Wednesday, August 17, 2011

Exhaustive Schedules

We've all heard the advice of not driving when tired because we make unwise decisions behind the wheel. I definitely remember taking finals on no sleep and looking at the questions as if there were written in Swahili instead of good ole American English. One particular area that has come under fire in recent years is medical school. Talk to an intern or resident and they will regale you with tales of being on shift for 36 hours at a time. More and more schools are requiring that their medical students be subjected to a more regulated schedule with interns and residents only working a maximum of 80 hours per week.

But is that a solution to medical mistakes?

According to British psychologist, James Reason, medical mistakes are like swiss cheese, "there are holes in each system, but they don’t usually overlap. An exhausted intern writes the wrong dose of a drug, but an alert pharmacist or nurse catches the mistake. Every now and then, however, all the holes align, leading to a patient’s death or injury." So, is the answer reducing the amount of time students spend working with patients?

Maybe not.

Ted Secctish argues that a problem with training medical professionals and medical mistakes is the ability to convey information in a clear, concise and concrete manner; "Patient handoffs are a nonstandardized process and a skill that’s not even taught" In a typical hospital situation that he was brought into observe, he found "patients were discussed in alphabetical order instead of severity of illness. The interns were repeatedly interrupted. Descriptions of the patients’ illnesses were incomplete. The chain of responsibility was sometimes left unclear." So, is a standardized procedure for handing off patients the answer?

Probably not.

In the end, the issue of medical mistakes will continue to be an issue. There is a not a single solution such as schedule adjustment or the addition of digital patient recording and computerized drug interaction checks.

**Information gathered from**

1 comment:

  1. As someone who has been in the Quality Assurance field for about 20 years, one of the most significant things I've seen in the field is the establishment of quality departments in major hospitals across the country. Let by the American Society for Quality Healthcare Division and other quality and healthcare organizations, hospitals are creating process and system approaches to reducing medical mistakes and improving patient care. Today, the Tenth Annual Quality Colloquium at Harvard University is wrapping up. The four day Colloquium bills itself as 'The Leading Forum on Patient Safety, Quality Enhancement and Medical Error Reduction'.  The Quality Assurance field has provided many tools for evaluating reasons for failure and taking effective corrective action. It's nice to see these tools, originally designed for manufacturing, embraced by the healthcare system to reduce medical mistakes.  As with any complex system involving humans, a systems approach is necessary so the holes don't 'overlap'. Some hospitals are doing excellent job of this. Some have a long way to go.