Francesca Rubulotta obtained her MD with laude and commendation at the University of Catania in Italy. In 2002, she gained accreditation in Anesthesia at the University of Trieste and later in 2004 she obtained her specialty in Intensive Care Medicine (ICM) at the Catholic University of Leuven. Her training in ICM took place in the USA, the Netherlands, and in Belgium. She is currently working in the UK as Consultant and Honorary Senior Clincial Lecturer in ICM and Anaesthesia at Imperial College, Charing Cross and St Mary’s Hospital in London. In 2012, she obtained her PhD at the University of Catania. She is currently studying for an executive MBA at Imperial College in London, UK. Since 2011 she is clinician for Anesthesia in Bariatric Surgery at Imperial College, international center of excellence. Dr Rubulotta is the Chair of the division of professional development (DPD) of the European Society of Intensive Care Medicine (ESICM) since 2013. Dr Rubulotta is a member of the European Board of Intensive Care Medicine (EBICM) and a member of the European Accreditation Board for Continue Medical Education (EACCME) in the Union of European Medical Specialities (UEMS), a member of the Governance Board of the EACCME, and a new member of the UEMS school of examiners (CESMA). Dr Rubulotta did her training in End of Life and Compassionate Care Medicine, in the USA at Brown University and she has been working in the ethic group of the ESICM for several years participating in several projects such as: Conflicus, Europain and Appropricus. Dr. Rubulotta has published papers, abstracts, chapters and reviews, mainly on education, sepsis, rapid response systems and ethics. She won the Best Paper Award given by the Anna Lindh EU foundation in 2007. Dr. Rubulotta has studied five different European languages.
Dr Rubulotta has been invited in several meetings including: ESICM, ESA, SCCM, Chinese Society of ICM, Indian Society of ICM, South Africa and ECCC.
Francesca loves cooking Italian food, she playing tennis (wining 2 tournaments getting her free staying in Marbella) and she has gained 3 world master gold medals (Riccione, Montreal and Kazan ), one silver master European medal (Budapest) and two National Italian master gold medals in WATERPOLO!

The Problem of Disproportionate Critical Care

Too much is not the answer for not enough
The number of published studies related to burnout, moral distress, conflicts, stressful conditions in the Intensive Care unit (ICU), is dramatically increasing over the last few years. Clinicians perceive the care as “inappropriate” when it clashes with their personal beliefs and knowledge. Care is considered “Disproportionate’ when the intervention or the action is perceived as too much or too little in relation to the expected prognosis in terms of survival or patient’s quality of life. ICU workers, who provide inappropriate or, more broadly, disproportionate care, are at risk for “burnout” and “moral distress”. This phenomenon is poorly investigated even if it could jeopardize patients’ quality of care and outcome. Similarly, no intervention has ever been tested with the aim of avoiding the mentioned threats. APPROPRICUS and DISPROPRICUS are European Society of Intensive Care Medicine (ESICM) studies performed over one day and one-month period respectively, in the ICU. Healthcare providers’ perception of care was measured as well as patients’ outcome. Results show that all healthcare providers in the ICU perceive every day both not appropriate and/or “Disproportionate care”. Moreover, people within the ICU are so much accustomed to a disproportionate behavior that they don’t consider it as deviant, despite the fact that it far exceeds their own rules. This phenomena is called “Social normalization of deviance” and people in one ICU grow more accustom to such behavior the more it occurs. Stress, conflicts, moral distress and burnout are driven by deviant behaviors and are proven to impair communication among the ICU staff. There is evidence in the medical and non-medical literature suggesting that the burn out leads to low performance and concentration. Good teamwork and an emphasis on clarifying ethical issues are associated with lower perception of inappropriateness of care, fewer conflicts, and smaller staff turnover rate.

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