Essential reading for "Structure and Process"

The "Structure and Process" section represents annotations and footnotes to Section 2.1.1 ("Structure and Process") from the CICM Second Part General Exam Syllabus (First Edition). For each of the syllabus topics, the expected knowledge domains are supposed to be "principles and practice / implementation", "relevant guidelines and evidence" and "controversies and risks". Where possible, these expectations were addressed throughout these chapters, though it was sometimes baffling or ridiculous to apply them (what are the risks of team-based health care? What is so controversial about fatigue mitigation or burnout prevention?). Of course the returning reader will agree that baffling and ridiculous is what we do here at Deranged Physiology, which means this mess has no new horrors for them. But this does mean that the chapters are probably not a good surrogate for published works, and the past paper SAQs are not a great syllabus because under new leadership the exam has become both fairer and more formidable.

What follows is a selected reading list of hand-picked review articles, important trials, influential papers and professional guidelines for Section 2.1.1 ("Structure and Process") from the CICM Second Part General Exam Syllabus (First Edition).  The articles and guidelines here are provided with the caveat that they appear here only because they must have, at some stage, appealed to one person, who may have minimal insight into the expectations of CICM examiners, and who may not have had all the time in the world to do a thorough literature review. That also may have been some time ago, and they may have since become obsolete. The readers with better options are humbly asked to submit them via the contact form below.

L1 topics for Structure and Process

Important (L1) topics for Structure and Progress include Transport of the critically ill patient, Rapid Response systems and principles of infection control. "Detailed knowledge and comprehension of the principles and facts" is expected, which presumably means "read the official CICM policy documents, they are right there". 

Transport of the critically ill patient

Rapid Response Systems / Critical Care Outreach

Principles of infection control including SDD

L2 topics for Structure and Process

Less important L2 topics contain such administrative nightmares as design and staffing of intensive care unitsrole of clinical information systems workplace cultureworkforce design and disaster management. The lower expectations for these topics presumably stem from the tacit understanding by the examiners that none of their senior registrars are at risk of being asked to design an ICU or to develop a mass casualty disaster management plan. On the other hand, it's a part of their future job, and so it would be irresponsible of CICM to produce graduates who have absolutely no idea about these matters. 

ICU design and organization

Role of clinical information systems, other expert systems

Workplace culture e.g., burnout, fatigue (management and prevention)

Role of team-based health care in ICU

Pandemic and major incident planning and response

There was nowhere else to put the FASTHUG

But it seemed like an important process that forms a part of the ICU ward round structure, and  therefore ended up being shoved into this syllabus section, sideways and on its edge.

Protocolised bundles of supportive care in general

  • CHECKLIST-ICU - 2016 - daily checklist and goal setting bundle; n=6877 in Brazil. No difference in mortality ((32.9% vs 34.8%) but a few secondary outcomes were better (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate)
  • 2018 SCCM guidelines on, basically, FASTHUG

Nutrition trials and guidelines

Analgesia and sedation

Thromboprophylaxis trials and guidelines

Patient mobility and positioning 

Physiotherapy for the critically ill

Pressure area prevention

Ulcer prophylaxis

Glycaemic control in the ICU

References

Parsons, Chris J., and Walter P. Bobechko. "Aeromedical transport: its hidden problems." Canadian Medical Association Journal 126.3 (1982): 237.

ANZCA "Guidelines for Transport of Critically Ill Patients

CICM "Minimum Standards for Transport of Critically Ill Patients" (IC-10, 2010)

"Commercial Airliner Environmental Control System: Engineering Aspects of Cabin Air Quality".

Oh's Intensive Care manual: Chapter 4 (pp.27)    Transport  of  critically  ill  patients   by Evan  R  Everest  and  Matthew  R  Hoope

Le Cong, Minh, and Geoff Ramin. "Preparation of the critical patient for aeromedical transport." PHARM. Retrieved June 25 (2014).

Milligan, J. E., et al. "The principles of aeromedical retrieval of the critically ill." Trends in Anaesthesia and Critical Care 1.1 (2011): 22-26.

MERIT Study Investigators. "Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial." The Lancet 365.9477 (2005): 2091-2097.

Lepape, A. "Prevention of nosocomial infections in ICU. What is really effective?." Medicinski arhiv 57.4 Suppl 1 (2002): 15-18.

Tejerina-Álvarez, Eva Esther, and Miguel Ángel de la Cal López. "Selective decontamination of the digestive tract: concept and application." Medicina Intensiva (English Edition) 47.10 (2023): 603-615.

De Waele, Jan J., Isabel Leroux-Roels, and Pieter Depuydt. "Selective digestive decontamination-Pro." Intensive Care Medicine 49.8 (2023): 979-981.

Hurley, James C. "Selective digestive decontamination- Con." Intensive Care Medicine 49.8 (2023): 982-983.

Thompson, Dan R., et al. "Guidelines for intensive care unit design." Critical care medicine 40.5 (2012): 1586-1600. 

Valentin, Andreas, Patrick Ferdinande, and ESICM Working Group on Quality Improvement. "Recommendations on basic requirements for intensive care units: structural and organizational aspects." Intensive care medicine 37 (2011): 1575-1587.

Rashid, Mahbub. "A decade of adult intensive care unit design: a study of the physical design features of the best-practice examples." Critical care nursing quarterly 29.4 (2006): 282-311.

Fraenkel, David J., Melleesa Cowie, and Peter Daley. "Quality benefits of an intensive care clinical information system." Critical care medicine 31.1 (2003): 120-125.

Tello, V. Gómez, et al. "Technical and functional standards and implementation of a clinical information system in intensive care units." Medicina Intensiva (English Edition) 35.8 (2011): 484-496.

Mason, Christopher, and Tim Leong. "Clinical information systems in the intensive care unit." Anaesthesia & Intensive Care Medicine 17.1 (2016): 13-16.

Theilen, Raphael, and Jakob Wittenstein. "AI-Based Decision Support Systems in Intensive Care." Roles and Challenges of Semantic Intelligence in Healthcare Cognitive Computing. IOS Press, 2024. 31-50.

Alameddine, Mohamad, et al. "The intensive care unit work environment: Current challenges and recommendations for the future." Journal of critical care 24.2 (2009): 243-248.

Guidet, Bertrand, and Vicente González-Romá. "Climate and cultural aspects in intensive care units." Critical Care 15 (2011): 1-7.

Mitchell, Pamela. Core principles & values of effective team-based health care. 2012.

Ervin, Jennifer N., et al. Teamwork in the intensive care unit. Vol. 73. No. 4. American Psychological Association, 2018.

Horvath, John S., Moira McKinnon, and Leslee Roberts. "The Australian response: pandemic influenza preparedness." Medical journal of Australia185.10 (2006): S35.

Thomson, William R., Zudin A. Puthucheary, and Yize I. Wan. "Critical care and pandemic preparedness and response." British Journal of Anaesthesia 131.5 (2023): 847-860.

Dawson, Angus, et al. "An ethics framework for making resource allocation decisions within clinical care: responding to COVID-19." Journal of bioethical inquiry 17 (2020): 749-755.

Bywood, Petra, et al. "Fatigue and burnout in healthcare." (2020).

Moss, Marc, et al. "A critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. A call for action.American journal of respiratory and critical care medicine 194.1 (2016): 106-113.