25th February 2016

Thoughts from the Critically Careful Forum

On 22nd January I was privileged to attend the first national Learning from Excellence event hosted by Dr Adrian Plunkett at Birmingham Childrens’ Hospital.  As a former West Midlands paediatric trainee who has rotated through BCH PICU twice I was aware of the fantastic work Adrian and the team had undertaken and had witnessed first hand the positive effects this had on staff.  On joining the Paediatric Emergency Medicine team at Leicester Royal Infirmary I was keen in some way to introduce the learning from excellence philosophy.  This idea complimented the Critically Careful Forum which Dr Gareth Lewis was already running in the department.

It was the story of our journey and experiences with the Critically Careful Forum, the good and bad, ups and downs that I was able to share with the audience on the 22nd.  I am aware that running a regular ‘Awesome and Amazing’ style meeting in an emergency department for many will be common practice.  Unfortunately there was nothing being delivered locally to provide multidisciplinary education for our staff.  Originally this monthly meeting was slow to get off the ground however it has gone from strength to strength.  This is a little scary as there is a definite expectation now from the staff who for the majority attend in their own time.

Ultimately we reflect on what has always been a busy previous month in the department.   We highlight a selection of cases which traditionally have been some of the more difficult and challenging ones with relevant learning points.  We have noted that there have been struggles to fully adopt a learning from excellence approach due to the self-deprecating nature of many of our staff.  Even those working in a paediatric emergency department struggle with the concept that not every child gets better.  There is often a feeling of, “what did we do wrong?” or “what could we do better?” when the answer is “nothing!”

We are increasingly however pushing ahead with learning from excellence as it is these cases that we believe we have most to learn from.  In the past 6 weeks we have introduced a new sepsis bundle and last month saw evidence of its success.  A patient with severe sepsis was identified at triage, prioritised for senior medical review and transferred to resus where ultimately care progressed to PICU level support with intubation, ventilation, antibiotics, fluid boluses and inotropes within 35 minutes of the child arriving.  This care will be highlighted and discussed at length but we will also recognise the wider staff efforts; those that ‘stepped-up’ to maintain excellent care for the other children in the department.

In this way I feel we have been able to maintain staff morale at high levels during a busy and challenging winter period.  I believe that this is an under-recognised benefit of the learning from excellence process.

I hope I was able to inspire some in the audience with our experience from Leicester, certainly I came away invigorated with lots of great ideas I am already setting into motion to allow us to better recognise and highlight the great work in our immediate and wider team.

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