The Australian and New Zealand Clinician Educator Network (ANZCEN) Unconference: What's an unconference and how can it develop communities of practice?

The Australian and New Zealand Clinician Educator Network (ANZCEN) is a collaborative interprofessional group developed to promote the development of education in critical care healthcare practice. In November 2018, 45 critical care practitioners met at the first ANZCEN Unconference. In an unconference, the participants drive the agenda, and learning occurs from the active process of engaging in a community of practice. The aim of this unconference was to develop an innovative approach to learning through a collaborative framework with interprofessional representation across critical care specialties. Four key themes were identified in the unconference as drivers of interprofessional critical care educational priorities: interprofessional learning, workplace learning, faculty development, research, and scholarship. In this discussion paper, we describe our experiences organizing, participating in, and evaluating an unconference, and we examine its usefulness as a medium for promoting the interprofessional learning agenda in critical care. We hope that the processes outlined in this discussion paper will provide a useful resource for other clinicians who are considering developing an unconference. Finally, we argue that the unconference offers a unique and important model for future education of critical care practitioners where the emphasis on collaboration and communication through interprofessional learning and practice will be required to improve health outcomes and promote a patient-centered model of care.

Measuring the added value of virtual communities of practice for developing the educator role of critical care professionals.

In healthcare settings, workplace learning is often supported by clinicians who strive to combine service provision and educator roles. We evaluated an international 12-month programme that supports widely distributed critical care health professional educators (HPEs) through a virtual community of practice (vCoP). Specifically, we evaluate if and how the vCoP approach affects learning experiences using an innovative evaluation framework in medical education-the value-creation framework (VCF). We used a mixed-methods approach to evaluation, including an anonymous survey and semistructured interviews. Themes from data sources were identified using the VCF as the common thread. Themes discussed by at least two-thirds of interview participants were analysed using narrative inquiry. 27 of 66 participants responded to the survey, and 15 participated in interviews. Positive and negative indicators of value creation were extracted and organised according to the framework's eight value cycles. Framework analysis made value-creation and potential flow-on effects in one value-creation cycle to another visible, offering insight into relationships. Themes from narrative inquiry elaborated on the results of the framework analysis. Using the VCF to evaluate the Incubator programme brings to bear the complexity of boundary-crossing HPE faculty development for critical care educators. The framework can be a valuable tool for evaluating a vCoP associated with faculty development programmes.

Outcomes after inter-hospital transfer of intensive care patients with haemorrhagic stroke: a 5-year retrospective review.

BACKGROUND: Inter-hospital transfer (IHT) of intensive care patients is a limited resource. We assessed the outcomes of patients with haemorrhagic stroke requiring IHT and intensive care and aimed to identify early prognostic factors of poor neurological outcome. METHODS: We conducted a retrospective observational cohort study of patients admitted to a single tertiary intensive care unit (ICU) with haemorrhagic stroke after IHT between January 2014 and December 2018. Primary outcome was poor neurological outcome (modified Rankin Scale ≥4 at time of discharge from hospital or rehabilitation unit). Secondary outcomes were mortality rate, rate of intervention, rate of organ donation surgery (ODS) and potentially avoidable transfer (PAT). PAT was defined as transfer where the patient did not receive an intervention and had a poor neurological outcome. RESULTS: Ninety patients were included in this study, 48 with intracerebral haemorrhage (ICH) and 42 with subarachnoid haemorrhage (SAH). Fifty-one (56.7%) patients had a poor neurological outcome, including 30 (33%) who died. Factors significantly associated with poor neurological outcome included age > 80 years, lower presenting Glasgow Coma Score (GCS) and bilaterally fixed and dilated pupils. Stepwise logistic regression demonstrated history of hypertension as significantly associated with poor neurological outcome in patients with ICH (P = 0.021). Seven (7.8%) patients had ODS. Sixty-four (71.1%) patients received intervention and 20 (22.2%) transfers were potentially avoidable. CONCLUSIONS: Patients in this cohort are at high risk of poor neurological outcome. Prognostic factors identified in this study may help referring, retrieval and receiving clinicians to discuss futility prior to pursuing IHT.

Computed tomography pulmonary angiogram as a result of medical emergency team calls: a 5-year retrospective audit.

OBJECTIVE: To determine the proportion of computed tomography pulmonary angiograms (CTPAs), performed after medical emergency team (MET) calls, that are positive for pulmonary embolism (PE), and whether there are useful clinical predictors of positive CTPA results. DESIGN: All patients from a tertiary referral hospital in Melbourne who had an MET response and an associated CTPA within 6 hours, from 2009 to 2013, were included. We reviewed medical records to assess indications for CTPA, including MET clinical triggers, time of day of the MET (implying the seniority of decision making), chest x-ray results and Wells scores as a clinical decision rule for PE. RESULTS: There were 4578 MET responses (in 3136 patients) over the 5-year study period, from which 70 CTPAs were ordered (2.2% of all patients). A PE was identified in 12 patients (17.1%). The median age of CTPA patients was 70 years (interquartile range, 60-76 years) and most were surgical patients (80%). The major MET triggers for CTPA were hypoxia (42.9%) and hypotension (28.6%). An abnormal chest x-ray was associated with a low likelihood of PE. The Wells scores and MET indications of hypoxia, hypotension and tachycardia were not accurate in predicting the presence or extent of PE. CONCLUSION: Clinical decision rules and MET indications were not significantly associated with the presence of PE on CTPA. However, an abnormal chest x-ray has a high negative predictive value and therefore may be helpful in preventing unnecessary CTPAs.