We have always had a culture for encouraging and generating new ideas amongst our staff on Intensive Care at Portsmouth. Over the last few years, we have made attempts not only to expand this area of our practice but to also to share our ideas for the benefit of other departments and our patients.

Presentation slides and a blog post about some of our innovations from a talk given by Steve Mathieu (Royal College of Emergency Medicine Scientific Meeting 2016) are available here from 22nd Sept 2016

Our systems development manager, Mike Lympany has created 3 incredible resources - TiM, BRAD and iSi. By combining clinical and technology expertise, these resources have contributed to improvements in the delivery of our care, dissemination of information to relatives and encouraging learning opportunities for our team. Learn more by selecting the images or visiting Mike’s website home page here

We have a growing library of ‘Watch out’ notices which have been created by members of our department. These serve as effective, quick reminders of potential high risk moments in Intensive Care and as a valuable educational resource. Our ‘Watch Out’ notices are displayed electronically on TiM and are rotated throughout the course of a shift. Our TiM screens are located near our blood gas analyser (concept of ‘learning in one minute’ whilst waiting for a sample to be processed) and where we meet to have our daily 5 minute safety brief.

Extra corporeal circuits are incorporated into many forms of advanced organ support systems e.g. Extra Corporeal Lung Assist (ECLA), Renal Replacement Therapy. An important part of their implementation in any critical care setting is to develop the governance protocols that ensure the patient safety against the potential catastrophic consequences of circuit complications e.g. disconnection.

An inherent component of this is simulation to build team work and mitigate the effect of human factors. There are high definition simulators housed in simulation suites available on the market costing several thousand pounds. These systems are designed and have the capability of delivering a more real-life experience. However, when the issues are related to teaching the mechanics of safe aseptic cannulation, circuit set up, circuit connection and manipulation, simple circuit related troubleshooting and practising circuit complication drills, that level of complexity may not be wanted or required.

When a simulator was required to commission the ILA Activve® extracorporeal circuit purchased to use on patients with respiratory failure in the Critical Department at Queen Alexandra Hospital Dr Kayode Adeniji developed the Extra corporeal circuit sumulator (ExCiS). It represents a cheap alternative to the high fidelity type simulators. It is a re-useable blood volume capacitor that can be repeatedly cannulated and used to demonstrate the setup and running of any kind of extracorporeal circuit (ECMO, ECCO2R, Cardiac Bypass, Renal dialysis, etc.) with components that can be purchased at any local hardware store and put together in your garage.

Though it was designed for simulation on the ilA Activve® ,it can be utilised to model the team-work and procedures needed to manage any extra corporeal circuit and is eminently configurable to the requirements at your institution.

A guidebook and instructional video are available by clicking the image below