Jottings from JICS: CQUINS, delayed discharges & perverse incentives

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by Jeremy Groves, Consultant Anaesthetist in Intensive Care

Looking at JICS this month the article by Stephen Gilligan, “Critical care delayed discharges: Good or bad?”, caught my eye.(1)  He argues that the evidence from ICNARC suggests that delayed discharges, especially in sicker patients, may be no bad thing.  He goes on to articulate that NHS England’s proposed CQUIN on delayed discharges (currently in limbo) would act as a perverse incentive that may have a detrimental effect on some of our patients’ outcomes. Continue reading “Jottings from JICS: CQUINS, delayed discharges & perverse incentives”

Bereavement Care in UK ICUs: Time for a Change

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by Jeremy Groves, Consultant Anaesthetist in Intensive Care

I’ve just been looking at the last Annual Report for the North Trent Critical Care Network and, if you look at the Network Units as a whole, the mortality rate is about 16%.  This equates to over a thousand deaths.  Now a death is not just a statistic.  To the relatives left behind, and to carers, there can be significant trauma.  This is true even for those with significant co-morbidity where death is always in the shadows.  It makes bereavement care a real and important issue. Continue reading “Bereavement Care in UK ICUs: Time for a Change”

Devastating Brain Injury Working Party

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by Dan Harvey, Chair, Devastating Brain Injury Working Party

The Faculty of Intensive Care Medicine and Intensive Care Society’s Joint Professional Standards (JPS) committee exists to help develop clinical standards and ensure quality and safe practice. Whilst this includes synthesis of research into evidence based guidelines, it also includes publication of guidance in areas where the evidence base is less certain, but clear risks to either patients or professional practice exist. Continue reading “Devastating Brain Injury Working Party”

Jottings from JICS: Prolonging the life of arterial lines – Finding the right solution.

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by Jeremy Groves, Consultant in Anaesthesia and Critical Care

It is disheartening for all concerned when an arterial line stops working.  The patient’s monitoring is compromised, re-siting a line takes up both medical and nursing time and it always seems to happen in the patient who is either desperately ill, or has such a poor arterial tree that the wire won’t thread.

An intervention that prolongs the life of a line must be a good thing Continue reading “Jottings from JICS: Prolonging the life of arterial lines – Finding the right solution.”

How can we better learn from our mistakes?

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by Jeremy Groves, Consultant in Anaesthesia and Critical Care

“The only real mistake is the one from which we learn nothing.” – John Powell

No one likes making a clinical error. If I look back and consider the mistakes I have made in my career they engender mixed feelings. There is the obvious embarrassment that they occurred in the first place, the feeling that, maybe I should have known better, and the concern that I would be professionally belittled by my peers if they knew about them. Continue reading “How can we better learn from our mistakes?”