The Footte Memorial Lecture was held on 3rd October 2007. The President, Mr John Miller, was in the chair. After a minutes silence in Dr Footte’s memory, he introduced the lecturer, Dr Mick Neilsen, consultant anaesthetist and recently retired director of the Southampton ICU. He spoke to the title ‘Its All Over Bar the Shouting’
He thanked the Society for the honour of being asked to give this lecture. He became the Intensive Unit director in 1984. Southampton was the first hospital in the country to set up an ICU with a 2 bedded unit in 1958. They had 19 admissions in that first year, with a 68% survival rate. By the 10th year they were admitting 125 patients per annum. By last year they were admitting more than 800 patients a year with an 86% survival rate. By the time he retired there were 21 beds in a new unit and 12 consultants. Even so there was always a shortage of beds he said. Last year this resulted in having to transfer 17 patients to other ICUs, and a further 68 having to be discharged from the unit at short notice before midnight, and a further 28 after midnight. He considered that the number of beds was hopelessly inadequate for the Southampton Group of hospitals.
He said he had had a wonderful team and enjoyed his time in the unit enormously. Unfortunately there was always a shortage of staff and there were problems recruiting suitably experienced staff. He also noted that junior staff often had an inability to recognise when a patient was severely ill which resulted in patients being admitted in extremis when an earlier admission might have changed the outcome and made management easier for the team.
Another problem for the unit was a constant fight against secondary infection.
His latest project was related to ‘end of life care’. He said few deaths were sudden or unexpected on the unit. He would discuss the outcome with the patient’s family and then a planned slow withdrawal of treatment would occur. His ambition was to see if some of the patients could be got home to die. Obviously if they were on all sorts of life sustaining treatment this would be impossible, but some patients who were on mechanical ventilation, needing only small amounts of oxygen, on small doses of drugs, could, he considered, be got home if the family were keen. His plan is that some patients who were likely to die in the following 12 hours could be got home, if there is a suitable space at the home, with an ICU nurse in attendance, and a consultant on call, by ambulance, provided it didn’t detract from GICU care.
He had floated the idea with colleagues and the departments and services that might be involved or affected and received encouraging support. Even the DOH was enthusiastic and has co-opted him onto the ‘end of life’ committee!
He is hoping that a 6 month pilot to formally evaluate the scheme will take place. He said that ‘if we can do it for the sickest patients then it can be done for anyone’.
The President then thanked Dr Neilsen for an enthralling presentation and the meeting was closed at 10.05 pm.