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
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.
I can’t thank Rony Robinson (@Rony37) enough for the privilege of joining him at BBC Radio Sheffield this afternoon. You can listen to the interview from around 1h37m of his show (after Christina Perri’s track 1000 years – beautiful).
The chance to articulate a little about this project, the transport service I’m currently working with (Embrace) and some life “stuff” too was an absolute pleasure. That said – does anyone like listening back to the sound of their voice?! Thanks for all the positive comments, they’re hugely appreciated.
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 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.
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.
The EPIQ programme training workshops are now being disseminated to locations in several countries. On several continents even. Originating from Canada (see my previous posts…) it’s not hard to see why this practical take on the IHI methodology for Quality Improvement, translated to consider the needs and opportunities specific to neonatal care, has captured units’ imaginations internationally.
Teams as glamorous and enthused as any you’ll find (see above!) came together from across the globe to train in EPIQ methodology, focusing on their 10 steps to success. A highly problem-based style of facilitation, each group selected and worked through (in an accelerated fashion) a real-life challenge for care in one or more of our base units. Examples included how to manage risks associated with the infection risks of mobile phones, a multitude of approaches to the location and pathways of care for intravenous antibiotics in “well” babies at risk… the variety was really stimulating.
Tools, tips and techniques evolved and disseminated throughout the day and it was utterly eye-opening to learn from colleagues around the world concerning their routines and standards of care. This was an incredible opportunity to explore defined approaches to evaluating a problem, sharing the language of a QI process and understanding some of the world wide priorities from direct clinical practitioners in neonatology. I would recommend it highly and hope that we can emulate the model back in the UK – a cohesive approach sharing a common language and toolkit.
“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 Network (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!
Osaka day 8 @wcmtuk Another day, another 500g delivery! It seems all the ELBW (Extremely low birth weight) babies are arriving whilst I’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
This morning an in depth discussion around nutrition in the ELBW infant. Some familiar challenges, but a real breadth of approaches and possible solutions. Local practices, specific challenges here in Tokyo with some very interesting clinically focused research – well done National Centre for Child Health and Development, excellent initiative to answer some taxing PN (parenteral nutrition) questions. Enteral feeding practices subtly different from those typical in the UK with some interesting food for thought (excuse the excellent pun) around breast milk fortification, oral supplements and metabolic bone disease.
In between observations and meetings, some important down time with the admin team… an origami swan Masterclass! Now mine looks a little er, less than perfect, but it’s a good start. Also a heart for the origami Christmas tree. Feeling very welcomed.
Some hugely thought provoking discussions on working practices too. Am mindful of the working and workforce issues which may seem so challenging back home, but the many privileges we have too. How about 1 week of annual leave per year UK trainees?