Churchill Fellow 2018 #EQuIIP

I’ve been saying a lot in the run up to this project how lucky I feel to be doing something so exciting, and to have the backing and engagement of so many people who believe in me.  A friend reminded me of this…

“Luck is a matter of preparation meeting opportunity”

Lucius Annaeus Seneca

selective focus photography of person holding the adventure begins mug
Photo by Simon Migaj on Pexels.com

However effort, motivation, opportunity and/or the stars and moon have brought about this opportunity – thank you for joining me on the journey. Follow my travels here on the webpage, share my posts far and wide, keep up with me on Twitter… however you choose to stay in touch, I look forward to sharing the adventure with you.

Ultimate in Conference Motivation

I do love a good conference. I even used to have a designated conference buddy. We had a superb routine… North America, Europe, UK… we took immense pleasure in a well planned conference trip. Though I’m without a partner in crime for this adventure – the EPIQ Conference, 2019 in Toronto, ON has been quite something. What a humbling and motivating experience. I’ll tell you a little about it. And tell you that the 2020 conference is in Banff, Canada in February – not a bad option if you’re intrigued by this post!

The Churchill Ballroom; venue for the conference dinner – how fitting!

The injection of enthusiasm, the infectious can-do attitude, the pro-activity have all particularly spoken to me on this element of my Churchill Fellowship travels. Over several days this conference recapped key principles and findings of the EPIQ QI programmes and research (see some of my other posts…), tantalised with novel ideas for improving care in level III NICUs (those looking after the smallest, sickest infants), and reported back to delegates on successes – and failures – of projects. I highlight that projects which were NOT overwhelming success stories, or that had gained traction but relapsed after some time, were openly presented and welcomed. Too often our biases to sharing success, positive changes and happy news mean that powerful lessons and opportunities to share from what isn’t working are lost to us. Not the case here.

That being said – many projects had rewardingly seen positive impacts on care of vulnerable babies and their families. The “elevator pitches” of these individual projects from units all over the country were quite the sight to behold. From a video adaptation of Frozen’s “Let it go”, to an audience participation N-I-C-U track to the melody of Y-M-C-A, teams from units of every province gave a 1-minute taster of their poster presentation to follow. I embraced it. Projects had followed the EPIQ 10 step improvement methodology to greater or lesser degrees but all embodied the spirit of the programme. Themes covered Reduction of nosocomial infection, NEC prevention (necrotising enterocolitis), Resuscitation and more prolonged stabilisation of preterm babies at mother’s side, and strategies for Antenatal corticosteroid stewardship (improving the timing of this key intervention) with the memorable tag #NoStaleSteroids.

An example poster from the Mount Sinai EPIQ team
One of the posters from Montreal Children’s Hospital

I’ll speak more on the results, the outcomes, the materials later. For the moment I want to bathe in the atmosphere. Everyone here was unified in working – hard – to improve neonatal care. This crowd have “drunk the Kool Aid” to borrow a phrase and they seem to like it. Long time locals, recent arrivals to the Canadian health system, allied professionals, experienced attending Neonatologists, medical students, parents… this was one of the most unified gatherings of diverse stakeholders I’ve had the pleasure to become a part of.

We heard from families too. Their poignant descriptions of care they did, and did not on occasion, receive made the subject matter all the more tangible. Emotional recollections of their experiences as parents of extremely preterm babies served only as further motivation for the conference team to make their ongoing participation in this work, and the conferences themselves, increasingly meaningful. Hats off to those parents, very seriously, who bravely and openly gave us their time and tales with which to empathise.

Welcome… to the snow

“Toronto isn’t usually like this” I’ve heard a lot in the last 24 hours… Whether blizzards and 20-30 cm of snow in a matter of hours are, or are not, normal occurrences here, my first impressions remain epic. This is quite a city. I’m here for the second leg of my Winston Churchill Memorial Trust Fellowship travels – to explore improving care and reducing variation in outcomes for extremely preterm babies – but if you’ve been following my story on Twitter you’ll already know that #EQuIIP. Today’s attire has included thermal vest and leggings, long sleeved top, jumper, fleece, standard trousers, scarf (let’s be honest, it’s a blanket…), glove liners, mittens, Big Coat and bobble hat. I was ok. Not hot.

Whilst here I’ll be visiting and meeting with teams at Mount Sinai Hospitals, The Canadian Neonatal Networkย (CNN), EPIQ (Evidence-based Practice for Improving Quality) and a few key others – it’s quite a schedule. The international EPIQ annual conference, QI workshops and CNN annual meetings are all on the agenda too – note book at the ready!

19th Dec ’18 – The babies just kept coming

Osaka day 8 @wcmtuk Another day, another 500g delivery! It seems all the ELBW (Extremely low birth weight) babies are arriving whilst Iโ€™m here to learn. Incredible team, so giving of their time to support my project. Typically this unit might have 30-40 babies of this age and size per year; this makes 3 just this week. An unanticipated opportunity to witness 1st hand the care and methods I’ve heard and read so much about.

Attempts to improve our ability to predict and prevent IVH in #ELBW at 23 weeks – are doppler waveforms on cranial ultrasound an important addition? Meticulous calculations and attention poured over fluid balance and haemodynamics too. 8 hourly echocardiography and CrUSS for the early days.. Innovative approaches combined with great attention to the basics.

Also meeting some of the long term residents on the NICU today; 3 months… 10 months…(!) discharge planning complexities for challenging growth and tracheostomies are common across the globe #ELBW