66 - Todd Rice - Learning and teaching how to “not just do something, stand there”

Mastering Intensive Care

This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice.

Dr Todd Rice, is an Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. Todd is a clinical intensivist, the Director of the Medical ICU (MICU) and the Medical ECMO Program, and leads VUMC’s MICU strategy for the care of COVID-19 patients.

In addition, Todd leads a substantial research program as a clinician scientist, and is co-chair of the Learning Healthcare System at Vanderbilt where the motto is "Learn What We Do and Do What We Learn." Professionally, he is proud of the evidence he has generated to improve the care of critically ill patients and the mentorship he has provided to other physician scientists. He loves ice hockey (watching, not playing) and is completely into enjoying life with his two sons.

Todd graduated from the University of Notre Dame and completed Internal Medicine residency at Indiana University School of Medicine. He completed Pulmonary and Critical Care Medicine fellowship training at Vanderbilt University where he obtained a Master’s of Science in Clinical Investigation.

Other roles Todd serves in include:

• President of the American Society of Parenteral and Enteral Nutrition
• Vice President for Clinical Trial Innovation and Operations in the Vanderbilt Institute for Clinical and Translational Research (VICTR)
• Critical care principal investigator for the Prevention and Early Treatment of Acute Lung injury (PETAL) clinical center at VUMC
• Medical Director of VUMC’s Human Research Protections Program

Todd and I recorded this conversation in March 2020, just before the COVID-19 impacted fully in our respective countries. I didn’t feel I should put this episode out during the crisis of 2020 so I held it back until now. I also asked Todd if I could interview him a second time now (in February 2021) to freshen up the interview with some perspectives on how COVID-19 has affected he and his colleagues in Nashville.

I hope you will gain immense value from what Todd speaks about on this episode, including:

• Why he’s considered an ICU junkie and how he’s changed over the years
• The principle of “Don’t just do something, stand there”
• Understanding the confidence/competence balance
• His 4 box method of understanding a critically ill patient’s situation
• The concept of the second victim with mistakes
• How transparency to families builds substantial trust
• Why he praises nurses in front of patient’s families
• The structure of the ward round at his ICU
• The importance of empowering nurses to ask questions
• His note-writing practice, and it’s benefits and risks
• His practice to look after himself during periods of clinical service
• The benefit of a mix of clinical and research work
• The importance of pragmatic trials studying things we are already doing
• His institution’s Learning Healthcare System and how it is used
• Some overall career tips
• How COVID-19 has affected his ICU
• How the ICU team is taking care of each other
• His ICUs struggle with harsh visitor restrictions and how they relaxed these safely

Please enjoy listening to Todd Rice.

Andrew Davies

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About the Mastering Intensive Care podcast: The podcast aims to inspire and empower you, through conversations about the human side of Intensive Care, to bring your best self to the Intensive Care bedside, with a focus on compassion, collaboration and personal wellbeing.

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Links related to Todd Rice

Todd Rice

Todd Rice on Twitter @toddrice_icu

Links to other resources (in order of mentioning)

ANZICS Clinical Trials Group

ARDSnet low tidal volume strategy study

EDEN study

TARGET study

PERMIT study

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Mastering Intensive Care at Life In The Fast Lane

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Audio Producer Chris Burke

Burke Sound & Media