ANZICS The Intensivist Newsletter April 2013

01THE INTENSIVIST APRIL 2013

02 Paediatric Acute Lung Injury Consensus Conference

04 President’s Report

07 Safety and Quality

08 Education

09 Membership

11 CORE

14 Death and Organ Donation Committee

15 PricE Committee

16 Paediatric

17 CTG

19 Regional Committees

APRIL 2013

Advocate for intensive care throughout Australia

and New Zealand

INTENSIVISTTHE

02 THE INTENSIVIST APRIL 2013

Paediatric Acute Lung Injury Consensus ConferenceIn 2011, I was asked to represent ANZICS and the Australian and New Zealand region on the Paediatric Acute Lung Injury Consensus Conference. The conference was the vision of three experts in Paediatric Acute Lung Injury-Doug Willson, Neal Thomas and Philippe Jouvet. The PALICC ‘s aim is to establish a more workable and clinically-relevant definition for Acute Lung Injury in children and look in detail at risk factors, management and outcome.

ANZICS, along with the corresponding European, Canadian and US ICU representative organizations, have endorsed this process which is likely to benefit paediatric intensive care practitioners worldwide.

International Consensus Conference on Paediatric Acute Lung Injury (PALICC)

In 1994, a consensus group of expert intensivists from North America and Europe met to establish uniform criteria to define acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). This definition included: (1) Acute onset of hypoxemia; (2) Bilateral infiltrates on chest X-Ray; (3) Pulmonary artery wedge pressure of less than 18 mmHg, or no clinical evidence of left atrial hypertension; and, (4) PaO2/FiO2 ratio ≤ 300 for ALI and PaO2/FiO2 ratio ≤ 200 for ARDS (regardless of PEEP).

Unfortunately the definition formulated in 1994 was not accurate enough to define the illness either for clinicians at bedside or for researchers conducting trials. The deficiencies included:

(1) PaO2/FiO2 ratio was not constant across a range of FiO2 and may vary in response to ventilator settings, particularly PEEP

(2) Inter-observer agreement in interpretation of chest X-ray findings was only moderate

(3) Elevated capillary wedge pressures were observed because of transmitted airway pressures and/or vigorous fluid resuscitation

(4) When compared to pathology, the ARDS definition sensitivity was of 84% and specificity only 51%

A second consensus group convened in Berlin in 2011 to modify the definitions of ALI/ARDS in an attempt to overcome the weaknesses of the 1994 definition. The resulting modifications appear to improve feasibility, reliability, and face and predictive

validity. (1) Identification of a risk factor as either direct lung injury (pneumonia, aspiration of gastric content, inhalation injury, pulmonary contusion, near drowning) or indirect lung injury (non-pulmonary sepsis, major trauma, multiple transfusions, severe burns, pancreatitis, non-cardiogenic shock, drug overdose); and, (2) The criteria presented in the table above.

Paediatric intensivists did not participate to the 2011 ARDS consensus conference and, consequently, the definitions are not adapted for children. Specific requirements for “Paediatric ALI/ARDS” definitions include different risk factors, PEEP criteria for hypoxemia, and considerations regarding physiologic differences in infants and children relative to adults. Paediatric lung injury differs in aetiology, in some aspects of treatment, and probably has significantly better outcomes compared to that of adults. As a consequence the 2011 definitions are of limited value for paediatric intensivists.

Despite the many epidemiologic, interventional, and outcome studies


completed looking at paediatric ALI, the vision as to how to improve the outcome of this deadly disease process is still lacking. Hence a group of paediatric intensivists will convene over a number of international meetings, culminating in the presentation of the final document and recommendations at the PALISI meeting in Salt Lake City 2014.

The first obvious goal will be to develop a better taxonomy to define paediatric acute lung injury. Secondly, the group will develop consensus criteria to study and treat acute lung injury, including short-term and longer-term outcomes. This will require review of existing data as well as discussion of current opinions and experience. Finally, we hope to develop collaborative relationships to spur research forward on an international scale.

SPECIFIC AIMS:

1. Definition, incidence, and epidemiology of ALI in children

2. Severity and co-morbidities

3. Ventilatory support

4. Pulmonary specific ancillary treatments

5. General (non-pulmonary specific) ancillary treatments

6. Monitoring of paediatric patients on mechanical ventilation

7. Non-invasive support and non-invasive ventilation in paediatric ALI

8. ECMO and other modes of extraordinary support

9. Complications and long-term outcomes

The Organizing Committee (OC) is made of 3 members of the Paediatric Acute Lung Injury Network (PALISI): Philippe Jouvet (Canada), Neal Thomas (USA), and Doug Willson (USA).

The process is endorsed by ANZICS, ESPNIC, PALISI.

Simon Erickson ANZ representative on PALICC Chair, ANZICS Paediatric Study Group

REFERENCES1. Gowda MS, Klocke RA. Variability

of indices of hypoxemia in adult respiratory distress syndrome. Crit Care Med 1997;25(1):41-45.

2. Ferguson ND, Kacmarek RM, Chiche JD, et al. Screening of ARDS patients using standardized ventilator settings: influence on enrollment in a clinical trial. Intensive Care Med 2004;30(6):1111-1116.

3. Villar J, Perez-Mendez L, Kacmarek RM. Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intensive Care Med 1999;25(9):930-935.

4. Villar J, Perez-Mendez L, Lopez J, et al. An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2007;176(8):795-804.

5. Rubenfeld GD, Caldwell E, Granton J, et al. Interobserver variability in applying a radiographic definition for ARDS. Chest 1999;116(5):1347-1353.

6. Meade MO, Cook RJ, Guyatt GH, et al. Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome. Am J Respir Crit Care Med 2000;161(1):85-90.

7. Ferguson ND, Meade MO, Hallett DC, et al. High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome. Intensive Care Med 2002;28(8):1073-1077.

8. Wheeler AP, Bernard GR, Thompson BT, et al. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006;354(21):2213-2224.

9. Esteban A, Fernandez-Segoviano P, Frutos-Vivar F, et al. Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med 2004;141(6):440-445.

10. Ferguson ND, Frutos-Vivar F, Esteban A, et al. Acute respiratory distress syndrome: underrecognition by clinicians and diagnostic accuracy of three clinical definitions. Crit Care Med 2005;33(10):2228-2234.

11. Angoulvant F, Llor J, Alberti C, et al. Inter-observer variability in chest radiograph reading for diagnosing acute lung injury in children. Pediatr Pulmonol 2008;43(10):987-991.

12. Kneyber MC, Brouwers AG, Caris JA, et al. Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit? Intensive Care Med 2008;34(4):751-754.


President’s Report THE FUTURE OF THE SOCIETY: STRATEGIC PLANNING

A Strategic Planning Workshop was held prior to the Board meeting in February. The Workshop was attended by the majority of the Board Directors. The Board reviewed the progress made against the goals and objectives agreed in the 2010 Strategic Planning process and attempted to establish the focus and objectives for the next three years. Our Society’s stated goal is to be respected as a leading authority and advocate for intensive care in Australia and New Zealand. There was much discussion and many suggestions around how we maintain and consolidate that position including improving our visibility and profile, improving access to information and reports, showcasing ANZICS’ achievements and regular review of ANZICS’ relevance. We would hope to have a report ready for circulation and member feedback by the ASM in October.

GOVERNANCE REVIEW

Discussions about Governance can cause anxiety among some doctors and I would include myself in that group. The more time I spend in this position the more I recognise the vital importance of good governance to the success of our Society. Governance is simply about maximising quality and reducing risk. I am sure we would all agree that these should be the guiding principles for delivery of good outcomes for our members, for the wider intensive care community and for our patients. Work continues on the Governance Review project, with a number of key policy documents having been reviewed by the Board at the February meeting. As I have mentioned previously the Board is working in particular on producing a robust Endorsement Policy. Hopefully this also will be ready soon for circulation to the membership.

ANZICS SCIENTIFIC MEETINGS

The 2012 ANZICS/ACCCN ASM held in Adelaide in October was a really successful meeting. Excellent feedback on the strong scientific program has been received from invited speakers and delegates alike.

Planning for the 2013 and 2014 ASMs is well underway. The integration of CTG, CORE, Death and Organ Donation +/- other Standing Committees as appropriate in to the main ASM programme is a welcome addition to the Hobart meeting. The inclusion of these sessions will provide an opportunity both to promote the work of the Committees to the wider membership and to engage with members. There has been a late change of venue for the 2014 ASM which is now planned to be held in Melbourne. The lack of the Sydney Convention Centre in 2014 meant that there was no real viable venue for a meeting as large as the ASM. The decision therefore was made in conjunction with the ACCCN to run the meeting in Melbourne. I would like to thank Deepak Bhonagiri and the NSW Organising Committee for the work that they have done. Thank you also to Stephen Warrillow and the Victorian Committee for taking up the baton. This is particularly impressive given the amount of work that Stephen is putting in to the Melbourne bid for the World Federation meeting in 2019.

By the time you read this the 15th Annual Meeting on Clinical Trials in Intensive Care will have been held from 7th – 9th March in Noosa. It promises to be yet another tour de force from the CTG with record numbers of registrants and a really exciting scientific programme. Well done and thank you to all involved.

The 2nd Singapore-ANZICS Intensive Care Forum will be held in Singapore from 12th – 14th July 2013. The Organising Committee has developed an impressive programme with a number of key international and local speakers.

The 7th Safety, Quality, Audit and Outcomes Conference will be held from 29th – 30th July 2013 in Sydney.

I encourage you all to attend.

The ANZICS-India Scientific Exchange Initiative will be held again in 2013, lead by Deepak Bhonagiri.

WORKFORCE ISSUES

Workforce planning issues remain a concern amongst members, many of whom have communicated their concerns to the Society and also to the College. There are reports of unemployed and underemployed Fellows particularly in the Eastern states. There are also reports of positions being advertised with no applicants. It would be useful to survey recently qualified Fellows regarding their employment status. We would like to work with the College to acquire this information.

From an ANZICS perspective there is a wealth of information regarding the working status of Fellows captured currently in the CCR survey. Following discussions with Peter Hicks and David Pilcher we are planning on adding some extra questions to the next on-line CCR survey which will be circulated in

October. This will hopefully shed some more light on the truth of the situation. In the meantime we will send a short survey to Directors to get some preliminary data. I would urge Directors of Units to engage with this process as the extra information acquired will put us in a better position to plan for the future. I would hope that we can work closely with the College to address these concerns.

ANZICS CORE

Discussions continue with Monash representatives regarding the proposed relocation of ANZICS CORE.

The Executive approved the CORE Management Committee proposal for funding to scope the AORTIC redevelopment project. This project is an important piece of work to ensure the ongoing delivery of CORE services.

“The 2012 ANZICS/ACCCN

ASM held in Adelaide in

October was a really successful

meeting.”


Discussions are ongoing with Queensland private units regarding participation in the ANZICS CORE Registries, following Queensland Health cutting its funding to ANZICS CORE by 40%. A number of units have indicated an intention to participate.

The 2010-11 CORE Annual Report was published in early February and can be viewed at http:// www.anzics.com.au/core/reports. I would encourage you to read this comprehensive and extremely informative report.

DEATH AND ORGAN DONATION COMMITTEE

The revised ANZICS Statement on Death and Organ Donation will be published shortly. The current version 3.2 will be published in electronic format.

It is hoped that the survey of attendees at the Family Donation Conversation Workshops, as discussed at the October Board meeting, will take place soon.

WORLD FEDERATION OF SOCIETIES OF INTENSIVE AND CRITICAL CARE MEDICINE

The 11th Congress of the WFSICCM will be held in Durban in August this year. ANZICS has a proud tradition of involvement with the World Federation having been there at the foundation. Malcolm Fisher and Geoff Dobb have demonstrated tremendous committment and involvement in the past. Unfortunately we have had no Australian and New Zealand representation for the past few years. I am pleased to say that John Myburgh has agreed to nominate as

the ANZICS representative to the Council. I would urge all members who are planning to attend to make sure that they cast their vote appropriately!

Stephen Warrillow will also be attending where he will be bidding to host the Congress in Melbourne in 2019. Having a representative on the Council puts a Society in a much stronger position when making such a bid. Stephen has worked extremely hard on this and I would encourage everybody who can to support both him and John.

Mary White President, ANZICS

ANZICS EVENTSClinical Trials Group (CTG) Novel Trial Design Workshop 30 May 2013 Wellington, New Zealand http://www.anzicsctg.org

Singapore-ANZICS Intensive Care Forum 2013 12 – 14 July 2013 Max Atria, Singapore Expo http://www.sg-anzics.com

Safety Quality Audit and Outcomes (SQAO) 2013 27 – 31 July 2013 Sydney, NSW http://www.sqao-anzics.com

The 25th ANZICS Intensive Care Medicine Course 8 – 11 August 2013 Melbourne, VIC http://www.anzics.com.au/conference/anzics-icm http://www.easternhealth.org.au/media/events/icm.aspx

Clinical Trials Group (CTG) Winter Research Forum 22 – 23 August Melbourne, VIC

ANZICS/ACCCN Annual Scientific Meeting 2013 17 – 19 October 2013 Hobart, TAS http://www.intensivecareasm.com

Are you up to date?A reminder to update your contact details to ensure that you receive all ANZICS communications. Contact Brent Kingston via [email protected] or +61 (3) 9340 3400.

ANZICS BOARDPresident Mary White

Vice President Andrew Turner

Honorary Secretary Simon Erickson

Honorary Treasurer Marc Ziegenfuss

VIC Regional Chair Stephen Warrillow

NSW Regional Chair Deepak Bhonagiri

SA Regional Chair Stewart Moodie

QLD Regional Chair Anthony Holley

NZ Regional Chair David Knight

WA Regional Chair Ian Jenkins

TAS Regional Chair David Rigg

CORE Chair David Pilcher

CTG Chair Colin McArthur

Paediatric Chair Johnny Millar

PricE Chair Ian Jenkins

AUSTRALIAN AND NEW ZEALAND INTENSIVE CARE SOCIETY ABN 81 057 619 986

PO Box 164, Carlton South, Vic 3053 Australia

T: +61 (0)3 9340 3400 F: +61 (0)3 9340 3499 E: [email protected] W: www.anzics.com.au

The 38th Australian and New Zealand Annual Scientific Meeting on Intensive Care and the 19th Annual Paediatric and Neonatal Intensive Care Conference

www.intensivecareasm.com.au

walK ON THE wIlDSIDE

KEY DaTES:

Abstract Submissions Open: 25 March 2013Registrations Open: 25 March 2013Abstract Submission Deadline: 12 July 2013Early Bird Registration Deadline: 16 August 2013


The Safety and Quality Committee is in the final stages of developing its first Strategic Plan (2012 – 2015). The Plan will be used to guide the Committee’s program to promote, support and encourage safety and quality in intensive care.

The Committee is continuing to develop the ‘Prevention of Ventilator Associated Pneumonia in the Mechanically Ventilated Patient Consensus Statement.’ The purpose of this Statement is to provide recommendations to guide local clinical practice guidelines aimed at reducing the risk of ventilator associated pneumonia in patients receiving mechanical ventilation. Members’ feedback will be sought and a survey is currently being developed in order to determine members’ agreement with the statement particularly in areas where evidence is lacking.

The Committee is also developing a central line insertion training framework. Development of this framework came as the result of interest from the membership following the launch of the CLABSI Prevention Project. The Committee anticipates that the framework will be used as a guide for those

units training clinicians new to central line insertion in Australian and New Zealand ICUs. The Committee anticipates seeking wider consultation and surveying the ANZICS membership as part of this development process.

Planning for the 7th International Conference on Safety, Quality, Audit and Outcomes Research in Intensive Care is well underway. The conference will be held at the Hilton in Sydney commencing Monday 29 July 2013. The organisers are planning for 2 concurrent workshops with program currently in the process of being finalised. Abstract submission is now open and will close on Friday 26th April 2013. For further information visit the conference website, www.sqao-anzics.com

You will also no doubt be aware that the Australian Commission on Safety and Quality in Health Care has developed the National Safety and Quality Health Service (NSQHS) Standards. The aim of the 10 standards is to provide a nationally consistent statement and improve the quality of health care in Australia. In September 2011, the Health Ministers endorsed the NSQHS Standards and a national accreditation scheme. Accreditation to the NSQHS Standards commenced in January 2013. For further information regarding the Standards and the National Accreditation Scheme please refer to the Commission’s website: www.safetyandquality.gov.au

The Safety and Quality Committee is on Twitter. Please follow us at @anzics_safety.

For further information regarding the ongoing work of the Safety and Quality Committee please feel free to contact [email protected].

Deepak Bhonagiri Chair, Safety & Quality Committee

ANZICS SAFETY & QUALITY COMMITTEE

Immed. Past Chair Tony Burrell

NSW Sumesh Arora

NT vacant

WA John Lewis

VIC Cameron Knott

SA Krishnaswamy Sundararajan

TAS Benoj Varghese, Michael Buist

ACT Manoj Singh

NZ Alex Kazemi

QLD Jeffrey Presneill

CICM Mary Pinder

ACCCN Bernadette Grealy

Co-opted Brigit Roberts

Safety and Quality

“Planning for the 7th International Conference on Safety, Quality, Audit and Outcomes Research

in Intensive Care is well underway.”


EducationFollowing on as a result of the survey of medical delegates at the 2012 ANZICS/ACCCN ASM, the Education Committee has provided a set of recommendations to ANZICS Board at their recent meeting.

As reported in the last Intensivist, the scientific content of the 2012 ASM was very well received. This is not to say though, that the results did not indicate areas which could be improved or at least we could understand better the educational needs of members. There appears to be two distinct groups of attendees, one with an interest in particular research or highly focused issues who are closely following or contributing to the development of this knowledge base. The second group are interested in mainstream issues of intensive care medicine and clinical service delivery who wish to ensure they are abreast of significant developments. The meetings of the Society must continue to be attractive to both groups across which there is clearly considerable overlap.

Among the recommendations tabled to the Board was that the major sub-committees of the Society provide updates on their ordinary and extraordinary activities, in a format or session separate from the AGM. It has been confirmed that both the ANZICS Centre for Outcomes and Research Evaluation and the ANZICS Clinical Trials Group are preparing to present at sessions, outside of the AGM, on their recent activities; an important outcome that will reassure members that their ongoing support to the Society is providing value for money and providing members with the opportunity to share in the outstanding knowledge and expertise of these groups of colleagues.

Another recommendation to the Board was that the adult and paediatric programs continue

to become integrated such that delegates and presenters can benefit and contribute to both programs in common domains. This recommendation resulted from the finding of the survey, which indicated that many of those attending the adult sessions had an interest in the

paediatric topics and similarly many of the topics on the adult program have a more general application.

Finally, the Education Committee is looking at ways in which ANZICS can provide more value from its invited speakers. The development of this will need to be of a strategic nature resulting in platforms for effective data dissemination and sharing, integral to the development of the Society. Work

on this will be an ongoing project of the Committee, with regular updates provided.

On the back of this survey of medical delegates, the Education Committee has now constructed a survey for those ANZICS members that were not in attendance at the ASM. This is an activity of perhaps even more importance than the delegate survey, as this will give the Society a unique insight into ways of increasing ASM attendance from those members who are not currently taking advantage of this meeting. This survey has been timed to be released within a week of this issue of The Intensivist. It is important to note, that anyone who attended the ASM, who elected to remain unidentified on registration, will also receive this survey. This ensures that all ANZICS members will have the opportunity to provide contribution to the ongoing shaping and development of the ASM.

Finally, the Education Committee now has an online speaker evaluation form. This is intended to assist ANZICS identify speakers at international meetings, who may be of interest for future meetings organised by the Society. This has been achieved by placing this speaker evaluation form on the ANZICS website. This short form is smart phone friendly, and is accessed at http://www.anzics.com.au/committees/education/speaker-evaluation-form. We urge you to visit this address from your phone, and bookmark it to your home screen for use at the next meeting you attend.

Gerry O’Callaghan Chair, Education Committee

ANZICS EDUCATION COMMITTEE

Deputy Chair Stephen Warrillow

QLD Matthew Keys, Todd Fraser

VIC Owen Roodenburg, Sam Radford

NSW Michael O’Leary, Charudatt Shirwadkar, Liz Fugaccia, Dhaval Ghelani

SA Mary White

WA Simon Erickson

ACT Sumeet Rai

NZ Rob Bevan

NT vacant

TAS vacant

“…the ANZICS Centre for Outcomes

and Research Evaluation and

the ANZICS Clinical Trials

Group are preparing to present at sessions, outside of the AGM…”


Membership of the Society remains strong with 737 members and continues to grow as a result of the efforts of the Regional Chairs, LinkPersons and members. I wish to express my appreciation to all our members, who have helped promote ANZICS and our activities.

A reminder to those members with outstanding subscriptions that they can be paid online via: https://www.secureregistrations.com/ANZICS

I would also like to take this opportunity to welcome the following new members:

Dr James Broadbent Wellington Hospital Capital Coast & DHB

Dr Rajeev Hegde Royal Brisbane & Women’s Hospital

Dr Laurence Walker Wellington Regional Hospital

Dr Dashiell Gantner The Alfred Hospital/Monash University

Dr Nick Kokotsis Maroondah Hospital

Dr Hamish Jackson Royal Hobart Hospital

Dr Paolo Calzavacca The Austin Hospital

Dr Palash Kar Royal Adelaide Hospital

Mr Caleb Economou Royal Brisbane & Women’s Hospital

Dr Amir Haq Wellington Hospital

Dr Angaj Ghosh The Northern Hospital

Dr Ida-Fong Ukor The Austin Hospital

Dr Larissa Douglas The Austin Hospital

Dr Andrew Dawson The Austin Hospital

Dr Christopher Moran The Austin Hospital

Dr Josh Ihle The Alfred Hospital

Dr Sachin Gupta Peninsula Health

Dr Angus Carter Ballarat Base Hospital

Mrs Luzviminda Azares Macquarie University Hospital

Dr Peter Velloza The Canberra Hospital

Dr Ramanathan Lakshamanan John Hunter Hospital

Dr Juan Carlos Mora The Austin Hospital

Simon Erickson Honorary Secretary

Membership


COREThe beginning of 2013 sees CORE in ‘business as usual’ mode. For the first time in a long time, we have an almost full complement of staff which will allow us to begin development on top of many routine activities.

THE ANZICS CORE ANNUAL REPORT

The most recent CORE Annual report was released at the beginning of the year and describes adult and paediatric Intensive Care practice in Australia and New Zealand in 2010/2011. With over 110,000 adults and children admitted to Intensive Care Units throughout the two countries each year, it is likely that every person reading this report knows a friend or family member who has been admitted to an ICU. Some will have come through the ICU as part of routine post-operative care following major complex surgery, some will have been admitted with life threatening medical conditions, most will eventually return home but all will have seen the huge efforts put in by staff to provide safe high quality care. This report describes not only the overall outcomes of these patients but details the services and high standards of care which are routine in all Australian and New Zealand ICUs. The report has been sent out to all ICU Directors and is available on line at http://www.anzics.com.au/core/reports

No other country is in a position to produce a report like this and everyone who practises in this field from the doctors, nurses, dieticians and physios providing direct bedside care to the data collectors, support staff and administrators should feel proud of the excellent outcomes in this report and this comprehensive description of Intensive Care Medicine in our two countries.

ANZICS CRITICAL CARE RESOURCES REPORT AND ANZ PAEDIATRIC REGISTRY REPORT

The most recent Critical Care Resources (CCR) Registry and ANZ Paediatric Registry reports have also recently been released. The CCR report details in depth the provision and capacity to deliver Intensive Care throughout Australia and New Zealand. The paediatric report provides a comprehensive picture of

paediatric Intensive Care practice and outcomes. Both of these are ‘definitive’ reports which provide a wealth of information for clinicians, researchers and policy makers. A huge thank you to all involved in their production.

ON-LINE CRITICAL CARE RESOURCES SURVEY

One of the most important achievements last year was the development of the on-line ANZICS Critical Care Resources Registry. By the time you read this the new survey will have been sent to you. We would urge all to contribute. It is only through this that we are able to provide such a comprehensive picture of Intensive Care resources (beds, staff and services). The on-line system also give you the ability to compare your hospital to your peer group and is available at https://ccrsurvey.anzics.com.au. If you need a login, contact us at [email protected]

CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION (CLABSI) REPORTS COMING SOON

At present 46 hospitals in Victoria, Western Australia, ACT and Tasmania have submitted data either directly or via jurisdictional infection control bodies. Provisional reports providing peer group comparisons of your ICU’s CLABSI rate will be available within a few weeks. To all the contributing sites and jurisdictions we say a big thank you. We look forward to being able to provide additional reports to you in the future once enough accumulated data is available.

NEW ADULT ICU PERFORMANCE REPORTS

Following the latest Adult Patient Database submission, CORE has introduced additional reports which detail your ICU’s readmission rates, after-hours discharge rates and provision of prophylaxis for venous thrombo-embolism. These are

available along with routine reports of mortality and length of stay on the ANZICS CORE portal. There is a progressive focus on additional markers of performance beyond mortality rates. These reports now allow ICU doctors to see how their hospital compares on numerous metrics. If you need access to your hospital report contact us at [email protected] or talk to your ICU Director and data submission staff.

QUEENSLAND PRIVATE HOSPITALS

At the beginning of this financial year, Queensland Health decided that it would no longer contribute funds to cover submission of data from and reporting to private hospitals in the state. ANZICS CORE has been liaising directly with private hospitals in Queensland. Presently over half of the hospitals have agreed to continue contributing to ANZICS CORE. The services offered by CORE (regional, national and international risk adjusted outcome reporting, performance indicator monitoring, comparisons of ICU resources, peer group reporting of CLABSIs, reports directly to ICU directors and CEOs, reports grouped by CICM level and by private ownership group) are available through no other quality assurance program. In an era where governance and accountability are paramount, we would urge all other private hospitals to join in too.

ANZROD

One of the major pieces of research over the past year has been the development of the new ANZ Risk of Death Model for adult ICU admissions. Watch out for presentations and publications over the next year while we assess its performance and ability to ‘beat’ APACHE.

Thank you for all your support,

David Pilcher Chair, ANZICS CORE

care when it matters

intensive care society







The Intensive Care Society Churchill House, 35 Red Lion SquareLondon WC1R 4SGT: 020 7280 4350 F: 020 7280 4369 E: [email protected] www.intensivecarefoundation.org search: Intensive Care Society trainees follow us @ICSMeetings search: Intensive Care Society trainees follow us @ICSMeetings search: Intensive Care Society trainees follow us @ICSMeetings

Monday 16 to Wednesday 18 December 2013The ICC, East ExCeL, London

The UK’s largest meeting for Intensive Care ProfessionalsJoin us for 3 days in December 2013• Sessions to include: ICU Costing, The Heart of the Matter, Traumatic Time, Optimal

staffi ng of an ICU, Non-Invasive Ventilation session, Change for the Better? Surgical Intensive Care, Trainee session: `Every Cloud has a silver lining’, Monitoring

• The Cauldron • Interactive Session • Pro-Con Debates• Joint ESICM Session• Research and Clinical Practice Free Paper Presentations• Gold Medal Award• Gillian Hanson Lecture• The David Bennett Lecture: An interview with Prof. Arthur Slutsky• Industry Symposiums• Interactive Exhibitions• Poster Display

Abstract Submission Each year the ICS offers new investigators the opportunity to present their work in either a poster or oral format at the State of the Art Meeting. We are now accepting submissions for the Gold Medal award and the Abstract Free paper presentations. Deadline: 5pm, 8th August 2013.

The State of the Art Meeting 2013

CPD Accreditation: 15 Points Pending Email [email protected] for further information


Since the last meeting of the Death & Organ Donation Committee (DODC) in October, the Committee and its members have been hard at work.

ANZICS STATEMENT ON DEATH & ORGAN DONATION

In the December edition of ‘The Intensivist’ I reported that the DODC had made a number of recommendations to the ANZICS Board, including; 1) the impact of sedative agents (including barbiturates), the testing of neuromuscular junction function and the timing of clinical testing (page 16); 2) the timing of brain perfusion imaging (pages 20 & 21) and 3) the wording used in the documentation of brain death (page 55). These changes were approved at the February Board meeting and are now included in the online edition of version 3.2. The ANZICS Board has raised new issues which will be addressed by the Committee.

THE ANZICS STATEMENT ON WITHHOLDING & WITHDRAWING TREATMENT

Under the auspice of the DODC End of Life Care Working Group (EOLCWG), the ANZICS Statement on Withholding & Withdrawing Treatment is now under review. Following on from the initial meeting of this group, it has been decided that this statement will now be updated to be called The ANZICS Statement on End of Life Care. An outline for this statement has now been drafted, and the chapters of each have been assigned to the various members of the EOLCWG. While this resource is set to be more comprehensive than its predecessor, the new statement will be a practical guide to assist intensivists in dealing with the challenging situations presented by end of life care.

The working group is set to meet face to face in Melbourne on 8th

May, prior to the upcoming 4th International Society of Advanced Care Planning & End of Life Care Conference (ACPEL, 9th – 11th of May). The aim of this face to face meeting of the EOLCWG will be to review and discuss the work on the various components of this statement, based on the literature reviews conducted by the working group members. Ongoing updates on the development of the Statement will be provided to the membership via ‘The Intensivist’. Once the statement has been prepared in its draft form, a period of consultation will be held with the ANZICS membership. The working group is also preparing a survey of all ANZICS members regarding their knowledge, attitudes and practice regarding care at the end of life.

The EOLCWG members are:

Chair Bill Silvester

QLD Brent Richards

VIC Charlie Corke

NSW Malcolm Fisher, Peter Saul, Theresa Jacques, Ken Hillman

SA Stewart Moodie

WA Geoff Dobb

NZ James Judson, Stephen Streat

TAS vacant

NT vacant

ACT vacant

Paediatric Stephen Jacobe, Jonathan Gillis

COMMITTEE MEMBERSHIP

As the Committee has not received any expressions of interest from the Tasmanian region, the Death and Organ Donation Committee is still seeking expressions of interest for this regional representation.

For further information, please contact myself, or [email protected]. Information about the Committee is available from http://www.anzics.com.au/death-and-organ-donation.

Bill Silvester Chair, Death and Organ Donation Committee

DEATH AND ORGAN DONATION COMMITTEE

Paediatric Johnny Millar

QLD Brent Richards

VIC Helen Opdam

NSW Deepak Bhonagiri

SA Stewart Moodie

WA Geoff Dobb

NZ Stephen Streat, James Judson

NT vacant

TAS vacant

ACT vacant

Death and Organ Donation Committee


The PricE Committee foresees some significant strategic activity ahead. At the most recent Board meeting there was significant discussion around the topic of workforce, the availability of suitable employment for recent graduates, the role of the Intensivist (as distinct from the ‘hospitalist’) and means by which ANZICS can assist members in advocating for appropriate and sustainable training and education structures.

There is evidence that we will have an excess of trained Intensive Care Medicine specialists from several sources, including our own modelling, previously shared in past editions of the Intensivist. However, further information supporting this view was published in November 2012 when Health Workforce Australia (HWA) released Medical Specialties Volume 3 of Health Workforce 20251, which modelled a surplus of Intensivists by 2025, unlike the vast majority of other specialties. Additionally, whilst a deficit of some 3,000 doctors in Australia by 2025 is a predicted, there is also a predicted deficit of some 150,000 nurses – this is likely to be a major bottle-neck in health care delivery, and Intensive Care Medicine will hardly be immune, with about 6 FTE of nursing staff required for each funded ICU bed.

ANZICS has been promoting the highest standards of intensive care medicine clinical practice and scientific endeavour for thirty-eight years in Australia and New Zealand since the inaugural meeting of

Bob Wright, Matt Spence, Geoff Clarke and others in April 1975 that gave rise to our organisation2. Intensive Care medicine is rigourous, intellectually challenging and is often the ‘last resort of the desperate clinician’- how often are we asked to take care of the whole critically ill patient and relieve our colleagues of a burdensome clinical problem- whilst we often engage the assistance of a multitude of other specialists to help with specific patient problems, we cannot ‘pass the parcel’ to anyone else- in our specialty, competence, diligence and dedication can save lives, whilst a lack of skill or experience can rapidly lead to the patient’s death. We must strive for the highest standards in Intensive Care Medicine- this means that we need to carefully select trainees, rather than allow all those who either wish to train, or find training avenues blocked in other, preferred, specialties to sign on.

The ANZICS PricE Committee is focussed on working constructively with the College of Intensive Care

Medicine to help maintain the specialty with the stature, reputation and pattern of work developed by our predecessors.

Ian Jenkins PricE Committee Chair

REFERENCES1. https://www.hwa.gov.au/

sites/uploads/HW2025_V3_FinalReport20121109.pdf

2. http://www.anzics.com.au/about-us/our-history

PRACTICE AND ECONOMICS COMMITTEEPaediatric Warwick Butt

QLD Ranald Pascoe

VIC Christopher MacIsaac

NSW Yahya Shehabi, Michael O’Leary, Mark Nicholls

SA Nick Edwards

WA Greg McGrath

TAS David Rigg

NZ Ywain Lawrey

ACT vacant

NT vacant

PricE Committee

“…there is a predicted deficit of some 150,000 nurses – this is likely to be a major bottle-neck in health care delivery,

and Intensive Care Medicine will be hardly

be immune…”


PaediatricANZPIC REGISTRY

The 2011 ANZPIC Registry Annual Report has been distributed to members in the last few weeks. The number of admissions contained in the report increases annually, with almost 9,500 children admitted to ICU in 2011. The report also contains more detailed data pertaining to both respiratory therapy and extracorporeal life support.

The Registry continues to collaborate with the UK PICANet on development of PIM3 and this endeavour is nearing completion. Requests for data and research proposals are welcomed by the Registry.

The ANZPICR Clinical Advisory Committee is due to meet again in coming weeks. The Committee will contribute to strategic planning for the Registry and will also address specific questions and problems regarding

data collection and interpretation. Unit-identified data will be reviewed by this Committee and there are plans to develop mechanisms to address data outliers and review data and research requests.

PAEDIATRIC STUDY GROUP

The Paediatric Study Group (PSG) made a significant contribution to the Noosa GTG meeting in

March, with results of ongoing studies and new proposals being presented to the meeting. The PSG is gathering significant momentum and forging important links with overseas PICU research networks. Point prevalence data collection continues apace, most notably with the recent commencement of

the SAFE-EPIC project looking at fluid resuscitation in PICU. This international study will gather data from more than 120 units around the world and is being led by

Rino Festa (Westmead Children’s Hospital, Sydney).

A three month observational study of sedation practices in PICU (Baby SPICE) is nearing completion and some preliminary results were presented at the March CTG Noosa meeting. The results of this study, which is being led by Debbie Long RCH Brisbane) and Simon Erickson (Princess Margaret, Perth), will inform an interventional trial along the lines of the SPICE trial being run by the Clinical Trials Group.

ASM

This year’s ASM in Hobart is keenly anticipated and excellent international speakers have been secured for the paediatric programme. Peter Laussen, Chief of Critical Care in Toronto and Tex Kissoon, President of the World Federation of Paediatric Critical Care Societies will both contribute to what promises to be a great couple of days in a unique setting.

Johnny Millar Chair, Paediatric Committee

ANZICS/ACCCN ASMThe 2013 ANZICS/ACCCN Annual Scientific Meeting will be held at the Hotel Grand Chancellor Hobart, from 17 – 19 October. Abstract submission opens on 26 March.

www.intensivecareasm.com

The 2013 ASM is on twitter! Follow us @ANZICSACCCN_ASM #ASM2013Hobart

“The 2011 ANZPIC Registry

Annual Report has been

distributed to members in the last few weeks.”


In my first column for the “Intensivist”, I would like to acknowledge the significant contribution the out-going Clinical Trials Group Chair Steve Webb has made to the group.

Steve has led the CTG for 3 and a half years in which time we have seen steady growth, the successful completion of several high-profile studies and the award of significant further competitive funding for new projects in both Australia and New Zealand. We wish Steve all the best as he takes a well-earned rest from CTG responsibilities.

The year has started successfully for the ANZICS CTG. Keeping our mission and values in mind, the Executive Committee held a strategic planning day on February 20th

followed by an executive meeting on February 21st. This strategic planning day was facilitated by Stephen Streat and set our priorities for the next three years. We are currently finalizing the plan and look forward to circulating this to the CTG community shortly.

The 15th Annual Meeting on Clinical Trials in Intensive Care was held at a new venue “The Outrigger, Little Hastings Street” in Noosa Heads. The meeting spanned over three full days from Thursday 7th to Saturday 9th March 2013 to accommodate an increasing demand for presentation and discussion time. Almost 200 delegates enjoyed the mixture of new study presentations, results and study updates from the local ANZ community as well as presentations from key invited speakers Jean-Daniel Chiche, President of the European Society of Intensive Care Medicine and Warwick Anderson, CEO of the NHMRC. Preceding the main meeting, the lively research coordinators day focusing on career progression and attaining higher degrees with guest speakers Amanda Rischbieth and Claire Rickard was also well attended by 90

delegates. Copies of presentations are available on the CTG website.

We are pleased to announce that registrations for the workshop on ‘Novel Trial Design’ on May 30th 2013 in Wellington (the day before the CICM ASM) are now open. We will be welcoming leading international researchers Prof Roger Lewis and Prof Derek Angus as well as local contributors including Rinaldo Bellomo to explore the potential for adaptive Bayesian designs and cluster-cross-over trials as alternative research designs to generate evidence to guide clinical practice. Registrations for this meeting are strictly limited, so please register early at www.anzicsctg.org to avoid disappointment as this will sell out.

The Winter Research Forum will take place in Melbourne a month later than usual, August 22nd and 23rd 2013 to accommodate for the changes to the Spring Research program. We will not be holding a separate Spring Research Forum in 2013. Instead CTG sessions with a broader educational emphasis will be incorporated within the ANZICS/ACCCN ASM to be held in Hobart in October 2013. We hope that you all enjoy this updated conference calendar.

The CTG Executive is currently reviewing six new studies for endorsement. We look forward to watching these proposals flourish into fully funded projects to further our mission to promote excellence in Intensive Care Medicine through collaborative clinical research focused on improving patient-centred outcomes.

Good progress is being made in a number of current studies. ARISE (early-goal directed care vs standard care) is into its last year of recruitment and we are hopeful that the results will be ready to present in Noosa in March 2014. BLISS (a sub-study of ARISE) will determine if the burden of bacteria

in the bloodstream of patients with septic shock is a determinant of outcome. The two traumatic brain injury studies, POLAR (early prophylactic hypothermia) and EPO-TBI (erythropoietin) studies are also making steady progress.

This year will be busy for CTG researchers as several new studies get underway. The ADRENAL (hydrocortisone for septic shock) has commenced in earnest. TRANFUSE (fresh vs standard aged red cells),

TARGET ( Augmented vs. Reduced Goals for Energy delivery), PHARLAP (open lung strategy for ARDS), BLING (infusion of beta lactam antibiotics), RELIEF (Restrictive versus Liberal Fluid), SPICE (targeted light sedation, using dexmedetomidine v’s standard care sedation) and HEAT (paracetamol versus placebo for

fever) are all preparing to or have also commenced recruitment.

It was very exciting to hear that the TEAM (a trial of early activity and mobility in ICU) completed recruitment just one hour prior to its presentation in Noosa. Congratulations to Carol Hodgson and her wonderful ‘team’ of clinicians, especially physiotherapists, who enabled this to happen in less than a year. Congratulations also to the ProGUARD investigators who completed recruitment just before Christmas 2012. We look forward to hearing the results of both these studies in the Winter Research Forum later this year.

In response to overwhelmingly positive feedback, the ANZICS CTG electronic newsletter will continue to be published three times per year. We welcome any feedback on this initiative which aims to keep all members of the community up to date with all that is happening in the CTG world and hope that you enjoy our Easter edition which will be distributed soon.

Colin McArthur Chair, Clinical Trials Group

CTG

“Almost 200 delegates enjoyed

the mixture of new study

presentations, results and study

updates from the local ANZ community…”

ICM 2013Thursday 08th August

CCCC - Clinical Challenges in Critical Care

Friday 09th – Sunday 11th August ICM Course - ANZICS Intensive Care Medicine Course

(focusing on ICU Management of the Critically ill)

http://www.anzics.com.au/conferences/anzics-icm or www.easternhealth.org.au/media/events/icm.aspx

CCCC - Clinical Challenges in Critical Care

A practical session to sharpen clinical reasoning and analytical skills

Challenging Physiology, ECHO in the Critically ill, Sedation, AKI Post Cardiac Surgery Thoracic Surgery Issues, Hemodynamic Support, IPPV Dramas, Pre-ICU Care of the seriously ill, Brain Death, Organ Donation,

Technical Challenges in ICU, Ethical Challenges in ICU

ICM Course – 25th ANZICS Intensive Care Medicine Course

Focusing on ICU Management of the Critically Ill Targeting Registrars and Fellows in the ICU and a good update for practicing Intensivists.

Beneficial for any Doctor involved in the management of the Critically Ill.

CCCC + ICM 2013 Topics Circulatory Volume Status, Pulmonary Embolism, Bleeding in the Critically ill

Physiological Goals in Peri-Operative State, Thoracic Surgical Issues, Liver Failure, CINMA, Oncological Issues, Chest Imaging, CT Brain, Recruitment in ARDS, Obstetric Critical Care,

Dysnatremia, Delirium, Organ Donation, DCD, Ventilator Wave Forms, IPPV in Asthma, Neuro-Critical Care, FCICM Exam Preparation, Critical Care Medicine Quiz

Acute Critical Event Simulation (Skill Stations)

IPPV Tricks, Difficult Airway, Acid-Base, Labs & Lytes, ECGs Intercostal Chest Drains, IABP, Difficult Airway, Hemodynamic data,

Registration Fees (Cost Includes: All Sessions, Course Manual, Lunches, and Course Dinner)

Clinical Challenges in Critical Care (CCCC) Thursday - 08th Aug $AUD 200 (Including GST) Intensive Care Medicine Course (ICM) Friday 09th – Sunday 11th Aug $AUD 750 (Including GST) CCCC & ICM Thursday 08th – Sunday 11th Aug $AUD 900 (Including GST)

Further Information

Registration Enquiries: Course Enquiries: ANZICS Assoc. Prof. Ramesh Nagappan

(03) 9340 3400 Pager: (03) 9387 1000 or Fax: 9871 3798 [email protected] [email protected]

Conveners

Dr. David Charlesworth

&Assoc. Prof.

Ramesh Nagappan


Regional CommitteesNEW SOUTH WALES

ANZICS NSW has been busy with an increased interest and membership applications especially from trainee members and recently qualified intensivists. ANZICS has a separate and valuable role for trainees and intensivists and it is heartening to see increased interest in ANZICS activities.

A joint ANZICS/CICM Medical Education Session on Electrical Impedance Tomography and Ventilator Associated Pneumonia is planned for the 13th March with the AGM being held on the same day.

There is broad support in New South Wales for ANZICS to maintain an ongoing role in the professional development and welfare of Intensivists and we now have ANZICS LinkPersons in most New South Wales ICUs. We will conduct regional meetings this year, and as always we are keen for enthusiastic members to volunteer to become involved with State or Standing Committees. If you are interested, or have any ideas, please do not hesitate to get in touch with one of those named below.

Deepak Bhonagiri New South Wales Regional Chair

ANZICS NEW SOUTH WALES REPRESENTATIVES

Death & Organ Donation Deepak Bhonagiri

Safety & Quality Deepak Bhonagiri, Tony Burrell, Sumesh Arora

Education Michael O’Leary, Charudatt Shirwadkar, Liz Fugaccia, Dhaval Ghelani

Abstract Review Committee Dhaval Ghelani, David Gattas, Michael O’Leary

CTG Ian Seppelt, David Gattas

PricE Mark Nicholls, Michael O’Leary

CORE Tony Burrell, John Lambert

QUEENSLAND

The year in Queensland has again commenced with flooding and the need to mobilise significant medical resources to ensure the safe evacuation of at risk

patients. Ex-tropical cyclone Oswald caused destruction along the Queensland coast with damaging winds, heavy rain, flooding, tidal surges and tornados. Tragically these floods, although not associated with the same magnitude of material loss as seen in 2011, again resulted in the loss of life. Bundaberg and the surrounding area were worst hit with flood levels rising devastatingly higher than in 2010/2011 floods. Authorities are estimating that more than 7500 people were affected and at least 3000 homes were inundated. The magnitude of the rescue effort was incredibly impressive with the mobilisation of C17 transport aircraft, a fleet of Black Hawk helicopters and two C130 Hercules aircraft evacuating patients from Bundaberg Hospital to Brisbane. Even weeks after the emergency, people are still unable to return home, many homes totally destroyed.

These events have occurred at a time when the Queensland Government is struggling to curtail costs and rationalise expenditure of the health dollar. The reforms, introduced in July 2012, have witnessed the establishment of seventeen Hospital and Health Services (HHS) facilitated by the introduction of new legislation namely the Hospital and Health Boards Act 2011. The HHS are independent bodies responsible for the provision of health services, generally managing a network of hospital and health services within a defined geographic area. Each HHS is responsible for their own Corporate and Clinical Governance, planning and delivery of services as specified in their service agreement with the Director General of Queensland Health. It is in this climate that we have seen the newly established boards going to work on increasing efficiencies,

while promising no “loss of frontline” services. Despite these reassurances intensive care beds have been lost. Those at the clinical coal face find themselves desperately juggling referrals to ensure no patient is deprived of care or comes to harm. We all recognise the need for more efficient delivery of intensive care services and in a valiant attempt to save ICU beds, sweeping changes in day to day clinical practice have been introduced. These have included significant changes to work practice models, including, but not restricted to consultants taking on more Registrar type work, as well as maintaining their usual duties. Laboratory and radiological service use have been further rationalised. Individual institutions are playing their own part, in their own way, to deal with the fiscal constraints. The pressure is unlikely to abate anytime soon. Maybe the quotation “Life isn’t about waiting for the storm to pass...it’s about learning to dance in the rain” applies more than ever.

A Queensland Health project team has recently approached ANZICS for input into their ten year plan for the delivery of intensive care services. Their plan is currently in a draft form and demonstrates the complexities of determining how best to deliver this vital care across a geographically huge state, with a population which is larger than that of New Zealand. It is critical that any plan is carefully considered and facilitates delivery of formal responses from all stakeholders. In this respect ANZICS would welcome comment from its membership, to be included in our formal response to the project team’s draft.

Queensland is fortunate to have a dedicated and very active intensive care research group, who continue to generate world class research and attract major grant funding.

This year the co-badged CICM/ANZICS Registrar Research Forum will again take place in November and we would urge registrars and specialists to consider attending. The forum is designed to encourage an interest in research and provide


“Intensive Care in Asia, Opportunities and Challenges”Date: 12 - 14 July 2013 Venue: Max Atria@Singapore Expo

CALL FOR ABSTRACTSSubmission of abstracts online will open on 14th Dec 2012

CALL FOR REGISTRATIONEarly Bird Registration will open on 14th Dec 2012

OVERSEAS SPEAKERSJohn KELLUMUniversity of Pittsburg, USA

Jean-Daniel CHICHE Hopital Cochin, France

DU Bin Peking Union Medical College Hospital, China

Charles GOMERSALLThe Chinese University of Hong Kong, Hong Kong

Younsuck KOHAsan Medical Center, Univesity of Ulsan College of Medicine, Korea

Neil MACINTYREDuke University Durham, North Carolina, USA

John MARSHALLSt. Michael’s Hospital, Toronto, Canada

… and other speakers from SICM and ANZICS.

TARGET AUDIENCEThe target audience comprises Intensivists, Anaesthesiologists, Respiratory Physicians, Critical Care Nurses and Allied Health Professionals involved in Intensive Care.

The theme of this Conference is, “Intensive Care in Asia, Opportunities and Challenges “which will focus on the many new challenges that professionals involved in Intensive Care, face in the everyday practice, and the opportunities present that, comes with the increasingly diverse roles that critical care practitioners play in the hospital setting.

For more information, please visit: http://www.sg-anzics.com

HIGHLIGHTSWorkshops• CriticalCareEmergencies:ASimulation-basedCourse

• IntensiveCareNephrology:BeyondBASIC

• ANZICSandAsianCriticalCareClinicalTrialsGroupsResearchFoundations Workshop: Preparing Your ICU for Research

• NeilMacIntyreAdvancedVentilationWorkshop

• RACE+

Society of Intensive CareMedicine, Singapore

Australian&NewZealandIntensive Care Society


an opportunity for established researchers to mentor and encourage new researchers. The meeting also provides an excellent opportunity for the presentation of formal projects.

The Queensland training Pathway has survived the first round of budget cuts and continued to coordinate very effectively the state-wide intensive care training scheme. The advantages of such a system have been clear to all involved and have represented a real advance in training within our state.

Queensland ANZICS has a strong and stable membership that represents the members’ interests in a range of activities, including safety, quality, research and private practice. Our regional committee will soon be seeking expressions of interest for a range of portfolios on this committee. We would strongly encourage members to consider standing for election and the opportunity to contribute in challenging times.

Anthony Holley Queensland Regional Chair

ANZICS QUEENSLAND REPRESENTATIVES

Death & Organ Donation Brent Richards

Safety & Quality Jeff Presneill

Education Matthew Keys

Abstract Review Committee David Sturgess, Greg Comadira, Michael Reade

CTG Jeff Presneill

PricE Ranald Pascoe

CORE Tony Slater, Dan Mullany, Ranald Pascoe

SOUTH AUSTRALIA

In South Australia, like other states, shrinking health budgets and changing health plans will have significant impacts on all Intensivists. First announced in 2007,

we are now 36 months away from the opening of the 1.7 billion dollar new Royal Adelaide Hospital, and adopting all the associated service changes that were proposed with it.

The lack of consultation and discernable progress over the last 6 years concerns all clinicians and professional bodies alike. The diminishing role of TQEH ICU, where the existing services at TQEH that rely on intensive care will go, what will fill the proposed 60 ICU beds at the RAH and the possible closure of the Repatriation Hospital ICU all have huge question marks over them. The Lyell McEwen hospital seems likely to take on the majority of the transferred load, as well as covering a new HDU at the local Modbury Hospital. Again, it is unclear how this will occur particularly with the Modbury HDU being currently staffed by fly in fly out 9 – 5 cover. All of these changes have high costs associated with them and are occurring when the State’s finances are failing and health budget cuts are being proposed. The new Health Minister, the ex Treasurer, has a very difficult task ahead and has received strong advice from all professional bodies to engage with the clinical workforce to find solutions.

Intensive Care services are always high on the agenda during these discussions. All specialties want a 24 hr ICU to treat their patients in the event of deterioration. Locally we have many highly skilled, under and unemployed Intensivists who could fill these roles at the various hospital sites. Unfortunately budget cuts make it unlikely that new appointments will be made and current Intensivists may have to shoulder the extra 24hr load. Historically the ever expanding definition of the ICU role, displacing existing medical and surgical registrars, has involved employing greater numbers of ICU registrars to cover the MET teams, increased night cover and the out of ICU services. This locally has resulted in a number of highly skilled Intensivists unable to find work on completion of training which is appalling. Sustainability of our specialty is vital for all and this increasingly insoluble problem will be further discussed at the upcoming ANZICS/CICM meeting.

Stewart Moodie South Australia Regional Chair

ANZICS SOUTH AUSTRALIA REPRESENTATIVES

Deputy Chair Ken Lee

Treasurer Adam Deane

Death & Organ Donation Stewart Moodie

Safety & Quality Krish Sundararajan

Education Adam Deane, Mary White, Gerry O’Callaghan

Abstract Review Committee Adam Deane, Matthew Maiden

CTG Sandy Peake

PricE Nick Edwards

CORE John Moran

VICTORIA

The challenges of Victorian hospital medicine have been exacerbated in recent months by funding disputes between the state and federal governments. As part

of this conflict, each side has contributed to a game of brinkmanship, which led to a substantial withdrawal of funding from the public hospital system more than half-way through a financial year. This removal of already committed resources from a system under strain caused major disruption at all levels. Many hospitals abruptly closed beds, cancelled elective surgery and reduced staffing. The task of achieving necessary savings consumed much time and effort as well as inflicting major inconvenience and distress.

A short time ago, the federal government announced that the funding would be restored, causing considerable initial relief to health care administrators. However, in order to receive the funding, hospitals must undertake the clinical workload required to ‘earn’ it. The catch being that this includes doing elective work which was cancelled as a cost constraint strategy during the period when the resources had been withdrawn. Such a strategy will only work of course, if no additional resources (i.e. no overtime, no backfill etc.) are required to treat these patients.

What all of this may mean for critical care remains somewhat uncertain. It may be that this episode should be interpreted as a warning regarding a


coming period of destabilisation and austerity in healthcare. For clinicians responsible for the management and administration of healthcare resources in addition to clinical work, the future seems likely to be rather challenging…

Stephen Warrillow Victoria Regional Chair

ANZICS VICTORIA REPRESENTATIVES

Death & Organ Donation Bill Silvester, Helen Opdam

Safety & Quality Cameron Knott

Education Sam Radford, Stephen Warrillow

Abstract Review Committee Ravi Tiruvoipati

CTG Andrew Davies, Craig French, Neil Orford

PricE Warwick Butt

CORE David Pilcher

NEW ZEALAND

As summer draws to a close the conference season is upon us again. This year’s regional meeting will be in Dunedin and Mike Hunter should be congratulated on

putting together such an exciting and varied program. The regional ANZICS meeting is the one time of year that the New Zealand ICU community congregate and our collective support is the only way that we can expect these valuable events to continue.

ANZICS has been in consultation with PHARMAC as they scope the mammoth task of assessment, standardisation, prioritisation and procurement of all medical devices. The process is in its early phase and I see this as a fantastic opportunity for our speciality. PHARMAC are looking for model specialities that are able to coordinate national equipment standards and appraise effectiveness of treatment. As a small, coherent specialist body we could come to simple collective purchasing agreements and measure outcome improvements with accurate ANZICS CORE data. Rather than being a threat to ICU, we are likely to be able to demonstrate efficiencies and cost savings that may be of benefit to

us all. In the next few months I will be looking for regional leads and opinion(ated) leaders to help with some of these decisions.

January saw the published Annual ANZICS CORE report for 2010 – 11. Amongst the highlights were our comparative data with Australia. You will not be surprised to hear that we have less beds (5.87 verses 8.75 beds per 100 000 population), sicker patients and yet our average length of stay is shorter. We have also opened more beds, with a 23% bed increase over 5 years compared to a population increase of only 5.3%. As I look out of my cracked and dusty office, I don’t see much of this increase in the South Island.

I am becoming increasingly concerned by the divergent directions the Intensivist bodies on either side of the Tasman are taking. The obvious areas of note are quality and organ donation. The CLABSI prevention project in Australia was funded by a grant from the Australian Commission on Safety and Quality in Healthcare who had no funding, mandate and therefore interest in spreading this initiative to New Zealand. Local funding from the Health Quality and Safety Commission has ensured completion of a similar project in New Zealand, however subtle differences in the project meant it ran independently off the ANZICS umbrella. This funding model is likely to continue for future quality initiatives and leaves the 96 NZ ANZICS members relatively isolated. Whilst there are clear advantages to not following an Australian lead, this independent approach may reduce our, already quiet, political voice.

Finally, the practice of organ donation is changing significantly in Australia with DonateLife. Whilst this may be a model we are required to follow in the future, New Zealand continues to take its lead from Organ Donation New Zealand (ODNZ) whose roots are firmly within ANZICS and its supporting Intensivists. I am always impressed by the tireless work put in by Stephen Streat and Jim Judson to support organ donation throughout New Zealand and we have the opportunity to demonstrate the success of this model with our collective committed ongoing support.

If you would like to comment on any of these topics or raise any issues that you feel are relevant to NZ ANZICS then please use the [email protected] email address, but

remember “reply” will always go to the whole list.

David Knight New Zealand Regional Chair

ANZICS NEW ZEALAND REPRESENTATIVES

Treasurer Ben Barry

Abstract Review Committee David Knight, Paul Young

CORE Peter Hicks

CTG Shay McGuinness, Colin McArthur

Death & Organ Donation Stephen Streat, James Judson

Education Rob Bevan

Safety & Quality Alex Kazemi

PricE Ywain Lawrey

WESTERN AUSTRALIA

Over the summer season we have not had any further ANZICS evening meetings, and we await the start of this year’s educational programme, along

with the evening research meetings that are very popular and, gratifyingly, supported by industry.

Tertiary healthcare, particularly in the southern sector of the city continues to undergo significant reconfiguration, in preparation for the opening of Fiona Stanley Hospital (FiSH), ostensibly sometime in 2014. It now appears that there will be a so-called ‘soft opening’ with commissioning of various aspects of the hospital over several to many months, rather than over a matter of days or weeks. Intensive Care is, in many ways, captive to the needs of other specialties- the requirement for ICU services, to a significant degree, depends upon the type and volume of surgical procedures being performed at a given site. We are still not really clear what quaternary and tertiary surgical services (and the volume) will be at each of the six hospitals that form the South Metropolitan Health Service. A ‘soft’ opening will likely require maintaining three tertiary ICUs for a period of time with resultant workforce and resource implications.

There will be an increase in total ICU beds with the redevelopment


in the south- public Level III ICU bed numbers will increase from 38 to 50, assuming only 30 of the 40 ICU beds at FiSH are commissioned in the short term. This increase is appropriate and overdue, given that Western Australia currently has significantly less ventilated and non-ventilated ICU beds per 100,000 population than the national average.

The wisdom, or otherwise, of placing ICUs in general hospitals at the periphery of the city is currently playing out. However, one hospital has developed a very effective and functional Level I ICU, staffed by a mixture of highly ICU-experienced specialists from the United Kingdom and an Australasian-trained Fellow of CICM. What is clear, is that these nascent and quite small ICUs are not a suitable place for a brand new CICM graduate, as there is little opportunity for frequent interchange with a tertiary centre or even a Level II ICU, and fresh graduates are not the ideal people to be establishing these ICUs from ‘the ground up’.

We are gaining some traction on having a functional Clinical Information System (CIS) in FiSH from Day 1 – if this occurs we will be advocating that the same system is rolled out to all other ICUs, including the new children’s hospital ICU that is currently under construction.

Once again, I would like to take this opportunity to thank our ANZICS Committee members- Ed Litton continues as our State representative CTG, Simon Towler has been WA’s representative on CORE’s Management Committee for a considerable period and given distinguished service- but would like to relinquish this role, John Lewis is on the Safety & Quality Committee, Greg McGrath is on the PricE Committee and Geoff Dobb is busy as ever on both Death and Organ Donation and the Abstract Review Committee. WA members Geoff Dobb and Steve Webb are assisting Michael O’Leary on the Organising Committee for the SIS-ANZICS scientific meeting 12 – 14 July this year in Singapore- this will be a brilliant meeting with an excellent faculty- I encourage all WA members to attend.

Ian Jenkins Western Australia Regional Chair

ANZICS WESTERN AUSTRALIA REPRESENTATIVES

Deputy Chair vacant

Death & Organ Donation vacant

Safety & Quality John Lewis

Education Simon Erickson

PSG vacant

Paediatric Simon Erickson

Abstract Review Committee Geoff Dobb

CTG Ed Litton

PricE Greg McGrath

CORE vacant

TASMANIA

The main ANZICS Tasmania focus in 2013 is the upcoming ANZICS/ACCCN Annual Scientific Meeting which will be once again held in Hobart. Past Hobart

ANZICS meetings have been very successful with some quite legendary social functions. We are really looking forward to welcoming you all to another great meeting in 2013. Hobart is a fantastic place for a meeting and this year it will be as good as ever.

A number of innovations and new approaches are being introduced to the program this year. We are developing a Smartphone app for the program and are already on twitter- @ANZICSACCCCN_ASM) #ASM2013Hobart. Updates on speakers, scientific program, abstracts, workshops, and the social program will be given through twitter so follow us to keep right up to date and join in the discussions. Our new and improved website is up and running so check it out now http://www.intensivecareasm.com.au/2013/.

The provisional program is soon to be published. There will be some interesting and controversial topics and a few new approaches here too.

Firstly, there will be some combined adult and paediatric sessions, covering aspects of critical care practice that overlap across age groups. Several small group workshops will also be conducted – these will require pre-registration

as numbers will be limited, so keep an eye on twitter and the website for these. Additionally, ANZICS CTG will present a series of updates on current and recently completed work, showcasing results and achievements directly to the bedside clinicians who every day recruit and manage the patients for the increasing number of high quality clinical trials conducted in our ICU’s.

Tasmanian ANZICS Committee representation includes Benoj Varghese and Mike Buist on the Safety & Quality Committee and Scott Parkes on the CTG Executive.

The redevelopment at Royal Hobart progresses slowly but a long overdue move into new bed spaces is imminent and much anticipated.

I have previously mentioned the ongoing funding problems in our state health system and little has changed over the past 6 – 12 months. Surgical waiting lists are a concern and we are struggling to facilitate high risk elective surgery as our ICU services continue to be stretched to capacity all around the state. In a time of significant budget restraint there is now increased demand and probably a need for more beds. The solutions are, as usual, very complex and we hope to be able to work through them.

David Rigg Tasmania Regional Chair Convenor, ANZICS ASM 2013

ANZICS TASMANIA REPRESENTATIVES

Abstract Review Committee Andrew Turner

CORE Alan Rouse

CTG Scott Parkes

Death and Organ Donation Committee Vacant

Education Vacant

PSG Vacant

Paediatric Vacant

Safety & Quality Benoj Varghese, Michael Buist

PricE David Rigg

Manchester – and beyond

We are looking for doctors with experience of Intensive Care Medicine to work in our state of the art Critical Care Unit in Central Manchester Foundation Trust, one of the United Kingdom’s leading University Teaching Hospitals.Come and join our team delivering high quality critical care to Manchester’s population and specialist patient groups from across the UK and beyond.Visit the Peak district and Lake district national parks, enjoy Manchester’s nightlife, eat on the Rusholme “curry mile”, and use the excellent air and rail links to explore the UK and Europe.

Develop your skills, enhance your CV and see the world! Want to know more? Contact [email protected] for details.

Manchester

London

Lake District National park – 90 minutes away

Gritstone climbing, Peak District National Park – 45 minutes away

The UK’s best music and nightlife

London – 2 hours away

World class sporting events on your doorstep

Royal Exchange Theatre, Manchester

ANZICS The Intensivist Newsletter April 2013

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Transcript of ANZICS The Intensivist Newsletter April 2013