Advanced Critical Care Practitioners. Time for action.

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Carole Boulanger, an Advanced Critical Care Practitioner (ACCP), discusses the role and how regulation is as equally important to ACCPs as it is to Physician Associates, and therefore the best way forward for the profession.

The Advanced Critical Care Practitioner (ACCP) has become a workforce solution for critical care units and is fully supported by the Faculty of Intensive Care Medicine (FICM) and the Intensive Care Society (ICS). The role developed from clinical need and provides a career option for nurses and allied health professionals (AHPs) wishing to choose clinical progression, rather than management or education; thereby keeping experience at the bedside.

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The Beginning of the End?

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Dr Gary Masterson, President of the Society, reflects on how changes in the way critical care is commissioned may impact on critical care bed provision.

There have always been (and always will be) bed pressures in critical care. I don’t know about you, but I find this the most stressful aspect of my job. However, over the last 20 years of my working life as a consultant, when I have had the misfortune of stumping around my hospital’s general wards, I am always extremely glad to return home to my critical care unit. The general wards struggle: they’re jam-packed with elderly and frail patients with nowhere else to go, grossly understaffed, chaotic and little in the way of continuity of care. You know what I mean. In critical care, we don’t suffer these problems to the same extent and, since the advent of critical care networks and a more regional approach to managing critical care beds, we can usually cope when bed are short.

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The press, medical information, ethics and money

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Jeremy Groves reflects on some of the wider issues arising from the tragic case of Charlie Gard.

I have already written about something the adult critical care community can take away from the tragic case of Charlie Gard; however, I think there are several other issues that we can mull over.  Charlie and his parents’ plight captured the public’s attention and everyone had a view, as I discussed before, informed or otherwise.  To me it was striking how much of the discussion, and presentation of clinical information, took place in the press.

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Life support for critical care staff

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Dr Linda Jayne Mottram, Intensive Care Consultant at Belfast HSC Hospital discusses the crucial importance of maintaining clinicians mental wellbeing in the current medical culture.

Basic life support algorithms start with the premise that clinicians check for danger before approaching the patient.  The rationale being that if you are injured by something in the environment, you will be of little practical use to a patient in extremis.   The same logic applies to scene safety in prehospital medicine. No one questions your commitment to the patient by protecting yourself first, because it makes common sense to do so.  You have to be free from injury in order to provide any meaningful assistance.

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A lesson from little Charlie

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Dr Jeremy Groves reflects on one implication that the case of Charlie Gard has in adult critical care.

The Charlie Gard case has been the dominant medical story over the last few months.  One cannot but have extreme sympathy for Charlie’s parents who fought valiantly to give their son a chance in life. It was a personal tragedy, played out on social media and in the press, where the pope, presidents, politicians and pundits all had a view and expressed it, informed or otherwise.

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Fasting our patients in the critical care unit. How can we get it right?

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Ella Segaran, Advanced dietitian for Critical Care, Imperial College Healthcare NHS Trust and Chair of the NAHP committee of the ICS, considers barriers to achieving nutritional targets in critical care and proposes some solutions.

On average critically ill patients only receive 50-60% of their nutritional target. As a critical care dietitian this causes me considerable frustration. I perform a detailed nutritional assessment, develop a feeding plan only to find the system is working against me. Underfeeding is associated with more infections and longer ICU and hospital stay. We know if we get it right and achieve more than 80% of the target we decrease mortality and ventilator days.

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In Search of the Intensive Care “Pessimist”

 

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By Peter Brindley

In spring I wrote in this venerable blog about travelling to India and hoping to see the elusive tiger 1.  In summer I subsequently came to Britain expecting to see nothing but ICU pessimists. I saw lots of Indian tigers; I met very few true British pessimists. Despite a UK summer that could be remembered for bombs, knives, fires and anger, your lovely country has endured, despite being injured.  Like much of the world, you have a political and healthcare system seemingly tailor-made to produce burnout and despondency. However, while many of you are “down”, you are definitely, and defiantly, not “out”. Continue reading “In Search of the Intensive Care “Pessimist””

The ARCP, – “if only i knew what i was supposed to do” – a tirade, and a request to my fellow trainees…

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by Jamie Strachan

The Annual Review of Competency Progression (ARCP) season has just passed for many trainees in Intensive Care Medicine in the UK, and we are at the start of a new academic year.  Those that sail through with an outcome 1 (ready to progress to the next year) breathe a sigh of relief, but those with any other outcome, for example an outcome 5,  need to provide more evidence and may feel despondent – “I didn’t know I had to have that paperwork in that place”…

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The Medical Training Initiative – a personal perspective.

The Medical Training Initiative enables overseas graduates to come to the UK for experience in intensive care. In small and large units with posts and training capacity the scheme can be mutually beneficial. Dr David Odaba, currently working at the Cumberland Infirmary in Carlisle, gives us his view on the application process and the benefit of the experience he gained. – Jeremy Groves

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Mediating conflict between health professionals, patients and families: It’s all about the human stuff.

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Sarah Barclay, Founder/Director, The Medical Mediation Foundation.

Conflict between patients, families and health professionals is upsetting for all and can affect decision-making about medical care and treatment. All too often the warning signs are missed.  This can lead to a breakdown of relationships that may end up in court. Although recourse to the courts will lead to a decision, there are inevitably perceived to be winners and losers. Complex, often agonising dilemmas for families, patients and health professionals are portrayed (and felt) as battles.

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