A summary of the ICNARC Annual Meeting 2019

ICNARC CMP Annual Meeting 1 May 2019

ICNARC hosted the Case Mix Programme (CMP) Annual Meeting (#ICNARC25), and celebrated our 25th birthday, on Wednesday 1 May 2019 in central London.

We welcomed a record 379 delegates from 140 hospitals to celebrate ‘25 Years and Counting’. Given the theme, the meeting was an opportunity to look back on our history, the progress made over time, and how we’ve grown as an organisation and a community. With data being more prominent than ever in people’s lives, it was also a chance for us to look to the future.

There were 16 speakers in total, and 8 exhibitors. The energy, enthusiasm and positivity, alongside the strong sense of community amongst delegates was witnessed during the debates and the many networking opportunities at breakfast, lunch and the drinks reception which rounded off the day.

The meeting was opened by Professor Rob Sneyd, Chair of the ICNARC Board of Management, who welcomed delegates and introduced the themes of the day.

Next up was Kerrie Gemmill, Managing Director, who, as chair for the morning session, encouraged the audience to participate in three ways during the day’s talks and presentations. Guests could vote in real time via sli.do; update social media with their thoughts via #ICNARC25 and ask questions directly from the floor after the talks.

Andrew Fleming, National Clinical Audit Manager, stepped up provide the annual CMP update, highlighting that the CMP has seen 100% participation of NHS adult general critical care units in England, Wales and Northern Ireland for over 5 years now. In tune with the 25-year theme, he reported that the CMP Database now holds over 2.5 million validated critical care admissions. New units were also welcomed, with a particular growth area being cardiothoracic critical care, through ARCtIC (the Assessment of Risk in Cardiothoracic Intensive Care). Andrew also talked through headline updates to reports, including the 2018 recalibration and update of the ICNARC risk model.

Audience members

Andrew also gave a call-out for case studies, where we are looking for success stories where CMP data have been used for local quality improvement. Then, looking to the future, he handed over to Sasha Korniak, Head of Data & Business Technology, who provided a first look at the new CMP data submission, validation and reporting system, Platform X, which is currently undergoing a staged rollout with CMP units.

Building on this theme of new developments, Professor David Harrison, Head Statistician, provided a CMP V4.0 dataset update, introducing the concept of a modular dataset.

Tim Matthews, Programme Coordinator (CMP), then took to the stage to award the CMP prizes, this year given to one unit in each CMP bed-band for outstanding participation. Winners were selected by their CMP Data Coordinators based on timeliness of submission, participation, engagement and data quality. There were also special 25th anniversary prizes for units that have complete, unbroken data since the start of the CMP, the winners were:
- Bristol Royal Infirmary – ITU/HDU
- Morriston Hospital – Ed Major Critical Care Unit
- Royal Cornwall Hospital – Critical Care Unit
- The Ipswich Hospital – ICU/HDU
Read more about the prize winners for 2019

Bristol Royal Infirmary ITU/HDU accepting their Long Service Award, with Tim Matthews 

After the morning break Professor David Menon, ICNARC Trustee introduced a session looking back at 25 years of ICNARC and the CMP, first focusing on trends in CMP data.

Paul Mouncey, Head of Research, presented Critical care epidemiology and outcomes, looking at trends in the case mix of CMP admissions over 25 years. Professor David Harrison followed up by presenting trends in Critical Care Quality Indicators over 9 years from 2009-2018. These presentations gave a fascinating insight into CMP data and critical care trends and illustrated areas of improvement in critical care over time. The analyses generated a great deal of interest, and we are planning to publish these. We are currently looking at the best method of doing this and will keep you all informed.

Reflections from early adopters then saw Dr Pete Nightingale, Consultant in Anaesthesia & Intensive Care Medicine, talk about his time at Whithington Hospital ICU, one of the first ICUs to adopt the CMP. Dr Nightingale recalled that critical care was struggling with a lack of both data and resources, particularly in the North West, and demonstrated that data was needed to highlight issues and inspire change. The very low cost of participation within the CMP audit (about 0.1% of ICU budget) helped ease the transition, resulting in overwhelmingly positive results and improvements.

This was followed by the Balloon debate, which proved to be one of the most popular sessions of the day, chaired by Professor Kathy Rowan, Director of Scientific & Strategic Development. The theme ‘What has ICNARC done for us…’ was fiercely debated across 8 topics; Risk models/ modelling; Auditing adult critical care; Database, epidemiology and outcomes; Researching critical care; Customer service at its heart; Patients and public at its heart; An Independent trusted voice; Training/ supporting associates. The knock out format saw the audience voting on sli.do after each presentation, with the presenter/ topic with the least votes leaving the balloon.

The Balloon Debate saw speakers in a 'basket' chaired by Professor Kathy Rowan

The debate saw fantastic engagement from the audience, and Dr Lisa Hinton came out on top with patient and public focus being voted ICNARCs greatest contribution of the last 25 years.

Following the lunch break, Sue James, a new ICNARC Trustee and former Trust Chief Executive introduced herself as chair of the afternoon session, which focused on the future.

Professor Kathy Rowan opened the session, elaborating on the ‘…and counting…’ part of the ’25 years and counting’ theme. She explained that strategy and planning have been a core part of ICNARC since our foundation and introduced our 5-year plan for 2019-2023 developed with the help of staff, trustees, and friends in the critical care community. She defined quality in care as a combination of effectiveness, humanity and equity, gave a reminder of ICNARC's vision, mission and values, and set out our key strategic priorities.

The remaining presentations looked at each of these strategic priorities, the first being to “work across regions and nations of the UK and internationally”, which the next two talks covered.

Alvin Richards-Belle, Trial Manager, presented results and insights from the POPPI trial. He acknowledged the presence of attendees from participating sites in the room and explained that whilst the complex psychological intervention did not reduce patient reported PTSD symptoms and severity, the trial did show that high levels of psychological morbidity were observed in the critical care population and the trial has generated a rich dataset for future analyses.

Dr Rory Dwyer

Dr Rory Dwyer, Clinical Lead, Irish National ICU Audit (INICUA), National Office of Clinical Audit (NOCA), Ireland, explained the development of INICUA as a collaboration between NOCA and ICNARC. INCIUA now sees Irish critical care units benchmarked against UK critical care, and the data and analyses have provided great insight. NOCA have now published the first Irish National ICU Audit Annual Report (2017).

The next two talks were on the second strategic priority, to “diversify and embrace new methods and areas”.

Dr James Doidge, Senior Statistician, looked at Data linkage to report longer-term survival, introducing data linkage as the process of combining data from different sources which all contain information on the same patient. James put the case for audit to look beyond acute hospital discharge, where CMP data currently ends, with the potential to use data linkage to look at long-term health and mortality

Dr Doug Gould, Senior Researcher, presented on Auditing family satisfaction, focusing on the humanity of care aspect of improving quality. He first looked at past work on measuring family satisfaction with care, including the results of the FREE study, before detailing plans for a future audit. This would be run on a cost recovery basis as an optional additional module to the core CMP dataset.

The final talks were on the third strategic priority, to “inspire, and be inspired by, the critical care community”.

Ruth Endacott, ICNARC Trustee and Professor of Critical Care Nursing, gave an overview of the SEISMIC study on Safe staffing in ICU, explaining that the links between staffing levels, patient nursing requirements and outcomes are not well understood, with this project being a first stage to understanding these relationships better. SEISMIC is being funded by a National Institute for Health Research (NIHR) development grant and Ruth gave some context as to how these grants work, and that they only last one year. With this in mind, and a lot of work to do in a short time, she ended with a plea for timely collaboration from units if they are approached to help.

The last talk was from Dr Mike Christian, Research & Clinical Effectiveness Lead/ HEMS Doctor, London’s Air Ambulance who gave an overview of the challenges faced by the London Helicopter Emergency Medicine Service (HEMS). He compared their current position, in which almost no data are available on patient outcomes, to the situation in critical care when ICNARC was founded 25 years ago and hopes to achieve an equivalent to the CMP for HEMS. Data collection in the pre-hospital setting faces many challenges but access to performance measurements is key to improving quality of care.

Ruth Endacott gave the closing remarks, citing an amazing day and a celebration of achievement over 25 years. As the audience included many young people, she was optimistic for the next 25 years. Ruth thanked ICNARC staff for devising the day’s program and delivering logistics, whilst also thanking attendees, external presenters and all other supporters.
The special 25 years drinks reception then rounded off a great day.

We highly anticipate next year’s meeting by which point there will be even more to celebrate and report back on. Date to be announced soon.


For any queries, please contact events@icnarc.org.