On the hottest April day in 70 years, the 21st ICNARC Annual Conference (#ICNARC18) started bright and early on Wednesday 18th April 2018 in London.
We welcomed over 320 delegates from across 142 hospitals nationwide, with roles ranging from Audit Clerks and Data Analysts to Consultants and Critical Care Network Managers.
There was a great level of energy, enthusiasm and engagement throughout the day, with opportunities to network in the morning, over lunch and at our celebratory drinks reception at the end of the day.The day also featured a variety of exhibitors who helped to make the day a success.
A varied and full programme
The varied programme featured 14 presentations from a wide range of internationally renowned speakers, over five key sessions, to discuss how we can work together to conduct rigorous audit and research in critical care.
Welcome and Updates
“…the pathway of the critically ill patient is complex… it is the collective effort of many that ensures the best outcome for the patient and their families.” Kerrie Gemmill, ICNARC Managing Director
This year, our comprehensive programme not only looked at the important work within the ICU but beyond the unit walls, through the work we do independently and in partnership as a centre for national clinical audit and health services research.
Kerrie Gemmill, Managing Director, gave a warm welcome to all delegates and invited Andrew Fleming, National Clinical Audit Manager to continue proceedings with a motivating update on the Case Mix Programme (CMP).
Andrew discussed the increasing levels of CMP participation, with continued growth into specialist units, how we’re updating reports and gave an update on plans for the new dataset.
“We’re gaining an increasing number of participating units and there are a larger number of DVRs being processed. Each of these requires work from both sides and we want to make the processes of participation more efficient....” Andrew Fleming, National Clinical Audit Manager
On this note, he handed over to Sasha Korniak, Head of Data and Business Technology for an introduction to our IT platform development project, which aims to enhance the user experience and streamline the data validation processes.
Our first external speaker of the day was Dr Dave Murray from the National Emergency Laparotomy Audit (NELA). He provided an update on how NELA is establishing data linkage with the CMP to reduce data collection burden and answer key questions faced by NELA.
Getting It Right First Time
Although the technology didn’t quite work first time, Dr Anna Batchelor gave a passionate talk about the Getting It Right First Time (GIRFT) initiative, which is looking at 36 specialities, including critical care. The GIRFT Programme is helping to improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes.
Dr Tim Gould, an ICNARC trustee, then spoke about the work ICNARC is doing to support GIRFT, by providing rich CMP data and drawing on ICNARC’s 20+ years of experience in presenting critical care data.
Outside the walls of the critical care unit – audit
Professor Sir Nick Black, ICNARC trustee, chaired our next session, focusing on the CMP and our auditing activities.
Tim Matthews, CMP Coordinator, gave an update on how we could extend the CMP dataset to collect more data prior to admission to/post-discharge from the unit.
“Whilst there may be a desire to expand the collection of data outside the walls of the ICU to pre- and post-admission, it is important to stay balanced to keep the high quality of data and reduce burden on local teams.” Tim Matthews, CMP Coordinator
Audience / panel debate: auditing the critically ill
We asked the questions:
Q1) should we change from auditing critical care unit admissions to critically ill patients
Q2) how do we define critical illness?
Q3) how do we define critical care, and those who deliver it?
Audience members were able to respond to and questions, share their experiences and offer suggestions about the auditing process.
Although the initial vote saw the audience in favour of auditing critically ill patients outside the unit, following the debate, the final vote was against this.
- Participation and Engagement
- Data Quality
- Audit Clerks of the Year.
We were also very happy to present an Outstanding Contribution Award to Christine Straughan from Freeman Hospital, Royal Victoria Infirmary (Newcastle). Congratulations to all the winners for each category.Our prize winners 2018
Professor Paul Dark, NIHR National Speciality Lead for Critical Care Research gave a national perspective on our work, with both research to identify best practice and audit to ensure that best practice is followed. He also spoke about the use of CMP audit data in helping to plan and support research studies.
Professor Gordon Rubenfeld from the University of Toronto provided the international perspective, comparing the CMP favourably with other international audits. He also spoke about the importance of integrating audit data with other data sources and maintaining strong quality control when using big data.
Paul Maddox, recently appointed Trustee and ICNARC’s treasurer, explained why he had become a charity trustee, describing his personal and professional motivations and highlighting ICNARC’s great achievements, despite the challenges we face, and the widespread recognition we have as an organisation.
“Every single thing that we think we know about the ICU starts from getting accurate patient data.” Professor Gordon Rubenfeld
Outside the walls of the critical care unit – research
Professor David Menon chaired the session and opened by commenting that “the goal of research is to find what’s important and make it measurable’
Paul Mouncey discussed the breadth of research being undertaken by ICNARC, both as leads and in collaboration with others. He highlighted work across the critical care journey, discussing specifically the chance for growth at the pre- and post- ICU stages.
Professor David Harrison posed the question ‘how can risk modelling be improved with linkage to routine data sources?’, noting the various sources of data available at each stage of the patient trajectory.
Professor Harrison’s talk then discussed three questions:
• How do the risk factors for one-year mortality compare with acute hospital mortality?
• What effect do comorbidities have on one-year mortality?
• Is the effect of comorbidities different among hospital survivors?
He concluded with a discussion on the implications of this modelling work for the CMP.
Professor Rowan, standing in for Dr Liz Wilcox who was sadly unable to join us on the day,gave an overview of Dr Wilcox’s work looking at the impact of relative strain on ICU performance. This work was undertaken as it has been noted that poor outcomes are seen at absolute strain, but less consideration has been given to relative strain.
Dr Manu Shankar-Hari presented his work on recovery after sepsis. Whilst sepsis incidence is increasing, in-hospital mortality is also improving. Despite this, sepsis survivors who leave hospital are at higher risk of death and higher risk of readmission – with approximately 50% of sepsis survivors re-hospitalised within 6 months of discharge.
Dr Shankar-Hari has used data from NHS Digital, ONS and ICNARC to study this question.
Professor Rowan provided the closing comments, thanking everyone for attending and all their hard work over the past year. The day was then rounded off with a celebratory Drinks Reception - our way of showing appreciation for all the hard work of the critical care units and the support we’ve received from partners over the past year.
We are already looking forward to our next ICNARC Annual Conference in 2019 - our 25th anniversary year. We’ll share the date as soon as we can!