DECEMBER 2013

Advocate for intensive care throughout Australia

and New Zealand

INTENSIVISTTHE

02 Social Media, Critical Care & ANZICS

05 Presidents Report

07 Membership

08 Safety and Quality Committee

09 Education Committee

11 Centre for Outcome and Resource Evaluation

14 Death and Organ Donation Committee

15 Practice and Economics Committee

18 Paediatric Committee

19 Clinical Trials Group

20 Regional Committees

2 THE INTENSIVIST DECEMBER 2013

Social Media, Critical Care & ANZICSTo most people over the age of thirty the words ‘social media’ are as alien as the words ‘pension plan’ are to those under it. To the non-participant, it is a confusing spectrum ranging from narcissists broadcasting ‘selfies’ (self-taken pictures of themselves) to the driving force behind the Arab Spring. With 1.2 billion monthly active Facebook users and 500 million total Twitter users, social media cannot be ignored.

Defining what exactly constitutes ‘social media’ is difficult. It covers an array of internet collaboration through websites such as Wikipedia, virtual social worlds in Second Life, video communities on YouTube and realtime conversations conducted through Twitter and Google Hangouts. What they all have in common is content created by, and for, anyone. This clearly has its weaknesses – conversations risk being hijacked by those who shout the loudest. However the strength of the collective can usually convince misguided outliers to sit down & shut-up and the ‘Truth’ rarely suffers in a free and open debate.

Consider the journal-cycle of old. A paper is submitted, subjected to peer-review and, if deemed worthy and after some delay, published in a paper-only journal circulated to a select group of paid subscribers. Any debate on the merits or otherwise of the paper would be subsequently conducted, back-and-forth, in the letters page. Eventually a few papers that stood the test of time find their key points summarised in a hefty textbook read only by those sitting exams. This entire cycle may take many years.

In 2013, many journals now make ‘articles in press’ available online months prior to paper publication. They distribute Table of Contents links through email and social media. These are further disseminated by individuals within online communities and the conversation begins. Papers are analysed, discussed & dissected in real-time, sometimes with the authors joining in. For example, a recent social media journal club found an error in the statistical analysis of a New England Journal of Medicine paper culminating in the publication of a correction1. This new era of near-instant post-publication review has such potential that, as of last month, PubMed began trialling

it as a forum for scientific discussion on everything they index2. Old media are slowly adapting to the ways of the new. Where practice changes may have an immediate impact upon outcome, it is almost negligent to wait for the post to arrive. To the next generation of Intensivists, quarterly printed journals will seem as archaic a means of communication as the fax machine does to (most of) us now.

Of the many facets of social media, few have been as enthusiastically embraced by Doctors as Twitter. Twitter is a realtime conversation where you can choose who to interact with and who to ignore. Through a historical quirk that many believe is Twitter’s greatest asset, they (and you) are limited to communicating in a haiku-like 140 characters or less. The need for brevity brings a focus on the relevant; if you can’t make your point succinctly, perhaps you don’t have a point to make.

The Twitter ‘hashtag’ (a ‘#’ followed by a keyword) has the potential to change the way medical conferences engage with their audience. Not only does it allow people on the other side of the world to follow a conference (Twitter is free and disregards geography and timezones) but also allows a parallel discussion amongst the audience whilst the speaker is presenting. This was taken to its logical conclusion during last year’s Social Media And Critical Care (SMACC) conference where the real time worldwide audience ‘conversation’ was integrated into the speakers’ discussions. The statistics for this conference alone are staggering – it generated 14,505 tweets from 1,411 participants with 17,627,752 ‘impressions’ (the number of times the #smacc2013 tag appeared in Twitter user’s timelines). Even the College of Intensive Care Medicine got on board at this year’s ASM in Wellington by tweeting references

as they were mentioned during presentations, negating the need for delegates to frantically scribble them down before they disappeared into the next slide.

Much has been written on the negative aspects of social media, often by conventional media understandably wary of a mass-communication medium that largely bypasses them. The signal-to-noise ratio may seem weak to the uninitiated. To make social media reap dividends users must create effective filters4. Although the choice of who to listen to may seem overwhelming, time wasters soon become apparent. Find Twitter users with similar interests then see who they ‘follow’; it is likely you and they will also have interests in common. From announcements of ongoing HEAT trial recruitment (@DogICUma) to an ever-expanding library of FOAM (Free Open Access Med(ical Ed)ucation) resources (@precordialthump), Twitter has something for every clinician. As a tech-friendly, early-adopter community, social media is a natural playground for intensivists.

Professional & privacy concerns are often raised but are easy to dismiss. Professionalism in the real world also applies to the virtual world. Don’t say anything you wouldn’t say in public that may reflect on your profession, your employer or your patients. You are, after all, shouting to the world. To quote a recent commentator subverting Andy Warhol, in the future, everyone can expect fifteen minutes of privacy.

So what of the future? The recent working party charged with planning the next iteration of the ANZICS website expanded their scope to recommend that the society engage clinicians through social media. In the virtual world, such a presence

3THE INTENSIVIST DECEMBER 2013

is becoming as essential as a user-friendly website or an email distribution list. For ANZICS, it is an easy way to advertise our work to a worldwide audience, for free. In doing so however, it must be understood that, unlike conventional broadcasting, this is a two-way process. Managed well, it has the potential to engage with the intensive care community not only in Australasia, but also internationally, building upon the reputation established by the CTG and the ASM.

Jump on in. Open a Twitter account4 and get involved in FOAM5. It’s free, not just for teenagers*, and you’re bound to learn something.

Alex Psirides Wellington @psirides wellingtonicu.com

Chris Nickson Melbourne @precordialthump

*Wellington ICU has a 8 specialists with a mean age of 45.8 years and a twitter penetration of 63%

References:

1: http://intensivecarenetwork.com/index.php/component/content/article/913-forum/690-nejm-decolonization-paper-does-it-add-up

2: http://www.ncbi.nlm.nih.gov/pubmedcommons/

3: http://lifeinthefastlane.com/information-overload/

4: http://www.twitter.com

5: http://iteachem.net/2013/06/ten-tips-for-foam-beginners/

MARK YOUR DIARY

The 39th Australian and New Zealand Annual Scientific Meeting on Intensive Care and the 20th Annual Paediatric and Neonatal Intensive Care Conference

KEY DATES:Abstract Submissions Open: 17 March 2014Registrations Open: 17 March 2014Abstract Submission Deadline: 4 July 2014Early Bird Registration Deadline: 8 August 2014

CRITICAl CARE: ThE hIgh pERfORMAnCE TEAM

www.intensivecareasm.com.au

@ANZICSACCCN_ASM

Like us on facebook ANZICSACCCN_ASM

4 THE INTENSIVIST DECEMBER 2013

Have you seen an excellent speaker at your latest conference?Well let ANZICS know about them! The ANZICS Education Committee has now established an online form that can be used to inform the Society about high calibre speakers that you would like to see at ANZICS conferences.

The form is smart phone and tablet friendly, so visit the ANZICS Education Committee space at http://www.anzics.com.au/committees/education/speaker-evaluation-form, and set a bookmark on your device to use at your next conference.

ANZICS Honour Roll The ANZICS Board would like to congratulate the following members on their appointment to the ANZICS Honour Roll:

Dr Peter Hicks

Professor John Myburgh

Medical Prize Winners – 2013 Hobart ASM The ANZICS Board would like to congratulate the following ANZICS/ACCCN ASM 2013 Prize Winners;

Best Medical PaperJohn Santamaria Over 13 Years, ICU Patients Have Increasing Comorbidities

Best Paediatric Medical PaperAndreas Schibler How Does High Flow Treatment Work? A Lesson in Physiology

Best Safety & Quality PaperKwok Ming Ho Incidence of and Risk Factors for Venous Thromboembolic and Mechanical Complications Subsequent to using Retrievable Inferior Vena Cava Filters for Thromboprophylaxis in Patients with Major Trauma

ANZICS CORE Best Paper Tim Coulson Risk Change: A New Method to Compare Cardiac Surgical Units

Matt Spence MedalYasmin Ali Abdelhamid Critical Illness Reduces the Enteral Absorption of Long Chain Triglycerides

5THE INTENSIVIST DECEMBER 2013

Presidents Report As this is my first report as President, I would like to say how proud I am to have been elected to this role. I have served on the Board of ANZICS since 1998 as the Tasmanian Chair until 2002, and since 2003 I have been part of the Executive in various positions. Over this time the landscape of intensive care has markedly altered including the formation of the College, and ANZICS has adapted and grown thanks to the hard work of the Board and Committee members. I look forward to a continued collaborative relationship with the College that will benefit both organisations and our specialty in both Australia and New Zealand.

Thanks must go to Mary White who has worked tirelessly for the Society for the last two years, including a recent update to the Society Regulations and governance structure, and who will now assume the role of Immediate Past President. The Executive structure is designed to allow a transition with minimal impact on the Society and I look forward to being able to utilise Mary’s corporate knowledge and support for the next twelve months. Given my role as State Medical Director for DonateLife, I have asked Mary to take an executive role in organ donation matters in order that I avoid any potential conflict.

The members of the ANZICS Executive have not changed this year with Marc Ziegenfuss continuing as Treasurer and Simon Erickson as Secretary. Marc has managed the Society’s finances with skill; our asset base has been maintained, despite no increase to our subscription rates and an increase in the Society’s good works outputs. Likewise Simon’s contribution as Secretary cannot be underestimated. The stability of the Executive has given me great confidence that the next twelve months should be one of consolidation and continued growth of the Society.

I would also like to take this opportunity to thank all members of the Board and Committees of ANZICS. There is a huge amount of pro bono work done to improve intensive care in our two countries, and mostly this work goes without acknowledgement. In particular I would like to thank David Knight for his efforts as New Zealand Chair, as

unfortunately he has had to step down from this position.

The ASM was held in Hobart this year, and included a number of workshops, the integration of CTG sessions, and a new initiative – the Intensive Care Global Rising Star Programme that attracted four international investigators. I would like to thank the Medical Convener – David Rigg and my fellow organising committee members for all their hard organisational work, the sponsors of the meeting and prizes, and those ANZICS members who presented at the meeting. This year a number of presentations were filmed so that highlights can be made available to members via the ANZICS website. This initiative has and will be managed by the Education Committee. Additionally there has been an in principle agreement for several of the paediatric presentations to be made available to OPENPediatrics website based in Boston.

Following the success of the combined S ingapore-ANZICS Intensive Care Forum meeting this year, a further meeting has been planned for 2015. Thanks must go to Michael O’Leary who has advised that he will not be continuing as Convenor for subsequent meetings. SQAO will be held in Melbourne in 2014 and will be themed on Medical Emergency Teams. One potential outcome of the meeting is the development of a position paper on the structure and role of MET teams. An EOI for a convenor is to be circulated in the near future.

The ANZICS- India Sc ient i f ic Exchange will continue in 2014 and an EOI for speakers will be

distributed next year. The Board has agreed to an alteration to our budget for this year to allow ANZICS representatives to attend meetings which hold strategic value to the Society. Committee Chairs have been asked to supply a list of meetings, and these will be ranked and funding allocated against this new budgeted line item. Guidelines for funding each meeting, including Brussels, will be generated and placed on the website, and EOIs for attendance will be distributed to members.

The Society website although functional is somewhat dated, and recognition of this has led to a Committee being formed to scope out a framework for a redesigned site. Recommendations from the group were presented to the Board by Alex Psirides. ANZICS is currently looking to source an appropriate IT company that can work with this Committee and develop a final product, which should not only be more user friendly, but should better highlight the work that is being done by the Society, and allow access to relevant education content as determined by the Education Committee.

The Independent Health Pricing Authority has commenced a co-payment for ICU activity in addition to Activity Based Payments. This payment is to assist hospitals with the cost of ICU, with an aim that it should encourage efficient and effective ICU practice. These co-payments are not made for DRGs where ICU has already been priced into the DRG such as post cardiac surgery. ANZICS has become involved in discussions with IHPA given concerns that funding may

6 THE INTENSIVIST DECEMBER 2013

not be universal and may not reflect ICU activity for complex patients that do not require ventilation. These discussions are ongoing and we hope to develop a widely applicable model that accurately reflects current costs for ICU activity.

Ian Jenkins as Chair of PricE, Mary and I have been meeting with a consultancy firm which has been engaged by DoHA to develop a submission to Medicare for Intensivists to raise out of ICU fees. The submission which is being modelled on current activity should be complete in the near future. If accepted the item numbers generated should provide an appropriate fee level for consultation by Intensive Care Specialists for private patients who are not admitted to ICU at the time of review.

I would like to conclude by mentioning changes that have occurred with the Intensive Care Foundation. Gill Hood has been elected Chair, and the Foundation Board has changed significantly in composit ion. ANZICS has always provided support to the Foundation through donations and significant in kind assistance. Our General Manager, Justin Williams has assumed the position of CEO of the Foundation in addition to his Society position. The dual role has provided a synergy, and is fully supported by the ANZICS Board. The Foundation announced $175,000 in grants for ICU research at the ASM in Hobart, and I would encourage a l l I n t e n s i v i s t s t o s u p p o r t the Foundat ion by donat ion and/ or offering contacts with po ten t i a l bene fac to r s . Fo r

f u r t h e r i n f o r m a t i o n p l e a s e vis it the Foundation website www.intensivecarefoundation.org.au.

Andrew Turner ANZICS President

ANZICS BOARDPresident Andrew Turner

Immediate Past President Mary White

Honorary Secretary Simon Erickson

Honorary Treasurer Marc Ziegenfuss

VIC Regional Chair Stephen Warrillow

NSW Regional Chair Deepak Bhonagiri

SA Regional Chair Stewart Moodie

QLD Regional Chair Anthony Holley

NZ Regional Chair Ben Barry

WA Regional Chair Ian Jenkins

TAS Regional Chair David Rigg

CORE Chair David Pilcher

CTG Chair Colin McArthur

Paediatric Chair Johnny Millar

AUSTRALIAN AND NEW ZEALAND INTENSIVE CARE SOCIETY ABN 81 057 619 986

PO Box 164, Carlton South, Vic 3053 Australia

T: +61 (0)3 9340 3400 F: +61 (0)3 9340 3499 E: anzics@anzics.com.au W: www.anzics.com.au

Are you up to date?A r e m i n d e r t o u p d a t e yo u r co n t a c t d e t a i l s to ensure that you receive all ANZICS communicat ions . Contact Brent Kingston via brent.kingston@anzics.com.au or +61 (3) 9340 3400

ANZICS EventsICU Research Coordinator Workshop – March 4, 2014

ANZICS CTG Meeting, Sheraton, Noosa – March 5 – 7 2014 http://www.anzicsctg.org

New Zealand Regional ANZICS Meeting – March 12 – 14 2014, Christchurch

SQAO 2014 Conference – July 2014, Melbourne, Victoria

ANZICS/ACCCN Annual Scientific Meeting 2014 9 – 11 October 2014 Melbourne, Victoria http://www.intensivecareasm.com.au/2014

To keep up to date on all upcoming Conferences a n d Eve n t s , m a ke s u re to c h e c k o u t t h e events page on the ANZICS website regularly; http://www.anzics.com.au/events

7THE INTENSIVIST DECEMBER 2013

In the past few months, ANZICS has seen membership to the Society continue to grow to 765 members. Victoria continues to hold the most members, followed by New South Wales and Queensland. Of the membership categories Full members and Trainee members continue to increase and remain strong.

This is a great accomplishment for our Society and I wish to express my gratitude to all our Members, Regional Chairs, LinkPersons and Committee Members who have helped promote and spread the word of ANZICS and the work it does for its members. Although ANZICS has been successful in recruiting new members, I must encourage all ANZICS members to continue to promote ANZICS and encourage people working within our specialty to join ANZICS.

A reminder to those members with outstanding subscriptions that they can be paid online via: https://www.secureregistrations.com/ANZICS

I would also like to take this opportunity to welcome the following new members to the Society:

Dr Clement Lee Westmead Hospital, NSW

Dr Chris Nickson The Alfred Hospital, VIC

Dr Michael Ashbolt Royal Hobart Hospital, TAS

Sharada Baig Kamireddipalli North West Regional Hospital, TAS

Dr Geoff Knight Princess Margaret Hospital, WA

Dr Kylie Julian Middlemore Hospital, NEW ZEALAND

Dr Kristine Estenson Redcliffe/ Caboolture Hospital, QLD

Dr Adrian Skinner Royal Melbourne Hospital, VIC

Dr Anthony Sheung Lai The Princess Alexandra Hospital, QLD

Dr Jonathan Barrett Cabrini Hospital, VIC

Dr Jonathan Purday Bunbury Regional Hospital, WA

Dr Samuel Gluck Royal Adelaide Hospital, SA

Dr Sarah Jones Royal Darwin Hospital, NT

Dr Jonathan Bannard-Smith The Austin Hospital, VIC

Dr Christopher Carter Queensland Health, QLD

Dr Ashley Crosswell The Alfred Hospital, VIC

Dr Abbas Mutair Monash University, VIC

Dr Wael Youssef Al Hayat Hospital, Jeddah SAUDI ARABIA

Simon Erickson, Honorary Secretary

Membership

PINBALL ADRENAL POLAR SPICE SPLIT SUDDICU ARISE HEE BLISS EPO-TBI HOT OR NOT PROGUARD DELAYED DISCHARGE ALISAH PHARLAP REACT SHOCK CLOSE IRONMAN HEAT IPHIVAP RENAL TARGET ARISE BLING RELIEF TRANSFUSE DAHLIA TEAM PINBALL ADRENAL POLAR SPICE SPLIT SUDDICU ARISE HEE BLISS EPO-TBI HOT OR NOT PROGUARD DELAYED DISCHARGE ALISAH PHARLAP REACT SHOCK CLOSE IRONMAN HEAT IPHIVAP RENAL TARGET ARISE BLING RELIEF TRANSFUSE DAHLIA TEAM PINBALL ADRENAL POLAR SPICE SPLIT SUDDICU ARISE HEE BLISS EPO-TBI HOT OR NOT PROGUARD DELAYED DISCHARGE ALISAH PHARLAP REACT SHOCK CLOSE IRONMAN HEAT IPHIVAP RENAL TARGET ARISE BLING RELIEF TRANSFUSE DAHLIA TEAM PINBALL ADRENAL POLAR SPICE SPLIT SUDDICU ARISE HEE BLISS EPO-TBI HOT OR NOT PROGUARD DELAYED DISCHARGE ALISAH PHARLAP REACT SHOCK CLOSE IRONMAN HEAT IPHIVAP RENAL TARGET ARISE BLING RELIEF TRANSFUSE DAHLIA TEAM

Sheraton Noosa Resort & Spa, Noosa, Queensland

ANZICS Clinical Trials Group 16th Annual Meeting

on Clinical Trials in Intensive CareMarch 5 - 7, 2014

www.anzicsctg.org

ICU Research Coordinator WorkshopMarch 4, 2014

Incorporating the

8 THE INTENSIVIST DECEMBER 2013

Safety and Quality Committee The Safety and Quality Committee is in the process of enacting its Terms of Reference and will be reformed by the end of November. The Committee’s first Strategic Plan has been approved by the ANZICS Board and will guide the Committee’s activities over the next two to three years.

The 7th International Conference on Safety, Quality, Audit and Outcomes Research in Intensive Care was held at The Hilton in Sydney from Monday 29 July – Wednesday 31 July 2013. The Conference program included a facilitated workshop to explore the issue of clinical handover in the ICU. A report on this workshop is currently being finalised and will be made available to ANZICS members. The Conference also included sessions on: The Australian Commission on Safety and Quality in Health Care’s Ten standards for safety and quality and how these standards relate to ICU; recognition and management of sepsis; communication with families and free paper presentations.

The 8th International Conference on Safety, Quality, Audit and Outcomes Research in Intensive Care is currently under way. An organising committee is currently being formed and it is anticipated the Conference will have a ‘MET’ theme. The Conference will discuss MET from an Intensive Care perspective including staffing, rosters, protocols, quality and reporting. The conference will be held in Melbourne with the venue yet to be confirmed.

The Committee is continuing development of a central l ine insertion training framework. Development of this framework came as a result of interest from the membership following the launch of the CLABSI Prevention Project. The Committee anticipates that the framework will be used as a guide for those units training Clinicians new to central line insertion in Australian and New Zealand Intensive Care Units. The Committee has created a short survey which all ANZICS members will be invited to complete in the near future. The results of this survey will be used to further develop the framework.

THE VAP SURVEY 2013 WHAT YOU TOLD US....

Thank you to all of you who responded to the VAP survey earlier this year. Much has changed in the VAP area since we sent the survey. VAP as we recognise it has been elevated to the apex of a spectrum of Ventilator Association Events (VAE) in the latest literature to come out of the USA. We await Australasian studies to define these conditions and the current ANZICS draft statement addresses prevention of VAP only. Nearly 60% of respondents to our survey had 10 or more years’ experience in Intensive Care and a similar number worked in tertiary hospitals. Almost 4 out of 5 of all respondents agreed that routine oral cavity examination is important, oral care with chlorhexidine is the standard and a soft toothbrush is preferred for oral care. Stress ulcer prophylaxis should only be used when indicated in patients deemed high risk of developing stress ulcers and not as routine according to 70% of respondents. Head of bed elevation, early mobilisation, hand hygiene and 20-30 cm H2O cuff pressure had your support but you were undecided about routine selective decontamination of the digestive tract and the role of supraglottic suctioning.

Overall this survey has given the Safety and Quality Committee a platform from which we can develop a better understanding and recommend measures to better prevent VAP or VAE in Australasian ICU.

For further information regarding t h e o n g o i n g w o r k o f t h e Safety and Quality Committee p lease fee l f ree to contact Jennifer.Holmes@anzics.com.au.

Deepak Bhonagiri Safety & Quality Committee Immediate Past Chair

ANZICS SAFETY AND QUALITY COMMITTEE

Chair Vacant

Immed. Past Chair Deepak Bhonagiri

NSW Ian Seppelt

NT Vacant

WA Krishna Ponasanapolli

VIC Jonathan Barrett

SA Krishnaswamy Sundararajan

TAS Benoj Varghese

ACT Vacant

NZ Alex Kazemi

QLD Angus Carter

CICM Mary Pinder

ACCCN Bernadette GrealyThe Safety and Quality

Committee is on Twitter. Please follow us at @anzics_safety.

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Education Committee An ongoing challenge for the Society is to continue presenting relevant and engaging high quality material to members, the Convenors, Scientific Committee members and all who contributed to organising the 2013 ASM are to be warmly congratulated for an excellent meeting. With this in mind all delegates will now receive the survey as constructed by the ANZICS Education Committee. This process is now embedded in annual organisation process and administered by the Professional Conference Organiser, as opposed to through the Education Committee in previous years. This survey more thoroughly investigates the scientific quality of the program and other related aspects of the meeting and provides a useful tool for the society to understand and meet the expectations of members. We would be most grateful to everyone who takes the time to provide us with feedback.

One of the reasons for establishing the ANZICS Education Committee was to investigate and implement ways for the Society to become more engaged with new Consultants and Senior Trainees in Intensive Care Medicine. The Committee is aware that Senior Registrars are mandated to receive training in the area of transition through such courses as the Alfred’s Consultant in Transition Course and the CICM Management Skills Course. Through the course of discussion, the ANZICS Education Committee has identified the opportunity for complimentary training for new Fellows, which shows them how to use the tools at their disposal from within the Society and the broader Intensive Care community, for the benefit of their ICUs and their careers.

At the Hobart ASM, ANZICS ran its first New Consultant Course: ANZICS – ‘Keeping it Real’ in response to this need. The course was included in the registration for participants, and was presented by leaders within the Society including Immediate Past President A/Prof Mary White, and President A/Prof Andrew Turner. This was an intimate course requiring pre-registration with capped attendance to allow for an interactive and informal format. Topics included ‘Leadership and Mentoring;

What ANZICS Can Do for You’ and ‘Research Capability; from Participant to Chief Investigator’ among others. Results from the course evaluation show that course participants achieved a better understanding of the learning objectives and the Society as a whole. The Education Committee is dedicated to continuing to deliver this course, and are pleased to note that the format of integrating the course with the ASM program was attractive to participants as well as the material covered. Visit http://anzics.com.au/downloads/cat_view/29-education-committee to download a copy of the course flyer.

In 2014 the ANZICS Education Committee will be rolling out an online education program which showcases the great material developed each year by the diverse activities of the Society. All the Committees and workgroups will present new and important information and scientific evidence of interest to members as well as highlights from the ASM and other meetings. ANZICS is currently planning investment in infrastructure required to deploy this program, with in-house facilities located at ANZICS House in Melbourne. This program will start in March of 2014, and will be in a webinar type format with an opportunity for Q&A afterwards moderated by a local expert in the field. By the time this article is published, the Education Committee will have met to finalise this new program. Details will be distributed through member lists as they become available. Please continue to provide feedback and suggestions to Chris Nash via chris.nash@anzics.com.au. We are particularly interested in suggestions for inclusion in the on-line webinars over the next 12 to 18 months.

Gerry O’Callaghan Chair, Education Committee

ANZICS EDUCATION COMMITTEE

Chair Gerry O’Callaghan

Deputy Chair Stephen Warrillow

QLD Todd Fraser

VIC Owen Roodenburg, Sam Radford

NSW Michael O’Leary, Charudatt Shirwadkar, Liz Fugaccia, Dhaval Ghelani

SA Mary White

WA Vacant

ACT Sumeet Rai

NZ Rob Bevan

NT Rajendra Goud

TAS Andrew Turner

Paediatric Scott Simpson

10 THE INTENSIVIST DECEMBER 2013

 

Intensive Care Foundation News 

Dr Gillian Hood, Chair of the Intensive Care Foundation, announced $175,000 in grants for eight Australian and New Zealand world-leading clinical research projects at the ANZICS/ACCCN Intensive Care Annual Scientific Meeting in Hobart in October.

Grants were awarded for the following projects:

Prophylactic intra-aortic balloon counterpulsation in high-risk cardiac surgery: The PINBALL Pilot Randomised Controlled Trial Dr Ed Litton, Royal Perth Hospital, WA Funding: $34,000

Intestinal GLP-2 as novel target in critical illness-induced malabsorption Dr Richard Young, University of Adelaide, SA Funding $30,900

Vitamin D dosing study in Intensive Care Unit patients with Systemic Inflammatory Response SyndromeDr Priya Nair, St Vincents Hospital, NSW Funding $29,000

Hydrogen sulfide and substance P: novel biomarkers for sepsis A/Prof. Geoffrey Shaw, University of Otago, NZ Funding: $26,000

Endothelin blockade in ex-vivo lung perfusion Prof. John Fraser, Prince Charles Hospital, QLD Funding: $25,000

Therapeutic hypercapnia after cardiac arrest, a multi-centre pilot feasibility and safety randomized controlled trial Dr Glenn Eastwood, Austin Hospital, VICFunding: $13,320

Gene expression profiling in critically ill patients with septic shock: a pilot study Dr Jeremy Cohen, Royal Brisbane Hospital, QLD Funding: $11,625

ADRENAL Consent Study - a multi-centre, prospective, observational study of the process of obtaining consent from potential participants or substitute decision-makers in the adjunctive corticosteroid treatment in critically ill patients with septic shockMs Heidi Buhr, Royal Prince Alfred Hospital, NSW Funding: $5,000

A/Prof. Geoffrey Shaw receives his grant from Intensive Care Foundation Chair, Dr Gillian Hood

The Intensive Care Foundation is dedicated to improving the care of critically ill patients in Australia and New Zealand by raising funds for clinical research projects, as well as building community awareness of intensive care and related issues.

The granting program is the largest single component of the Foundation’s work. Since 2000 the Foundation has made grants totalling more than $2.6 million to Australian and NZ research projects.

intensivecarefoundation.org.au

                  

11THE INTENSIVIST DECEMBER 2013

In this copy of The Intensivist, I focus on one of the main functions of ANZICS CORE: Benchmarking of Intensive Care practices and identification of outliers. We are in an era where health departments have to justify their expenditure while ensuring the provision of high quality and resource efficient care. ANZICS CORE fulfills these requirements for Clinicians and the Departments of Health throughout Australia and New Zealand.

BUT FIRST……. A FEW WORDS ABOUT FUNDING FOR ANZICS CORE

Much of our focus in the latter half of 2013 has been to prepare and submit a request for on-going funding to the jurisdictional departments of health in Australia and New Zealand. This is through The Triennial Funding Agreement which has recently been tabled and discussed at the National Intensive Care Registries Steering Committee.

It costs roughly $1.1 million to run the bi-national registry reporting program by CORE each year (‘dirt cheap’ when you consider this is a similar figure for many state based registries run through University institutions). For the past decade, funding has come almost exclusively from jurisdictional departments of health and has been divided on a population basis. For instance, New South Wales with 27% of the population, contributes 27% of

the funding, even though there are more Intensive Care beds per head of population here than in most other regions of Australia and New Zealand. Until Queensland reduced their funding to cover only public ICUs (leaving a potential shortfall of approximately $70k per year which now has to be sought directly from private ICUs in the state), all jurisdictions had very similar agreements, arrangements and deliverables.

IDENTIFICATION OF OUTLIER INTENSIVE CARE UNITS BY ANZICS CORE – THE GOOD, THE BAD AND…THE PRIVATES?

Perhaps CORE’s most important ‘deliverable’ is to provide a reporting process which allows benchmarking of ICU outcomes. Inherent in this is the identification of ‘outlier’ ICUs. This is primarily done by examining a funnel plot of standardized mortality ratios (SMRs), such as the one below:

WHAT HAPPENS WHEN AN ICU APPEARS TO HAVE WORSE OUTCOMES THAN EXPECTED?

Hospitals with an SMR above the upper control limit (i.e. who appear to have more deaths than expected for their peer group) have their data undergo further scrutiny through a defined process called the “ANZICS Outlier Management Policy’ http://www.anzics.com.au/downloads/doc_download/543-anzics-core-outlier-management-policy. Between July 2011 and June 2013, 18 individual units have been investigated as outliers, including two additional non-outlier units reviewed at the request of specific jurisdictions.

In some of these cases, the high SMR has been wholly or partly explained by data quality issues or by variation in case mix. However when this has not appeared to be the case, more in-depth analyses of outcomes within specific patient groups and of resources (e.g. staffing, ICU bed access etc.) at the ICU in question have been undertaken. These have then been fed back both to the ICU in question and to the local health department.

Centre for Outcome and Resource Evaluation

12 THE INTENSIVIST DECEMBER 2013

WHAT ABOUT NON-CONTRIBUTING UNITS?

Contribution to ANZICS CORE essentially remains voluntary. One could debate whether this should remain so. It is obviously impossible to know how outcomes at non-contributing units compare to their peer group. ICUs treat the sickest patients in the hospital and often have the most dedicated and hardworking medical and nursing staff. We all believe we are doing the best for all of our patients, but some sites get an uncomfortable shock when they see for the first time actually how their outcomes compare………this is a reality! I personally encourage all ICUs to contribute data and review their quarterly reports. If you care about your outcomes, measure and compare them. Please contact us at anzics.core@anzics.com.au or call to speak to one of the CORE team on 03 9340 3400 for help.

WHAT ABOUT THE PRIVATE SECTOR?

Many of us work in both private and public hospitals. Reporting of public sector ICU outcomes follows a clearly defined process but this is sometimes less clear for private hospitals. Private hospital SMRs generally appear lower (better) than those in the public sector. There may be many reasons for this, not least the fact that scoring systems may overestimate the real risk of death for low severity post-operative patients (a large proportion of the private ICU work load). However variation in outcomes at private hospitals is much greater than at public hospitals and cannot be wholly explained by deficiencies in mortality prediction or case mix variation.

Do health departments have a responsibility for benchmarking quality of care delivered to patients in private hospitals? Queensland Health no longer pays ANZICS CORE for reporting of outcomes of patients at private ICUs in the state. In Queensland we now have a difficult situation where some private ICUs still send data to CORE but do not contribute financially and thus do not get reports. What happens if one of these ICUs appears as an outlier? Does CORE have a responsibility to perform additional investigations? If it appears outcomes are indeed worse at this hospital, should this be reported and if so to whom? If CORE starts reporting on these ‘non-paying’ hospitals, does this mean that the remaining jurisdictions are now effectively funding reporting services

for private ICUs in Queensland? These are questions to which I have no answer but may to have to tackle in the near future.

HOW CAN THE OUTLIER PROCESS BE IMPROVED FURTHER?

ANZICS CORE has already introduced a number of processes to enhance the Outlier identification processes such an inter-jurisdictional clinician-led working group for reviewing outlier reports, structured generation of reports, clarification of governance processes and additional analyses of performance measures such as after-hours discharges, VTE prophylaxis and hospital acquired infection rates. New developments are also on the horizon which will further improve these processes. These include:

The Australian and New Zealand Risk of Death (ANZROD) model for adult patients

h t tp : //www.ncb i .n lm .n ih .gov/pubmed/24074958

Paediatric Index of Mortality (PIM – 3) for paediatric patients

ht tp : //www.ncb i .n lm .n ih .gov/pubmed/23863821

The ANZICS-CORE Enterprise Reporting System (in development at the moment and due for testing in 2014)

Investigation of “good outliers”. There is much potentially to be learnt from hospitals whose ICUs have consistently better outcomes than others. ANZICS CORE has already identified a number of ICUs which appear to have consistently better outcomes than their peer group. The next step is to work out if these findings are real and in what way these ICUs differ from the rest.

Too many Clinicians reading this, the work done by individuals at ANZICS CORE producing these reports will be invisible! It is likely you have never seen an outlier report for your hospital but if you have, you will know the huge efforts put into them and will recognize the high standard of analysis in them. Comparative reporting of ICU outcomes in this way is the most important method of monitoring our Intensive Care system and helps ensure we provide care we can be proud of.

David Pilcher Chair, ANZICS CORE

ANZICS CORE ADVISORY COMMITTEE

APD David Pilcher

CCR Peter Hicks

ANZPICR Anthony Slater

S&Q Deepak Bhonagiri 

VIC Graeme Hart

NICRSC Rep Martin Lum

CTG Steve Webb, Colin McArthur

NT Dianne Stephens

SA John Moran

WA Ian Jenkins

ACT Manoj Singh

QLD Dan Mullany, Ranald Pascoe

NSW John Lambert

TAS Matthew Brain

Others representation may be invited by the CORE Management Committee related to specific issues for discussion.

13THE INTENSIVIST DECEMBER 2013

• Conference speakers Brian Robson

Brian Kavanagh

Hannah Wunsch

Kathleen Vollman

Jean Michel Arnal

John Frazer

Janos Pataki

Mike Ardagh

Richard Beasley

Nick Cross

George Downward

Alastair Gibson

Peter Hicks

Shay McGuinness

Maggie Meeks

Alex Psirides

Paul Young

REGISTRATIONS NOW OPEN!

ANNUAL SCIENTIFIC MEETING 2014BREAKING THE MOULD

Rydges Latimer Christchurch

CHRISTCHURCH, NEW ZEALAND, 12-14 MARCH 2014

www.anzics2014.co.nz

Totara sponsors

For more information and to register visit the

conference website www.anzics2014.co.nz

• Industry exhibition

• Welcome cocktails

• Conference dinner at Christchurch’s

Transitional ‘Cardboard’ Cathedral

www.anzics2014.co.nz

14 THE INTENSIVIST DECEMBER 2013

In June of this year the Death and Organ Donation Committee conducted the 2013 Organ Donation Survey. This survey investigated general attitudes and practices in organ donation, as well as the newly introduced Australian Organ and Tissue Authority (AOTA) 2 day Core Family Donation Conversation (CORE FDC) workshop.

We received a strong response to this survey, which was circulated to both ANZICS and CICM members. There was a broad response rate across specialties and jurisdictions, with only 27% of responses being Medical Donation Specialists or NZ Link Doctors. Of those surveyed, 62% had not attended the Core FDC workshops, with 42% indicating they intended to attend. 43% of those who did not attend indicated that “I am already skilled at discussing organ donation”.

From the 107 respondents that did attend the AOTA FDC workshops, > 75% agreed or strongly agreed with having learnt something that they could put into practice, thought that the workshop was worthwhile and would recommend it to colleagues. > 80% respondents agreed or strongly agreed with support for organ donation, including DCD, and agreed it is the primary responsibility of Intensivists to conduct donation conversations. The results are yet to be discussed fully by the DODC committee but many of the additional comments from members will enable ANZICS to inform AOTA when reviewing this workshop content. Thank you to those who contributed to the survey, more in depth results will be available once all the responses have been discussed by DODC.

With the recent attention on the AOTA, the ANZICS DODC remains committed to representing the interest of Intensivists, and by extension of the Australian public, in the domain of organ donation. The DODC is widely recognised for its expertise in this area, and as such is represented in on the Core FDC Steering Group to guide course content. AOTA have also agreed to make the reading of the ANZICS Statement on Death and Organ Donation and multiple choice question test as prerequisites for

attending the Core FDC workshop. The DODC will continue to advocate on behalf of Intensivists on this issue. Please contact anzics@anzics.com.au if you have any queries or concerns regarding this matter and they will be forwarded to the Committee.

The ANZICS End-of-Life Care Working Group (EOLCWG) continues to meet and develop its statement, which will incorporate and replace the Statement on Withholding and Withdrawing Treatment. The working title for the statement is the ANZICS Statement on Care and Decision Making at the End-of-Life for the Critically Ill. The working group is set to convene at ANZICS House in Melbourne in February of 2014 where a medical editor will be engaged, with a view to publishing this by the end of 2014.

On behalf of Bill Silvester Chair, Death & Organ Donation Committee

ANZICS DEATH AND ORGAN DONATION COMMITTEE

Chair Bill Silvester

Deputy Chair Stewart Moodie

Paediatric Johnny Millar

QLD Brent Richards

VIC Helen Opdam

NSW Deepak Bhonagiri

WA Geoff Dobb

NZ Stephen Streat, James Judson

NT Vacant

TAS Vacant

ACT Vacant

ANZICS END OF LIFE CARE WORKING GROUP

Chair Bill Silvester

Deputy Chair Stewart Moodie

QLD Brent Richards

VIC Charlie Corke

NSW Peter Saul, Theresa Jacques, Ken Hillman, Jonathan Gillis, Malcolm Fisher

WA Geoff Dobb

NZ James Judson, Stephen Streat

TAS Vacant

NT Penny Stewart

ACT Vacant

Paediatric Stephen Jacobe, Jonathan Gillis

Neonatal Dominic Wilkinson

CICM Charlie Corke

Death and Organ Donation Committee

15THE INTENSIVIST DECEMBER 2013

Practice and Economics CommitteeThe PricE Committee has continued to be active over the past four months with a number of activities around providing a forum for members to debate and discuss workforce issues. Continuing negotiations with the Department of Human Services and with Medicare and groups commissioned by them about new and existing item numbers in the Medicare schedule, and with dealing with various professional matters ranging from individuals’ issues with respect to billing or rostering, through to agency requests for information or assistance on a wide range of professional and industrial matters. We recently held a face-to-face meeting in Melbourne at ANZICS House to discuss the following issues and form a work plan for the next six-twelve months.

WORKFORCE

We are all aware that there are a large number of registered CICM Trainees and that there has been a significant increase over the past ten years in the number of new Fellows graduating each year. It is also self-evident that Intensive Care Medicine, more than almost any other specialty is quite ‘inelastic’– that is, Consultant positions are dependent upon ICU beds, either public or private, and that it is very difficult for an Intensivist to ‘self-generate’ workload outside of either public hospital departments or existing private practice groups. What has become apparent in the discussions over the last twelve months is that there is disagreement, predominantly between the PricE Committee of ANZICS and CICM, as to whose responsibility it is to try to manage the matching of likely positions to the number of Trainees that are being produced.

However, there are changes to the training structure by CICM, both definite (commencing 1 January 2014) and yet to be confirmed, that will go some way toward ensuring that those who train in Intensive Care Medicine are both suitable and prepared for the arduous path that training requires, and that the number of Trainees commencing that path is more reasonably matched to likely jobs at the other end.

The PricE Committee recently surveyed members online about workforce and work-style issues

and there has been a very pleasing high response rate to this survey. Results were presented to the Board at the October Board meeting and at the AGM in Hobart. Whilst there is not space here to reproduce all of the data, both the members’ survey and the survey conducted of ICU Directors yielded some interesting data. The following pie chart shows the distribution, amongst 66 ICU Directors who completed the survey of the estimated likely number of new Consultant positions becoming available in their units in the next five years:

How many new FTE ICU consultants do you expect to appoint in the next five years? (median 1; mean 1.3 )

123%

223%

035%

312%

45%

52%

Amongst members who replied to the members’ survey it was illuminating to find that 13% were currently actively seeking paid employment- we deliberately did not ask whether they were currently employed or unemployed (as Intensivists) or whether this sought employment was locum work in addition to (any) current work.

Are you currently actively seeking paid employment in Intensive Care (includes

locum work)?13%

85%

2%

Yes No Other

MEDICARE

Previously I had reported that our previous Medicare submission had been essentially rejected, save for the probability that an item number relating to ward consultations would be introduced. Whilst there was some stuttering progress on this, progress had ground to a halt until mid-2013, when the Department of Health and Ageing appointed an external consultancy, Aspex Consulting, to prepare a submission around four new item numbers or groups of numbers, including for consultations performed outside of the Intensive Care Unit by a Specialist working in Intensive Care Medicine. This would include consultations done as part of MET calls to private patients and also other times we are asked to attend patients with complex illness outside of the ICU. This work is currently in progress, but we are confident that we can achieve a good outcome for members. There had been little contact with Aspex Consulting recently, however, A/Prof Mary White and I met with their Principal and an Officer from the Department of

16 THE INTENSIVIST DECEMBER 2013

Health and Ageing recently to review the submission data. Any new Item Numbers will have a miniscule impact on the overall income of Intensivists, even those working in busy private hospitals, but what it does achieve is cement, in funding bodies eyes, at least, the pivotal role Intensivists play outside of the ICU.

ICU FUNDING UNDER ACTIVITY BASED FUNDING (ABF)

As readers may be aware, the Commonwealth now funds State entities based on activity, with an ‘efficient price’ for various diagnosis-related-groups (DRGs) being determined by the Independent Hospital Pricing Authority (IHPA). Where a DRG (such as with cardiothoracic surgery) implies a very likely admission to ICU, the ICU cost component is included in the moiety paid for the overall DRG. Where that is not the case, a per diem payment for ICU has been in place since the initiation of this ABF funding model. Initially it was intended that this be restricted to only Level III ICUs, based on the CICM classification. This would have severely impacted on the funding for smaller and, in particular rural and regional hospitals and their ICUs, so this restriction was lifted temporarily where states specified they wanted a payment for other ICUs. This is about to change again, and the proposal is to limit funding, on a per diem basis, to ventilated patients only. Again this would relatively disadvantage ICUs in smaller or regional centres where many admissions may not be ventilated, but are not well

enough to be safely cared for on the ward. ANZICS PricE Committee will be working closely with the IHPA to establish a model that is equitable, robust, fair, reliable and most importantly does not limit the ability of regional and metropolitan ICUs to deliver high quality care. There is now agreement that there will be testing of various models using CORE data to attempt to validate the use of a severity of illness scoring system as a marker of length of ICU stay and cost (e.g. APACHE IIIJ).

FUTURE DIRECTIONS FOR PRICE COMMITTEE

The period ahead sees plenty of work for PricE to carry out, around the above three areas. The fiscal position of the States and the Commonwealth is far from rosy, Intensive Care Medicine can be expensive, and we must be vigilant, on behalf of our patients that ICU is not unduly targeted in any cost-reduction strategies. The ANZICS Board will soon be seeking nominations from the regions for members of the PricE Committee, we are very keen to encourage ‘new blood’ onto the Committee.

If members have any queries please feel free to contact me at ian.jenkins@health.wa.gov.au or speak with your regional representative, listed below.

Ian Jenkins Chair, PricE Committee

PRACTICE AND ECONOMICS COMMITTEE

Chair Ian Jenkins

NSW Michael O’Leary, Mark Nicholls

NZ Ywain Lawrey

QLD Ranald Pascoe

SA Nick Edwards

TAS David Rigg

VIC Stephen Bernard

WA Greg McGrath

Warwick Butt (Paediatrics)

ACT Vacant

NT Vacant

Follow the ANZICS ACCCN Intensive Care ASM on Twitter (@ANZICSACCCN_ASM) and Facebook (ANZICSACCCN_ASM) for all the latest updates and highlights from the event.

20TH ANNUAL CONFERENCE OF INDIAN SOCIETY OF CRITICAL CARE MEDICINE &18TH ASIA-PACIFIC CONGRESS OF CRITICAL CARE MEDICINE

2ND ANNUAL CONFERENCE OF CRITICAL CARE NURSES SOCIETY

A JOINT MEETING OF

CRITICARE 201414 - 18 February, 2014

Jaipur

www.criticare2014.comwww.apaccm2014.com

Its all first - ISCCM, APACCM & CCNS together

Theme : Multidisciplinary Closed ICU Care

Above All - You will have the Newly Discovered Indian Talent on the fore

CME Credits Points with RMC will be requested.

Its Jaipur

Its Rendezvous Birla Auditorium

Weather at it best

Sepsis Antibiotics

The Charm of Awesome historic Sisodiya Rani Gardens

The Mystic Rajputana Hospitlaity at its best

Just think of Coming

Talent at its best

Jambooree of Knowledge, skill, training, workshop, fellowship and celebrations

CONFIRMED INTERNATIONAL FACULT Y

TOP SESSIONS ON

BEST OF INDIAN FACULTY, A BLEND OF EXPERIENCE AND FRESH TALENT FROM EAST TO WEST AND NORTH TO SOUTH

PLENARIES, SEMI PLENARIES, PANEL DISCUSSIONS, ORATIONS, AWARDS, MEET THE EXPERTS, THEME SESSIONS, SPONSORED SESSIONS, PARALLEL ADULT, PEDIATRIC AND NURSING SESSIONS AS NEVER BEFORE

Tropical Fever Ventilation

Multiorgan Failure The Talk of the Town

Reviews Whats in Store for Future

Mitchell LevyUSA

Neil MacintyreUSA

Luciano GattinoniItaly

Sangita MehtaCanada

Anthony McleanAustralia

Marin KollefUSA

Niranjan KissoonCanada

Vinay NadkarniUSA

Peter RimensbergerSwitzerland

Luca NeriItaly

Ravindra MehtaUSA

Edgar JimenezUSA

Younchuk KohKorea

Marc ShapiroUSA

Why you must attend?

TM

Dr. Narendra Rungta President, ISCCMCongress Chairman &Chairman, Scientific Committee

Dr. H. Bagaria Organising Chairman

Dr. Manish MunjalOrganising Secretary

Jeevan Rekha Critical Care and Trauma HospitalMahal Yojna, Central Spine, Near Akshay Patra Temple, Jagatpura, Jaipur 302025 INDIATel. : +91 141 515 50 50 • (Direct) +91 141 515 50 75 • Fax : 011 4582 3473e-mail : Dr. Narendra Rungta [drnrungta@gmail.com]Dr. Manish Munjal [drmmunjal@hotmail.com • manish@jeevanrekhahospital.in]

Dr. Manish MunjalOrgANISINg SeCreTArY

Conference Secretariat

17THE INTENSIVIST DECEMBER 2013

20TH ANNUAL CONFERENCE OF INDIAN SOCIETY OF CRITICAL CARE MEDICINE &18TH ASIA-PACIFIC CONGRESS OF CRITICAL CARE MEDICINE

2ND ANNUAL CONFERENCE OF CRITICAL CARE NURSES SOCIETY

A JOINT MEETING OF

CRITICARE 201414 - 18 February, 2014

Jaipur

www.criticare2014.comwww.apaccm2014.com

Its all first - ISCCM, APACCM & CCNS together

Theme : Multidisciplinary Closed ICU Care

Above All - You will have the Newly Discovered Indian Talent on the fore

CME Credits Points with RMC will be requested.

Its Jaipur

Its Rendezvous Birla Auditorium

Weather at it best

Sepsis Antibiotics

The Charm of Awesome historic Sisodiya Rani Gardens

The Mystic Rajputana Hospitlaity at its best

Just think of Coming

Talent at its best

Jambooree of Knowledge, skill, training, workshop, fellowship and celebrations

CONFIRMED INTERNATIONAL FACULT Y

TOP SESSIONS ON

BEST OF INDIAN FACULTY, A BLEND OF EXPERIENCE AND FRESH TALENT FROM EAST TO WEST AND NORTH TO SOUTH

PLENARIES, SEMI PLENARIES, PANEL DISCUSSIONS, ORATIONS, AWARDS, MEET THE EXPERTS, THEME SESSIONS, SPONSORED SESSIONS, PARALLEL ADULT, PEDIATRIC AND NURSING SESSIONS AS NEVER BEFORE

Tropical Fever Ventilation

Multiorgan Failure The Talk of the Town

Reviews Whats in Store for Future

Mitchell LevyUSA

Neil MacintyreUSA

Luciano GattinoniItaly

Sangita MehtaCanada

Anthony McleanAustralia

Marin KollefUSA

Niranjan KissoonCanada

Vinay NadkarniUSA

Peter RimensbergerSwitzerland

Luca NeriItaly

Ravindra MehtaUSA

Edgar JimenezUSA

Younchuk KohKorea

Marc ShapiroUSA

Why you must attend?

TM

Dr. Narendra Rungta President, ISCCMCongress Chairman &Chairman, Scientific Committee

Dr. H. Bagaria Organising Chairman

Dr. Manish MunjalOrganising Secretary

Jeevan Rekha Critical Care and Trauma HospitalMahal Yojna, Central Spine, Near Akshay Patra Temple, Jagatpura, Jaipur 302025 INDIATel. : +91 141 515 50 50 • (Direct) +91 141 515 50 75 • Fax : 011 4582 3473e-mail : Dr. Narendra Rungta [drnrungta@gmail.com]Dr. Manish Munjal [drmmunjal@hotmail.com • manish@jeevanrekhahospital.in]

Dr. Manish MunjalOrgANISINg SeCreTArY

Conference Secretariat

18 THE INTENSIVIST DECEMBER 2013

ANZPIC REGISTRY

The 2012 ANZPIC Registry Annual Report is being finalised for printing and will be distributed to members shortly. The number of admissions contained in the report continues to increase annually, with more than 10,000 children admitted to ICU in 2012. The report also contains more detailed data pertaining to both respiratory therapy and extracorporeal life support.

The most recent iteration of the paediatric index of mortality, PIM3, has been completed using data from the Registry and from the UK PICANet. A manuscript detailing the refined score is due to be published imminently. Requests for data and research proposals are welcomed by the Registry, and the last 12 months has seen increased interest in utilizing this rich source of data.

The ANZPICR Clinical Advisory Committee met in July and plans to meet again in early 2014. The Committee will contribute to strategic planning for the Registry and will also address specific questions and problems regarding data collection and interpretation. Unit-identified data will be reviewed by this Committee and there are plans to develop mechanisms to address data outliers and review data and research requests.

PAEDIATRIC STUDY GROUP

The Paediatric Study Group is gathering significant momentum and forging important links with overseas PICU research networks. Point prevalence data collection continues apace, most notably with the ongoing SAFE-EPIC project looking at fluid resuscitation in PICU. This international study is gathering data from more than 120 units around the world and is being led by Rino Festa (Westmead Children’s Hospital, Sydney). Initial results from this study will be presented at the Noosa CTG meeting in March.

A three month observational study of sedation practices in PICU (Baby SPICE) has been completed, capturing data on approximately 250 patients in all PICUs in Australia and New Zealand. Initial results were presented at the Hobart ASM in October. This work has led to a proposal for a pilot study of early goal-directed sedation in PICU which has been led by Simon Erickson (Princess Margaret, Perth). It is hoped that the pilot will start early next year and lead to a grant application for a large randomised, controlled trial the

following year.

ASM

The ASM in Hobart was very successful, with a strong and lively paediatric scientific and social programme. Work is well underway in preparation for next year’s meeting to be held in Melbourne. Felix Oberender is organising the scientific programme and has already secured Professor Pat Kochanek, Editor-in-Chief of Pediatric Critical Care Medicine as a plenary speaker for the paediatric programme.

Johnny Millar Chair, Paediatric Committee

ANZICS PAEDIATRIC COMMITTEE

Chair Johnny Millar

Immediate Past Chair Simon Erickson

QLD Andreas Schibler, Tony Slater

NSW Gary Williams, Marino Festa

SA Michael Yung

NZ John Beca, Gabriel Nuthall

TAS Vacant

VIC Warwick Butt

ACT Vacant

NT Vacant

WA Simon Erickson

Paediatric Committee

19THE INTENSIVIST DECEMBER 2013

The ANZICS CTG has continued through the latter half of 2013 with good progress in study programme development, recruitment in a number of studies, and with several publications from endorsed studies. TARGET (Augmented vs. Reduced Goals for Energy delivery) completed its pilot with encouraging results presented at the ASM in October, and the management team is finalising the protocol and grant application for a major phase III study. The TEAM (a trial of early activity and mobility in ICU) programme has also had encouraging results from its observational study and will shortly commence a pilot study to assess the feasibility of a major trial. This programme development sequence illustrated by these 2 research groups, although very time consuming, has become an excellent process to develop very high quality studies that are attractive to funders.

Most major funded CTG studies are now actively recruiting. ARISE (early-goal directed resuscitation in sepsis vs standard care) study is nearing the end of recruitment and we are looking forward to the results being presented next year. The ADRENAL (low dose hydrocortisone for septic shock) has commenced recruitment at a pleasing rate, as has HEAT (paracetamol versus placebo for fever); TRANFUSE (fresh vs standard aged red cells) and BLING (infusion of beta lactam antibiotics) are also moving steadily forward. Of the two traumatic brain injury studies, EPO-TBI (erythropoietin) has the edge over POLAR, but expansion to include some French sites for POLAR should assist. PHARLAP (open lung strategy for ARDS) recruitment has been limited by the reducing incidence of this syndrome. SPICE (targeted light sedation, using dexmedetomidine vs standard care sedation) has recently commenced recruitment and is aiming for 4000 patients expected to receive mechanical ventilation for at least 2 days. RELIEF (Restrictive versus Liberal Fluid use peri-operatively) is a joint study with the ANZCA Clinical Trials Group and has recently commenced recruitment.

The Winter Research Forum was held in Melbourne with a full 2 day programme, which particularly focused on early development projects benefiting from

constructive feedback with the smaller group setting. A successful CTG morning programme was also run at the Hobart ASM in October, with standing room only at the fluids session! We plan to follow the same format in 2014 to fully evaluate this approach. In March we will return to the Sheraton in Noosa for our major annual meeting at which we will celebrate the 20th anniversary of the formation of the Clinical Trials Group. We are pleased to welcome Anders Perner from the Scandinavian Critical Care Trials Group as our international visiting speaker. The Winter meeting will be held in Sydney, August 21–22, 2014, and discussions are underway to look at a combined meeting with the Canadian Critical Care Trials Group in the next year or two.

We are grateful for the support of the Intensive Care Foundation in its recent awards to CTG researchers. This funding provides a very useful “helping hand” to projects and programmes that are just commencing, and we congratulate Priya Nair ($29,000 for’ Vitamin D dosing study in Intensive Care Unit patients with Systemic Inflammatory Response Syndrome’), Ed Litton ($34,000 for ‘Prophylactic intra-aortic balloon counterpulsation in high-risk cardiac surgery: The PINBALL Pilot Randomised Controlled Trial’), Glenn Eastwood (‘Therapeutic hypercapnœa after cardiac arrest, a multi-centre pilot feasibility and safety randomized controlled trial’) and Heidi Buhr ($5,000 for the ADRENAL Consent Study)

The Executive Committee has met three times this year, and has completed our 2013 – 2016 strategic plan and a major review of the CTG Terms of Reference, with particular revision of the structure and operation of the committee, and some smaller changes to the endorsement process. As well as some changes to the office bearers in the middle of year, regional representatives have also been appointed by their constituencies. I would like to welcome Manoj Saxena (NSW), Michael Reade (QLD), Adam Deane (SA) and David Cooper (TAS) as new members to the Executive. Neil Orford (VIC), Ed Litton (WA) and Shay McGuinness (NZ) have been re-confirmed as in their positions as regional representatives. We look forward all of their contributions as the CTG moves into its 20th year in 2014!

Finally I would like to thank all of the CTG member units and wider ANZICS community for your excellent support for the many projects that have been undertaken this year. There is a lot happening at the moment, and many ICUs are feeling the strain with a reduction in capacity to undertake research. Thank you again for making the effort, and I hope you can enjoy a well-earned break this summer.

Colin McArthur Chair, CTG

ANZICS CLINICAL TRIALS GROUP

Chair Colin McArthur

Immediate Past Chair Steve Webb

Vice Chair Craig French

Secretary Sandy Peake

Treasurer David Gattas

CORE David Pilcher

PSG Simon Erickson

IRCIG Rachael Parke

QLD Michael Reade

VIC Neil Orford

NSW Manoj Saxena

SA Adam Deane

WA Ed Litton

TAS David Cooper

NZ Shay McGuinness

Co-opted Member Dianne Stephens

CTG Report

20 THE INTENSIVIST DECEMBER 2013

NEW SOUTH WALES

ANZICS NSW has been busy with an increased interest a n d m e m b e r s h i p applications especially from Trainee members

and recently qualified intensivists. ANZICS has a separate and valuable role for Trainees and Intensivists and it is heartening to see increased interest in ANZICS activities.

There is broad support in New South Wales for ANZICS to maintain an ongoing role in the professional development and welfare of Intensivists and we now have ANZICS LinkPersons in most New South Wales ICUs. Last Month, on the 13th of November we had a CME session cobadged with CICM to update the membership on the soon to be adopted Intensive Care Clinical Information system. Theresa Jacques, Brett Abbenbroek and Sean Kelly presented an overview of the implementation and potential for outcomes and research reporting using the CIS at a well-attended session at the Royal Prince Alfred Hospital. As always we are keen for enthusiastic members to volunteer to become involved with State or Federal Committees. If you are interested, or have any ideas, please do not hesitate to get in touch with one of those named below.

Deepak Bhonagiri New South Wales Regional Chair

ANZICS NEW SOUTH WALES REPRESENTATIVES

Chair Deepak Bhonagiri

DODC Deepak Bhonagiri

S&Q Deepak Bhonagiri, Tony Burrell, Sumesh Arora

Education Michael O’Leary, Charudatt Shirwadkar, Liz Fugaccia, Dhaval Ghelani

Abstract Review Committee Dhaval Ghelani, David Gattas, Michael O’Leary

CTG Manoj Saxena, David Gattas

PricE Michael O’Leary

CORE Tony Burrell, John Lambert

SOUTH AUSTRALIA

Congratulations to the Tasmanian Organising Committee for an excellent ASM. South Australian Intensivists attended in large

numbers and contributed to a number of sessions as speakers, chairs and judges. Of particular note was the hugely popular literature review session with speakers Mike Anderson, Adam Deane and Bala Venkatesh. A mixture of science and humour hopefully cemented this session as a regular event at the ASM. The Education Committee, chaired by Gerry O’Callaghan, ran its first Consultant Transition Course educating the new Consultant group on the value of ANZICS and hopefully encouraged some to contribute further to the Society. Very well done to Dr Yasmin Ali Abdelhamid for taking home the Matt Spence medal, she had strong competition from other Royal Adelaide Registrars as well as interstate presenters. Yasmin’s success has meant that this is the third year in a row that the Matt Spence winner has come from South Australia; this reflects the strength of research mentorship within all the major hospitals in Adelaide.

With the finalisation of the ANZICS regulations, it will be an opportunity to look at the roles of the various ANZICS representatives within SA over the next few months. Hopefully we can improve the representation from all of SA’s hospitals and bring some fresh ideas on how ANZICS can further deliver benefits to all of its SA members. If any members have specific ideas or requests then please feel free to contact me for assistance.

Stewart Moodie South Australia Regional Chair

ANZICS SOUTH AUSTRALIA COMMITTEE

Chair Stewart Moodie

Deputy Chair Ken Lee

Treasurer Adam Deane

DODC Stewart Moodie

S&Q Krish Sundararajan

Education Adam Deane, Mary White, Gerry O’Callaghan

PSG Vacant

Paediatric Michael Yung

Abstract Review Committee Adam Deane, Matthew Maiden

CTG Adam Deane

PricE Nick Edwards

CORE John Moran

VICTORIA

Recent months have seen a range of activities involving Victorian Intensivists, and as the year now draws towards its

conclusion it is good to reflect on our various achievements.

Education has been a major focus in 2013, with a range of events throughout the year. The Victorian Intensive Care Education Network (VICEN) has conducted eleven sessions including Trainees from nine hospitals (public and private) spread across metropolitan Melbourne. With up to twenty-five Trainees attending, this is now a major contribution to Intensive Care training within the state. All participating hospitals

Regional Committees

21THE INTENSIVIST DECEMBER 2013

provide a full day of education which variously incorporates lectures, bed-side tutorials, equipment reviews, practice exam cases and simulation sessions. The inclusion of a paediatric day hosted by the Royal Children’s Hospital was a welcome addition to this year’s schedule. Feedback has been extremely positive and plans for 2014 are now well underway. The Victorian Intensive Care Network (VIN) has also consolidated its status as an innovative educational forum. The program has very broad appeal and achieves impressive attendances, with noted success in engaging with Senior Trainees and new Fellows. A joint event was recently held with the TSANZ on quality improvement collaboratives and tracheostomy care, utilising the expertise of A/Prof David Roberson who visited from Harvard. The overlap between our areas of interest with other craft groups was well explored and similar events are planned for 2014.

The efforts to establish closer engagement with the WFSICCM were rewarded earlier this year through the election of Professor John Myburgh to the council. I am grateful to John as well as Adam Deane and John Botha for their work at the World Congress in Durban to achieve this result. As ANZICS delegates to the General Assembly, all were instrumental in returning our Society to a central role in this important forum. Further to this success, ANZICS went on to beat seven other cities from around the world and win the rights to host the 2019 World Congress in Melbourne. Over three years of sustained work has gone into this bid and it is wonderful to finally be rewarded. Gabrielle Hanlon from the ACCCN was an instrumental partner in the preparation and presentation process and deserves great credit for this outcome. Mary White and Paul Fullbrook have also been key contributors to the overall process and ensured that our vision of a genuinely multidisciplinary bid team was conveyed to the council. While 2019 is quite a while off, it is certain that the event will be a remarkable celebration of Intensive Care and planning has already commenced. In the meantime, much work is being done for next year’s ASM in Melbourne and an energetic multidisciplinary organising committee has done much to ensure that preparations are on track.

Many hospitals are in the throes of national standard accreditation at present and all Intensivists will be well aware of the work involved in preparing for assessment. Whilst incredibly demanding, the clinically relevant and

outcome focussed nature of most standards have probably ensured higher levels of clinician engagement than in the past. As is often the case, Intensive Care is a major focus for many aspects of accreditation and all units have been required to direct precious resources to work through the complex and rigorous process of achieving compliance with each standard and ensuring adequate substantiation. Hopefully these efforts will also generate sustainable improvement in a range of domains which can positively impact on our patients and their families.

I would like to welcome Ben Gelbart to the role of Deputy-Chair of the Victorian Regional Committee and look forward to working with him. With clinical engagement across adult and paediatric intensive care, it is great to have Ben in this important role where he will do a great job of supporting the interests of colleagues in both areas of practice. Thanks to all the Victorian ANZICS members who have participated with enthusiasm in the activities of 2013 and also to the ANZICS House team who continue to provide dedicated service to the society in everything they do.

I wish all ANZICS members a wonderful holiday season and much success in 2014.

Stephen Warrillow Victorian Regional Chair

ANZICS VICTORIA COMMITTEE

Chair Stephen Warrillow

Deputy Chair Ben Gelbart

DODC Bill Silvester, Helen Opdam

S&Q Jonathan Barrett

Education Sam Radford, Stephen Warrillow

PSG Vacant

Paediatric Johnny Millar

ARC Ravi Tiruvoipati

CTG Neil Orford, Craig French

PricE Stephen Bernard

CORE David Pilcher

NEW ZEALAND

I am delighted to inform you of the successful candidate for the ANZICS New Zealand Regional Representative, Dr Ben Barry. We are pleased to have Ben on the Committee and are looking forward to working with him on the ANZICS Board. On behalf of the Board I would also like to thank Dr David Knight for all of his hard work over the past few years. David has made significant contributions for New Zealand and we would like to wish him well with all of his future endeavours.

On behalf of the NZ Committee, ANZICS is pleased to announce the upcoming NZ Regional ANZICS Meeting to go ahead from March 12th to the 14th 2014, in Christchurch. Presentations by Jean Michel Arnarl, Hannah Wunsch, Brian Kavanagh, Shay McGuiness, Paul Young and Brian Robson (Clinical Director, Healthcare Improvement Scotland) are amongst the early highlights.

For more information, visit the following link; www.anzics2014.co.nz

Simon Erickson ANZICS Honorary Secretary

WESTERN AUSTRALIA

It seems that tertiary medical care in Western Australia is currently a tale of two cities (in one)- North Metropolitan Health

Service, caring for about half of Perth’s population appears, certainly from an outsider’s point of view, to have a degree of stability, albeit with the same fiscal restraints and pressures that are squeezing the whole system, whilst the reconfiguration occurring in South Metropolitan Health Service is overwhelming and chaotic. This instability and change particularly affects Intensivists for two reasons- firstly their clinical practice is necessarily based in public tertiary institutions and secondly, they have a habit of becoming passionately involved in hospital organisation, management and planning.

With less than a year to the clinical opening of the 780 bed Fiona Stanley Hospital, in Perth’s southern suburb of Murdoch and the subsequent reduction in size of the ICUs at Fremantle and Royal Perth Hospitals, there is still not clarity around location of much service provision, workforce modelling, recruitment requirements and indeed the funding available for staff. What we

22 THE INTENSIVIST DECEMBER 2013

are seeing is a very top-down approach to hospital management- this doesn’t sit well with shop-floor Intensivists, who, in Australia and New Zealand, have been able to be reasonably autonomous, patient-focussed and make do with available resources for the last forty-odd years.

There is a new, malignant phrase that has appeared- “affordable FTE”- presumably what staff that can be employed based on revenue from activity based funding (ABF). It appears staff numbers will be determined by available funding, not quality service provision requirements. Interestingly the national model of funding ICU activity is also undergoing significant revision- how it will look in two-three years from now is virtually anyone’s guess. It may well be based on a per-patient payment based on acuity at admission.

On a more positive note, since the last edition of The Intensivist, we have had three evening educational meetings- two organised by industry and one organised by ANZICS and supported by industry which was formatted as a pro-con debate around balanced crystalloid solutions versus saline.

Recently Ed Litton was re-elected unopposed as Western Australian representative on the Clinical Trials Committee (CTG) for a further term. John Lewis stepped down as the Safety & Quality Committee nominee from our state and has been replaced by Krishna Ponasanapalli. Many thanks are due to John for his work on the S&Q Committee….and congratulations to Ed and Krishna on their (re-)election. Brigit Roberts has been co-opted onto the committee for a further term.

As this is the last The Intensivist publication for 2013, I wish to wish all ANZICS members a joyous and safe holiday season- am I alone in believing the best parties in December always seem to be on my on-call nights?

Ian Jenkins Western Australia Regional Chair

ANZICS WESTERN AUSTRALIAN COMMITTEE

Chair Ian Jenkins

S&Q Krishna Ponasanapalli

CTG Ed Litton

CORE Vacant

PricE Ian Jenkins, Greg McGrath

ARC Geoff Dobb

DODC Geoff Dobb

Education Simon Erickson

Australian Resuscitation Council Vacant

PSG Vacant

QUEENSLAND

Q u e e n s l a n d Government Hospitals continue to experience significant structural changes that have i m p l i c a t i o n s f o r

Intensive Care medicine. In May 2012, legislation was introduced to formalise the conversion of the health districts created in the 2005 Queensland restructure to independent local Hospital and Health Services (HHSs). Under these new arrangements the HHSs each have their own Board that manages and oversees the operations of the HHS and is accountable to the Minister for Health. These new management structures have sought to enhance the efficiency of public health delivery, however for many working in the health sector this has been an unsettling and concerning time. Proposed individual employment contracts have only just been released this week to all Senior Medical Officers and Visiting Medical Officers in Queensland. These documents may signif icantly alter our current entit lements, remuneration and private practice income. The individual contracts will replace previous arrangements, with all VMOs and SMOs being removed from Workplace Awards or Enterprise Agreements. This will terminate the Medical Specialists’ ability to improve and protect conditions through collective bargaining. These contracts have been re leased for a fourteen day consultation process, but at this stage crucial information regarding remuneration, hours of work and right of private practice are still to be provided. Furthermore fourteen days would appear to be a woefully inadequate review period. Extremely concerning are the proposed conditions whereby individual Specialists can be dismissed, with what appears to be very little recourse to due process. While these

arrangements will affect all Medical Specialists and the Australian Medical Associat ion is support ing i ts membership, it may become important that organisations such as ANZICS intervene to support individual craft groups. More than ever ANZICS is relevant and indeed needs a strong m e m b e r s h i p t o d e l i v e r a powerful message.

The Queensland Regional Committee has continued with the successful co-badged ANZICS/industry education evenings. The most recent meeting that was held on the 5th November with Professor Peggy Knudson, University of California San Francisco, Chief of Surgery, San Francisco General Hospital and Trauma Center, presenting on venous thromboembolism prophylaxis in the Intensive Care environment. The presentation generated robust debate and the evening appeared to be thoroughly enjoyed by all. Early in October Dr Colin Page, Clinical Toxicologist, Queensland Poisons Information Centre & Hunter Area Toxicology Service, Calvary Mater Hospital and Staff Specialist Emergency Physician, Princess Alexandra Hospital spoke at a very informative co-badged ANZICS/industry education evening meeting. He delivered a fascinating presentation looking at the QT interval- its measurement and more importantly its practical clinical utility.

2013 has seen ongoing discussions be tween ANZ ICS CORE and Queensland private units (and PHAQ) regarding the arrangements for the ongoing funding of private unit participation in the data submission fo l lowing the wi thdrawal of Queensland Health funding as of 1 July 2012. Many units have acknowledged the importance of this data collection and submission with respect to unit performance appraisal, standards and accreditation. Therefore many of these units have established funding to continue involvement in this incredibly important quality assurance activity. We continue to encourage every unit to come on board.

Late last year Queensland Health approached ANZICS Queensland to provide comment on the vision for Intensive Care into the next decade. This was indeed done and we were able to furnish them with a formal response. In July 2013 “Adult intensive care services state-wide health service strategy 2013” was published. The document details the challenges faced by our specialty over the next decade and potential solutions are offered. What is clear to all is that vast geography, an aging population, increasing co-

23THE INTENSIVIST DECEMBER 2013

morbidities alongside increasing public and medical expectation will see an ever increasing demand for the delivery of Intensive Care services in our state.

Queensland is blessed with a very active Intensive Care research group, who continue to generate world class research and attract major grant funding. In this regard special thanks must go to Dr Jeffery Presneill who did a great job as the Queensland ANZICS CTG representative. It is with tremendous enthusiasm that we welcome Professor Michael Reade to this position after he was successfully elected in September this year. We look forward to his energy and commitment in representing Queensland’s research interests and appreciate the good fortune to have a researcher of his calibre on the regional board.

ANZICS has continued its support for the annual co-badged CICM /ANZICS Registrar Research Forum which designed to encourage an interest in research among Queensland Registrars and Specialists. This forum provides an opportunity for established Researchers to Mentor and encourage new Researchers. The meeting will be held this week in Brisbane and promises to be very informative. All are encouraged to attend and if you have missed it this year, why not protect your diary for this time next year!

The Queensland training Pathway has continued to very effectively coordinate the state-wide Intensive Care training scheme despite changes to its funding model. Dr Bruce Lister has provided great energy and wisdom to the process. The advantages of such a system have been clear to all involved. Individual Trainees are tracked and assisted to navigate through appropriate hospital appointments to deliver an all round critical care training experience. Opportunities for trainees continue to be created in a range of facilities and a centrally controlled process ensures Queensland remains a popular state for Registrars to undertake their training.

Finally Queensland ANZICS has a strong and stable membership that represents the members’ interests in a range of activities, including safety, quality, research and private practice. While the Queensland intensive care community continue to face challenges on many fronts, a powerful and effective professional society is not a luxury but rather an absolute necessity.

Anthony Holley Queensland Regional Chair

ANZICS QUEENSLAND COMMITTEE

Chair Anthony Holley

Deputy Chair Rajeev Hegde

DODC Brent Richards

CORE Dan Mullany

PricE Ranald Pascoe

CTG Michael Reade

PSG Anthony Slater, Andreas Schibler

S&Q Angus Carter

Abstract Review Committee David Sturgess, Greg Comadira, Michael Reade

TASMANIA

The 2013 Hobar t ANZICS ASM was a great success, with the Hotel Grand Chancellor on the waterfront being a perfect setting.

The intimate design of the venue created a buzzing atmosphere which encouraged delegates, trade and speakers to mingle and interact. The program was very well received and had something for everyone, demonstrating once again that the ANZICS/ACCCN Intensive Care ASM is the leading multidisciplinary event in our region. I would like to thank the entire Organising Committee, both the local Hobart team and those from interstate who assisted us with the Paediatric program, for all their hard work on this event. Informal feedback has been very positive from both delegates and speakers, and I have since received congratulatory messages from international speakers.

Through the hard work of Dr Adam Deane, the ASM this year launched a new initiative ‘The Intensive Care Global Rising Star Programme’. This programme funded up and coming young researchers from all around the world to present at the ASM, providing four additional international speakers to the scientific program, sponsored by Baxter Healthcare and ANZICS. The aim of this programme is to identify promising and innovative young Clinicians and Scientists.

Calls for applications were sent to the relevant Intensive Care Societies in Canada, the United States and South America, as well as Europe (including the UK and Ireland) and Asia. Applicants had to have a strong research background with publications in high-impact peer-reviewed journals. Beyond encouraging high end research in Intensive Care Medicine, this program aspires to build scientific links between Intensivists in our region and others. Adam did a marvellous job organising this, and we cannot thank him enough. This is planned to be an ongoing feature of future ASM’s, and will help build the reputation of ANZICS around the world, as being a Society which fosters frontier medical research.

The Social Program in Hobart was once again stunning, with the Friday Night party being a standout event. The Museum of Old and New Art (MONA) opened its doors to our delegates, in a rare opportunity for a private viewing of the entire gallery. Party goers had the opportunity to peruse the art of this provocative private collection at their leisure, with venue management allowing an extra hour over contract for our delegates to thoroughly enjoy. Once through the gallery, the main exhibition space was transformed into a dance floor and mingling area, which became one massive dance floor by the end of the evening. There were several areas for delegates to explore and interact, including the below ground ‘Void bar’, surrounded by three stories of sandstone wall on one side and eclectic furniture and art on the other. The food was also a spectacle, with grazing stations containing 30 varieties of cheeses from around the world, truffle pizza, and oysters on the half shell. There were even massive gardens that were entirely edible which looked completely in place in a gallery of art. The Gala dinner, hosted adjacent to the famous Salamanca Place, was also a fantastic evening. Free Paper awards were presented, as well as

A/Prof Andrew Turner presenting the Matt Spence Award to Dr Yasmin Ali Abdelhamid.

24 THE INTENSIVIST DECEMBER 2013

research grants from the Intensive Care Foundation. The Paediatric Dinner was held at Frogmore Creek Winery; a cosy and intimate setting which looked out over vineyards, as paediatric delegates mingled with speakers and the Paediatric Organising Committee.

It was a pleasure to host the ASM in Hobart this year, and it is fair to say that the event showcased the very best that we have to offer. I am sure that this world class event made a lasting impression on both our international counterparts, as well our Australasian critical care community. Congratulations to all involved, and we look forward to the 2014 ASM in Melbourne building on this success.

David Rigg Tasmania Regional Chair Convenor, ANZICS ASM 2013

ANZICS TASMANIA  COMMITTEE

Chair David Rigg

Abstract Review Committee Andrew Turner

CTG David Cooper

PricE David Rigg

CORE Alan Rouse

S&Q Benoj Varghese

DODC Vacant

Education Vacant

PSG Vacant

Paediatric Vacant

A/Prof Mary White, A/Prof Andrew Turner, Dr Adam Deane and the winners of the Intensive Care Global Rising Star Programme.