Volume 2 Issue 4 December 2015

 

Clinical Communiqué

Download PDF:  Clinical Communiqué December 2015 Edition

In this edition

  • Editorial
  • Case #1 Wrong Place, Wrong Time
  • Case #2 The Subtle Signs of Sepsis
  • Expert Commentary 1: Optimising Access and Care for the Critically Ill – A Regional Perspective
  • Expert Commentary 2: The Anatomy of a Modern Retrieval Service

Editorial

When cases of patient deaths in hospital are reviewed at mortality case review meetings or coronial inquests, there are common themes that frequently emerge. These themes are the critical elements that need to be present, or performed well, in order to provide safe and effective patient care. They include communication, documentation, awareness of one’s skills and limitations, recognising the deteriorating patient, and following guidelines, to name but a few. Failure or sub-optimal provision of even one element, inevitably leads to a failure in a system and the potential for patients to suffer preventable harm.

What happens when another layer is added to the system? When well-functioning processes are required not only for the care of a patient in a single hospital, but also for the integration of their care between hospitals? The system becomes bigger, more complex, with more room for error. At the primary team level, communication, documentation, and decision-making should be performed as effectively as resources and personnel allow. These professional skills are just as vital however, at the interface of the referral and receiving hospitals, and at the juncture between the hospitals and ambulance or retrieval services.

The two cases in this issue explore the challenging scenarios of managing a deteriorating patient in a rural or regional setting, and the obstacles that are faced when attempting to transfer a critically ill patient for ongoing treatment. The clinicians involved in each of the cases had to deal with the medical issues of the sick patient while also navigating their way through the obvious, and not so obvious, confounding factors that arise when referring or receiving patients from distant geographical locations.

In this issue we have the privilege of presenting two expert commentaries from senior clinicians with vast experiences in regional transfers of critically ill patients. Associate Professor Matt Hooper provides an eloquent and insightful overview of critical care retrieval systems, and Professor Alan Wolff and Mr Ian Campbell share their erudite views on the priorities and actions that regional centres must take when transferring patients to tertiary services.

Our thanks go as well to our guest author, Dr Gerard Fennessy who brings his intensive care and retrieval medicine expertise to the synopsis of the first case.

The end of 2015 marks a historic milestone for us as the Communiqué website is about to reach 80,000 lifetime views. We are very grateful for the readership, the support, and the feedback we receive, as we can all learn valuable lessons from eachother in our respective healthcare communities.

As we enter the festive season, we wish everyone safe travels and happy holidays. We look forward to bringing you more cases, commentaries and educational resources in 2016.