Critical Crosstalk

2017 - 3 June – Patient- and Family-Centered Care
Ashish Khanna, MD, FCCP; Utpal Bhalala, MD, FAAP
In this article, Critical Crosstalk moderators reflect on SCCM's talk show-style sessions presented for the first time at the 46th Critical Care Congress.

A talk show for critical care medicine? Really? A first-time event for the Society of Critical Care Medicine (SCCM)? You think people want to talk medicine? Those questions pretty much summarize our conversation with staff partner Colette Punda when she first approached the In-Training Section with the idea of what was conceived as an open forum where audiences would have an opportunity to talk to the experts one-on-one.

The concept itself was not entirely new. Indeed, our colleagues at the European Society of Intensive Care Medicine had been doing this for some years now and with some success. For SCCM’s maiden foray into this area, Dr. Utpal “Pal” Bhalala and I (Ashish Khanna) were asked to moderate these sessions. While this was an honor, it also brought with it some apprehension of the unknown.

We decided to think of themes that would relate to the broader multispecialty audience of the Society. We understood that the best topics would be those that took the medical part away from critical care medicine. After many weeks of deliberations and discussions, we came up with four Crosstalk sessions. The narratives below, written by each of us moderators, revisits Critical Crosstalk as seen from our eyes and heard from our ears—the fun, the knowledgesharing, and the commitment to continuing excellence in critical care that embodies our professional desires and the mission of SCCM.

Ashish Khanna: 
The very first session of the very first SCCM Crosstalk promised to be the mother of all Crosstalks! One look at the title and you would know why: “eICU: Here to Stay or Run Away?” Those of us who practice any amount of clinical critical care know and understand that the advent of the tele-ICU or remote ICU during this decade has been a watershed event in the field. There is actually a pre- and post-eICU (electronic intensive care unit) era. In addition, as with any other technology, there are believers and nonbelievers. The chosen experts for this session were Daniel R. Brown, MD, PhD, FCCM, and Craig M. Lilly, MD, FCCM. While Dr. Brown chairs a department at the Mayo Clinic that boasts one of the larger eICU systems in the country, Dr. Lilly comes from the University of Massachusetts and is one the founding fathers of the eICU movement in North America. I said as I introduced him, “If you ever type in eICU in a PubMed search, the one name that will almost always come up is his.” 

I was marginally nervous about audience presence. My fears were soon dispelled, as we filled up and spilled over. People streamed in and very soon all I could see was one raised hand after another, with yet another question. The discussion revolved around the operational success of the eICU system, patient and family satisfaction, measures of outcomes, and using the eICU to improve best practices in critical care medicine. The question of money and how the investment into the setup could ever yield returns and be justified as a solid business proposal was explored and probed again and again. Then there was the paradox that the eICU systems were expensive and therefore affordable for the bigger systems only, while the real benefit is seen in the semi-rural communities where ICUs essentially do have no doctor in the house at all, but these smaller systems cannot afford to set up their own eICU networks. Certainly, eICU is not a new phenomenon, but its ramifications in the era of cost redistribution and budgeting in healthcare is suddenly in the limelight. At the end of the session, the question of covering pediatric and neonatal ICUs with a similar system came up for discussion as well. A show of hands at the end, almost all in support of eICUs, strengthened my belief that this system of practicing medicine is indeed here to stay!

My next session was titled “Social Media in the ICU: Likes, Dislikes, and Such!” This Crosstalk featured Anthony “Tony” T. Gerlach, BCPS, PharmD, and Heatherlee Bailey, MD, FCCM. Tony comes from Ohio State University, where he is a critical care specialty pharmacist in the surgical ICU. In addition, he is part of the SCCM’s social media task force and an avid tweeter. Dr. Bailey is an emergency medicine physician at the Durham VA Medical Center and is also the current secretary of SCCM. She was part of the “nonbelievers club” when we started the talk. We started with a general overview of what constituted social media presence in the ICU. We also clarified differences between the more professional portals such as Twitter and LinkedIn and other not-so-professional venues in the nature of Facebook. Twitter certainly has taken over the world of medicine, and I quoted figures to support this. We as a specialty were lagging. However, the SCCM Congress in Hawaii was a trend in the right direction for us as we significantly increased our tweeting activity and meaningful time spent on social media critical care feeds. Indeed, some of the Congress sessions had concurrent Twitter chats to support them. ​

The big areas of concern remain protected patient information, ethical conduct on social media, and knowing where to draw the line, so to speak. Dr. Bailey told of some instances of trainees overstepping the line of professionalism in their enthusiasm to be seen on social media, with disastrous consequences. The responsibility of representing your institution, even though your tweets represent you, came up for significant discussion throughout. But there were also benefits brought up by the audience, such as some senior educators who had utilized certain social media venues such as YouTube for educational videos and online teaching modules. Twitter itself was a huge repository of early access to evidencebased medicine and a refresher on the latest and greatest in clinical practice. I myself have heavily engaged on Twitter to advertise our Crosstalk sessions, to good effect. Actually, Twitter itself was full of Crosstalk session images and reactions from attendees, which was positive reinforcement for us. All done and dusted, at the end of the hour-long session, we swayed Dr. Bailey to the believers’ side (though she is yet to set up a Twitter account, per my last conversation with her)!

Utpal Bhalala: 
When I sat down and thought about my own journey through my training and early faculty years, some ideas came to mind. One was related to my involvement with the Society. My mind drifted back to Congress in Orlando in 2007. It was seven in the morning when most of my fellow friends were still in their beds in their Orlando hotel rooms and I was pouring coffee into a plastic foam cup, picking up a bagel, and getting ready for an informal meet-and-greet session for trainees at Congress. Collette Punda, one of the SCCM staff partners, and Todd Dorman, MD, FCCM, the SCCM liaison for the In-Training Section, welcomed us. We learned that the SCCM In-Training Section was not doing well and that the Society was trying to revive it. In the months and years following that meeting, a talented group of individuals in the section and I worked diligently and helped revive the section. This was my first involvement with the Society during my critical care training.

 This also triggered the idea of the Critical Crosstalk titled “Ask Not What the Society Has Done for You; Ask What You Have Done for the Society.” I decided to interview Timothy G. Buchman, MD, PhD, MCCM, and Timothy S. Yeh, MD, MCCM, two senior SCCM members who had been involved with the Society over many years who would be likely to bring different perspectives to the Crosstalk. It was a highly informative session. The guests went back to the good old days and described their stories of involvement with the Society. Their narration of networking through snail mail and organizing Congress in relatively smaller venues in the early days made us feel grateful and privileged for what we have in the current era! Their input on the process of getting involved with the Society and countless networking opportunities was invaluable to the trainees and junior faculty. When asked about balancing his primary work in the ICU with his Society-related work and life outside of work, Dr. Buchman very aptly said, “It’s all about work-life integration and not necessarily about work-life balance.”

The other exciting Critical Crosstalk I moderated was “An ICU Is Only as Good as Its Team Members.” This featured the expertise of Vinay M. Nadkarni, MD, FCCM, and Judith Jacobi, BCPS, PharmD, MCCM. The audience area was full and the spectrum diverse, from intensive care providers who came from large academic centers to others from community hospitals with the private practice model. A large part of the discussion involved teamwork around multidisciplinary rounds in the ICU. There was a great discussion on different styles and formats of multidisciplinary rounds, specifically in relation to academic versus nonacademic ICU rounds. The audience shared their experiences—what has worked and what has not worked well within their systems. The audience themselves added valuable expertise to this session. Their input on work rounds with teaching rounds, rounding with multiple specialists, and how to be efficient on rounds triggered many different discussion points. Among the many interesting questions, one that stood out was “Do we really need to round?” To spark discussion on management of team conflict during codes and traumas, one of the cases I presented was a teenage boy brought into the trauma bay with loss of consciousness. While the team decided to intubate, there was a heated argument about rapid sequence intubation between an emergency department resident and a senior pediatric ICU fellow. We also spent a lot of time on the family as a part of the team—does it facilitate, obstruct or jeopardize the care of the patient? The session went beyond the scheduled time, and we felt that there still was a lot that could have been discussed!

When all was said and done, these sessions were a huge success. A lot of credit goes to the SCCM Congress organizers, the Program Planning Committee, and our staff partners. Their support, encouragement, and organizational skills helped us all the way through. Marketing this newly introduced talk show was key to its success. The Crosstalk venue within the convention center, the informal seating arrangement, the hands-free, wireless audio system and all the appropriate “jazz” were wellplanned and lent a lot to the atmosphere. The environment was all-inclusive, informal, and engaging—ideal for such an event. The future remains bright. We can only see Critical Crosstalk grow in stature at every subsequent Congress in the years to come.​