Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a "pre-op checklist" to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of ...
Posts tagged Surgery
Appreciating the beauty of a time out in the OR
If you've ever spent time in the operating room, you are already familiar with the words the circulating nurse uses to signal the time out - the few minutes before a procedure begins when the surgical and anesthesia teams review a patient's case. If you're a non-medical type, or a medical student whose surgical rotations are scheduled late in the 3rd year, then you're just as clueless as I was ...
Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about a decade ago. From it we learned that anywhere from 44,000 to 98,000 individuals die each year of preventable medical errors (and other sources suggest the number might even be much higher). In this continuing series of posts on disruptive and transformational technologies, there are some that ...
Paperwork causes unintended distractions for physicians and nurses
I admittedly snorted out loud when I read a New York Times article recently regarding increased physician distraction due to electronic devices, especially with the advent of the smartphone with its emails, text messages, calls, and other alerts that ping intermittently throughout a typical work day.There is no question that electronic devices distract physicians as the article pointed out. But that's like complaining about a leaky faucet when there's a flooded basement ...
How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are there more things in nursing, Horatio, than science can explain? Can we touch patients and zap them with calmness or take away their pain? Can we, by our mindset during our provision of care, substantially affect our patients’ outcomes? Can any of this be taught? Can we ...
Robotics can revolutionize the delivery of medical care
Robotics has the potential to revolutionize the delivery of healthcare. It can help extend the delivery of information, expertise and clinical care across time and geographical space barriers. Robotics offers the opportunity to enhance quality of care through extension of clinical expertise and leveraging of integrated datasets and best practices. It can be used across the continuum--from the hospital setting (e.g. OR, ER, etc.) into primary care offices and even ...
How patients can avoid medical errors
Most of you are quite familiar with the rather astounding facts regarding medical errors. There are many reasons why medical errors occur in healthcare. There are errors in omission, there are errors because of poor communication, there is the ever present risk of human error and perhaps the ever increasing stress on physicians to see more and more patients in less and less time. ...
What kind of shoes should you wear in the hospital?
I got home recently after a 14 hour day in the operating room with (predictably) a pair of really tired feet, which lead me to think about shoes, foot rubs, and the fact that no one ever talked to me about this in my training.What kind of shoes should you wear in the hospital?There’s a lot of walking in the hospital, but there’s even more standing. Running shoes don’t provide ...
Is ethical for parents to refuse surgical treatment for their child?
The principle of autonomy is one of the four guiding principles of medical ethics, the others being beneficence, nonmaleficence, and justice. It means that patients have the right to decide what is done to their own bodies. For children under eighteen, the age of majority, this means their parents decide for them. What happens when parents refuse a treatment that their child’s doctors recommend? (The right of a minor child ...
Make an informed judgment on the abilities of your surgeon
How many of the 40 million plus patients undergoing an operation this year are truly informed of their surgeon’s track record? I suspect the vast majority of patients entering the operating room today are unaware of existing, vital information that would enable them to make an informed judgment on the professional abilities of their surgeon.Most patients who end up in a surgeon’s office are there because their primary care physician ...
Did hospital politics lead to physician suicide?
What causes a doctor to commit suicide?A story about a radiation oncologist from Springfield, IL brought this strange case to my attention. Dr. Thomas G. Shanahan committed suicide by cutting his throat in November of 2011. He was respected in his field, having published many research papers and traveled the world helping to set up brachytherapy clinics in several countries. He also had been an acting alderman in ...
Length of stay differences in the uninsured is less than you think
There was a bit of excitement on Twitter recently with a number of tweets about a paper published in the Annals of Family Medicine which shows that uninsured patients are being released from hospitals significantly sooner than insured patients. The numbers don’t lie.From the abstract: "Across all hospital types, the mean length of stay … was significantly shorter for individuals without insurance (2.77 days) than for those with either private ...
Technological advances can solve our current healthcare crisis
It can’t be ignored that dramatic transformation in our healthcare system is imminent. The economy, market forces and increasing political demands will soon force physicians and healthcare professionals to change how we take care of our patients. Just as the days of housecalls are gone, so is our current system of delivering care.The rising cost of healthcare now has the government and insurance companies placing more emphasis on controlling costs, ...
The honor of patient responsibility
"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their lungs, but ... no pressure".Gulp.I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from ...
MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin ...
Rigid regulation can become detrimental to patient care
The last four days have provided a sharp glimpse into the future that awaits those of us in the health care profession, physicians in particular. Over the last few years physicians have been burdened with mountains of paperwork, most of which contributes little to patient care, but does take time away that could be better utilized caring for our patients. However, the last four days have demonstrated that the administrative ...
I will never be the physician that my father was
Let me start by saying that I love my father dearly. We have an excellent relationship, and talk regularly. So there’s no bitterness in this post, nor any desire to engage in armchair psychology.My father, now retired, was a general and thoracic surgeon, who was triple-boarded in critical care, and ran a trauma unit in inner-city Philadelphia. He was in private solo practice for most of his career. He worked ...
Changing the incentives in the operating room
Last year I wrote about a few strategies for decreasing costs in the operating room. Since being in fellowship operating many days per week, I’ve come up with a new idea, this time a bit more radical.In Freakonomics, Leavitt and Dubner posit that in all things, human beings respond to incentives. If you want to understand human behavior, all you have to do is identify the incentives that drive ...
In Kenya, operating in our comfort zone
"Traveling makes one modest – you see what a tiny place you occupy in the world. " -Gustave FlaubertWe have come to Kenya, expecting to work outside of our "comfort zones."Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor ...
Considering cancer and heart disease in opposing ways
The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.Response to treatment of limited incidence and duration are accepted and deemed beneficial. ...
