Crit Care Med. 2019;47(12):1692–1698. doi:10.1097/CCM.0000000000004009   PubMed link   Associated editorial Lee HW, Park Y, Jang EJ, Lee YJ. Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis [published correction appears in Intensive Care Med. 2019 Oct 8;:]. Intensive Care Med. 2019;45(8):1072–1081. doi:10.1007/s00134-019-05681-3   PubMed link Ma J, Chi S, Buettner B, et al. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit Care Med. 2019;47(12):1707–1715. doi:10.1097/CCM.0000000000004016   PubMed link   Links to 10 Journal articles mentioned briefly Barreto BB, Luz M, Rios MNO, Lopes AA, Gusmao-Flores D. The impact of intensive care unit diaries on patients' and relatives' outcomes: a systematic review and meta-analysis. Crit Care. 2019; 23(1):411. Published 2019 Dec 16. doi:10.1186/s13054-019-2678-0   PubMed link Ramchand P. The gift. Lancet. 2020; 394(10216):2283–2284. doi:10.1016/S0140-6736(19)32961-7   PubMed link Harrington JL. The Case for Waking. JAMA. 2019; 322(22):2251. doi:10.1001/jama.2019.17962   PubMed link Maskell G. True candour. BMJ. 2019; 367:l6754. Published 2019 Dec 3. doi:10.1136/bmj.l6754   PubMed link Rimmer A. Bring me joy. BMJ. 2019; 367:l6745. Published 2019 Dec 16. doi:10.1136/bmj.l6745   PubMed link Klaber RE, Bailey S. Kindness: an underrated currency. BMJ. 2019; 367:l6099. Published 2019 Dec 16. doi:10.1136/bmj.l6099   PubMed link Morgan M. Matt Morgan: Cold food on hot desks. BMJ. 2019; 367:l6829. Published 2019 Dec 10. doi:10.1136/bmj.l6829   PubMed link Rimmer A. Suicide in anaesthetists: five minutes with . . . Samantha Shinde. BMJ. 2019;367:l6781. Published 2019 Dec 2. doi:10.1136/bmj.l6781   PubMed link Auriemma CL, Van den Berghe G, Halpern SD. Less is more in critical care is supported by evidence-based medicine. Intensive Care Med. 2019;45(12):1806–1809. doi:10.1007/s00134-019-05771-2   PubMed link Auñón-Chancellor S. Earthling. Ann Intern Med. 2019; 171(12):937–938. doi:10.7326/M19-2759   PubMed link   Links to 8 Journals searched New England Journal of Medicine JAMA: Journal of the American Medical Association BMJ: British Medical Journal The Lancet Annals of Internal Medicine Critical Care Medicine ICM Journal: Intensive Care Medicine American Journal of Respiratory and Critical Care Medicine Critical Care   Links to other resources mentioned Mastering Intensive Care podcast - Episode 3 with Rinaldo Bellomo Critical Care Reviews Link to sign up to Critical Care Reviews newsletter PRISMA statement Mastering Intensive Care podcast - Episode 32 with Kate Harding   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 50 with Andrew Davies Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 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 Audio Producer Chris Burke Burke Sound & Media

Episode 56: What’s in the Journals to help you care - February 2020

Anyone who has heard UK intensivist Prof Mervyn Singer speak at an Intensive Care conference will no doubt enjoy listening to him speak on this episode of Mastering Intensive Care. Mervyn Singer is Professor of Intensive Care Medicine at University College London in the UK. He was born, bred, trained, and now works in London as an intensivist and a researcher whose career spans from basic mechanistic work through to translational investigations and multi-centre trials. He co-chaired the ‘Sepsis-3’ international definitions task force, is Editor-in-Chief of Intensive Care Medicine Experimental and Treasurer of the International Sepsis Forum. Mervyn has published widely in a variety of journals and has authored or co-edited several textbooks including the Oxford Textbook of Critical Care. He was the first UK intensivist to be awarded Senior Investigator status by the UK National Institute for Health Research, and to be invited to give plenary lectures at the European and US Intensive Care Congresses. In this conversation Mervyn is full of his usual enthusiasm as we covered many important topics including: How he became an intensivist What he’s observed about the physiological basis of intensive care The clinical ward round process he follows The scheme in his ICU to allow patients to die at home How he leads an end of life conversation The benefits to having an ICU-based psychologist How institutions might better care for their junior staff How much he enjoys his career His "can do" attitude How his passion for sport has helped him His regular sleep pattern The value he receives from doing body stretching His use of email and social media Mentoring younger trainees Which of his research makes him most proud His tips for giving a good lecture Some excellent advice to conclude our conversation   I invite you to listen in to my conversation with Mervyn Singer.   Andrew Davies   --------------------   About the Mastering Intensive Care podcast: The podcast is aimed to inspire and empower you to bring your best self to the intensive care unit, through conversations with thought-provoking guests. The hope is you’ll glean insights to move you closer towards being the best and most human healthcare professionals you can be, so you can make the most valuable contribution to your patient’s lives.   --------------------   Links related to Mervyn Singer Prof Mervyn Singer Mervyn Singer brief CV   Links to other resources (in order of mentioning) David Bennett's Obituary (co-authored by Mervyn Singer) Edith Piaf The Cricket “Ashes” New Normal Project podcast   Links related to Mastering Intensive Care podcast Mastering Intensive Care podcast - Episode 51 - A Recap of 2019 Mastering Intensive Care podcast - Episode 52 with Martin Bromiley Mastering Intensive Care podcast - Episode 53 with Paul Wischmeyer Mastering Intensive Care podcast - Episode 54 with Deborah Cook 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 Audio Producer Chris Burke Burke Sound & Media

Episode 55: Mervyn Singer - Career enjoyment, curiosity and a “can-do” attitude

This podcast is designed to inspire intensive care clinicians to become the very best they can be at delivering care to their critically ill patients.

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Mastering Intensive Care

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