Dr Peter Laussen: a quiet achiever propelling paediatric critical care
Dr Peter Laussen wears many hats. He is the Chief of the Department of Critical Care Medicine at the Hospital for Sick Children in Toronto, Canada – one of the leading hospitals with an active research program which has produced highest volume of academic manuscripts than any other pediatric critical care program in the world in 2018. Besides that, he is also the Professor of Anesthesia at the University of Toronto, David and Stacey Cynamon Chair in Critical Care Medicine and co-Chair of the SickKids Artificial Intelligence steering committee. In 2006 he was a founding member of Risky Business, a unique forum for discussing risk management in healthcare.
And to describe him as an experienced and accomplished intensive care physician and academic would be an understatement.
Having worked in Melbourne and Boston before moving to Toronto, Peter has a larger than life vision – bringing hopes to pediatric cardiac critical care through advancing medical technology. He is the driving force to propel the quality of critical care.
A first of its kind integrated software program T3 which stands for Tracking, Trajectory and Trigger is the brainchild of Peter. The innovative platform aggregates the physiologic signals streaming from patients in Critical Care. It is a platform that tracks vital patient data on a single, easy-to-manipulate monitoring system viewable on standard web browsers in the hospital. “I built T3 with the idea of developing a very integrated visualization platform, one that allowed users to drag and drop physiologic features, zoom in/zoom out on aspects of the data, etc. so that we had a much better idea as to the trajectory of a patient,” he explains .In short, it has streamlined the way physicians track the evolution of a patient’s course and improved data management in the ICU. The T3 platform is now in 20 hospitals across North America and the world and is continuing to scale.
Advance recently spoke to Peter who has passionately shared his story.
Interview by Tammy Lee, Marketing & Communications & Digital Manager, Advance.
What made you move to Toronto?
A long story. Born and raised in Melbourne, attended Box Hill High School, Melbourne University Medical School. Completed residency and anaesthesia training at Austin Hospital in Melbourne and then paediatric critical care at Royal Children’s Hospital. Worked on staff in both the Departments of Anaesthesia and Critical Care at Royal Children’s before moving to Boston in 1992. The move to Boston was initially to be 12-18 months. This was sabbatical and a long service leave that had accrued during my time as a resident and registrar in training, plus I received some extended time from Royal Children’s. When I arrived at Boston Children’s, I worked in the Cardiac Anesthesia Division as well as the Cardiac Intensive Care Unit as faculty. I also joined one of the research labs where I was involved with a piglet model evaluating the effects of deep hypothermic circulatory arrest and cardiopulmonary bypass on the immature brain. My clinical work since arriving in Boston and now in Toronto, therefore the last 26 years, has been focused on paediatric cardiac intensive care and anaesthesia. Heart disease in children is more common than one would perhaps appreciate. Newborns can have quite a range of malformations of their heart and the rapid advances that have gone on over the last three decades has meant that the vast majority of newborns can have corrective or very effective palliative surgery. In addition to these congenital defects, infants and children are also at risk for acquired illnesses such as myocarditis (inflammation of the heart) and cardiomyopathy. It is a very intense and complex area of medicine, but one that is incredibly rewarding when you see the improvement in longer term outcomes and quality of life.
I was in Boston from 1992 through 2012. For the last 10 years I was Chief of the Division of Cardiovascular Critical Care in the Department of Cardiology. I held the D.D. Hansen Chair in Pediatric Anesthesia and appointed Professor of Anesthesia at Harvard University in 2008. In addition to running a large division, I have maintained a very active academic profile in a whole range of areas related to pediatric critical care and anesthesia.
In 2009, I started to develop a software program called T3 (this stands for Tracking, Trajectory, Trigger tool). It was really the first of its kind to be a web-based application that aggregated the physiologic signals streaming from patients in Critical Care. Prior to this, the data or the signals would stream across a monitor every 10 seconds and then be lost. We couldn’t capture it any way and therefore it meant we couldn’t use this information to either debrief on events or to use it in a way that would enable us to do predictive modelling. So I built T3 with the idea of developing a very integrated visualization platform, one that allowed users to drag and drop physiologic features, zoom in/zoom out on aspects of the data, etc. so that we had a much better idea as to the trajectory of a patient. The license for T3 is owned by Boston Children’s Hospital and is now held by a company called Etiometry Inc. in Boston. I continue to work with Etiometry as a medical and scientific advisor and we have continued to build the T3 interface, to make sure that it is usable and scalable. The T3 platform is now in 20 hospitals across North America and the world and is continuing to scale.
One of the other advantages of the T3 platform is the ability to capture data which we can then use for predictive modelling. With Etiometry, a completely new physiologic index has been created and is now FDA approved. It’s the first of its kind in critical care and is called the Inadequate Oxygen Delivery Index. As the name states, it gives the probability of low oxygen delivery which is a very important feature when you’re managing patients with critical illness. The IDO2 index is displayed on the T3 platform, which was another important component in its development, i.e. a platform that would allow the display of predictive algorithms. We have other algorithms being evaluated as well.
All of this preamble gets to why I moved to Toronto. After 20 years in Boston, I had progressed as far as I felt I would go from an academic and professional point of view and this wonderful opportunity to lead a large department of critical care was offered to me. The Department of Critical Care at SickKids has just celebrated its 50th year and is one of the 2 or 3 oldest in the world. We have an extremely active research program, and in fact last year produced more academic manuscripts than any other pediatric critical care program in the world. In addition to our research, we have a very large training program, with trainees coming from all over the world. We currently have over 400 alumni and we keep connection with the vast majority of them so that we can continue collaborations and friendships across the globe.
It was an honour to be appointed as the Chief of this department given its storied history and the impact it has had across the world in paediatric critical care. In addition, it was an opportunity for me to bring T3 from Boston Children’s to another prominent medical institution. We have deployed T3 across all 42 beds in our intensive care unit here. In my lab (www.laussenlabs.ca) we have a team of engineers and clinicians who work together to utilize physiologic data for predictive modelling. We have also addressed fundamental engineering concerns by developing a bespoke data management platform(called AtriumDB) that allows us to efficiently store and retrieve a vast amount of physiologic data. You will see on our website that we currently have over 3800 patients, over 500,000 patient hours and 2 trillion data points. We are actively using this information for not only research about underlying physiology of disease, but to understand the trajectory of patients, their physiologic state and the risk for an event within that state. I think a unique feature has been building a team of engineers, machine learning and computer science experts as well as clinicians to provide context and expert knowledge; bringing this all together has really accelerated the processes of discovery.
The final point I would make, and I know this has been long winded, is that SickKids is a great brand. For many, many years it has been a prominent leader in paediatric illness across the world. Working in this environment is stimulating and engenders imagination and discovery. It is a place to thrive and one in which to develop really strong partnerships and collaborations (both at the hospital but across the University of Toronto as well). Toronto of course is also a wonderful city in which to live. I love its multicultural aspect, its tolerance and cosmopolitan feel. Indeed, my wife and I sold our suburban home in Boston and bought a townhouse midtown; going urban has been fun. We have four children, all of whom have remained in the States which is the only downside, but then again we do travel frequently to see them.
A note on my family, my wife (Julia Murphy) and I met on the first day of med school at Melbourne University. We didn’t go out together for a few years but once we did, we rapidly progressed towards matrimony. Julia was a family practitioner in Melbourne and then in Boston and retired from active clinical practice a couple of years ago. We have four children, all of whom were born in Australia and are now living in Boston, Chicago and LA. Despite having been out of Australia for the last 26 years, we all retain very close ties with family and our friends and have maintained our Australian citizenship.
What does your typical workday look like?
Typical workday starts around 7:00 with a review of clinical activities in the intensive care unit. If I am scheduled to be on clinical service, morning rounds usually start somewhere around 7:30. I lead a team of clinicians and my role is to make sure that we all understand the problems that we are trying to manage for each patient as well as appreciate the risks and potential for harm, and to make sure that we all have the same mental model as to the expected trajectory of a patient. I also have an important role in advocacy, not only for my decisions for care but also for efficient resource allocation as well. I work in a publicly funded system and cost constraints are an everyday factor of life and we simply have to be wise about the choices we make.
After attending to rounds and making sure that we have plans in place for patient management, my days vary according to a whole range of different meetings and responsibilities. During my first four years in Toronto, I was chair of the Medical Advisory Committee and the Hospital M&M (Mortality & Morbidity meeting) and have been very actively involved in all aspects of quality and safety. More recently I’ve been appointed co-chair of the Artificial Intelligence Steering Committee at the Hospital and I’ve been spending a great deal of time helping to organize the infrastructure we need to make sure artificial intelligence can be utilized on a daily basis in the care of patients and the translation of research.
My typical day usually ends around 7:00 or 7:30, much later if I am on call. I still have a very active research program and need to spend time on various research protocols, writing grants and overseeing the overall direction of my lab. Another area in that I am actively engaged is risk management. In 2006 I was one of the co-founders of Risky Business conferences. These are risk management conferences in healthcare and structured around the premise that we can take important lessons from other high risk industries and apply them in healthcare to improve quality and safety. Since 2006 we have held conferences in London, Boston, Toronto and Cape Town, as well as numerous satellite conferences across North America. We have a very interactive website www.risky-business.com, in which you will find open source access to over 100 videos of previous speakers. I love Risky Business conferences. I have learned so much about risk management and ways in which to approach it. One of the most enjoyable however has been getting to know so many people from across diverse industries which has really helped enrich my life.
What has been the highlight of your career?
It is hard to say this in certainty because I really think I have been blessed and have had many highlights. In Boston, I think being appointed full professor at Harvard University was a highlight. Harvard University has a very rigorous process for academic appointment, particularly at the professor level, and being able to achieve this I think was validation of the research, education and scholarship that I had been undertaking prior to the appointment. The second is my appointment as Chief of the Department of Critical Care here at SickKids and as the David and Stacey Cynamon Chair in Paediatric Critical Care Medicine. As I noted above, this is a unique institution and department with a worldwide reputation, and being able to lead this and have the opportunity to bring it forward and develop new strategies and vision for critical care that I know will have an impact globally is an honour and a privilege. And of course, being the lead inventor of the T3 risk analytic platform.
What are the biggest rewards and emotional challenges working in paediatric healthcare?
The rewards and emotional challenges all relate to patient care. I have been fortunate to be at the ground level when paediatric cardiac critical care really started to develop as a separate entity and field. I was fortunate to be part of and witness amazing advances in the technology that we could bring to save many lives and improve their longer terms outcomes. Throughout my career I have had the opportunity to see a dramatic reduction in mortality and morbidity to newborns, infants and children born with heart disease. At the same time it has been rewarding to be part of the development of new technology to improve outcomes. Along with this has been the opportunity to train many registrars, Fellows and trainees from across the globe. Not only being able to train them but to see them subsequently go on to have an impact in the field and make a difference wherever they are working is incredibly rewarding. The impact of mentorship has therefore also been an important reward personally.
There are of course emotional aspects working with children who have heart disease, because not all patients survive; outcome can be unexpected and poor despite all the treatments and interventions undertaken. Paediatric cardiac critical care is intense and complex. It is a team commitment from physicians, nurses, respiratory therapists and all allied healthcare workers focusing on doing the best we can to help patients recover and lead a normal and high quality of life. It also means that we are very closely involved with parents and families and it is hard not to develop emotional attachments. Every year around the holidays, I receive many cards from graduates from our intensive care unit and it is always so rewarding to see how these families have moved forward and how well they are doing.
Because of the intensity and complexity of care, and the emotional challenges that come with caring for critically ill children, it is not surprising that clinicians develop close bonds in this field. We get to know each other well, learn to depend on each other, look to others for support and affirmation, and for comfort and solace. I have been so fortunate to work at 3 of the top children’s hospitals in the world….first Royal Children’s, then Boston Children’s and now in Toronto. Throughout this journey I have gotten know wonderful physicians, nurses and allied health care professionals, administrators, clerks and environmental service staff and so on. I have worked alongside them at the bedside of critically ill children during all sorts of challenges, I have learnt from them, they have helped keep me focused and humble, and (as my wife would say) they have been a second family. I see this as a reward.
What do you miss most about Australia?
There are many things I miss. First of all, family. Our parents, siblings and extended family all still live in Australia (Victoria) and we try to get back there as often as we can. I miss the Australian culture, the laid back no-nonsense approach. I miss the laconic Australian sense of humour and not taking yourself too seriously. I miss meat pies, sausage rolls and lamingtons. I miss seeing my Aussie rules football team, Melbourne Demons, and although their fortunes have not been so good over the last 50 years, I remain a passionate supporter.