Day 2

With all that transpired yesterday on Day One, I started of the day eager to listen and learn. The Teeter-Totter Game showed me the way communication should work and how if we all work “closely” together we can achieve something great and worthwhile. The most impactful part of the session for me was Carol’s story. The way she has it set up is very impactful for the listeners, and really lets you absorb the information in the right way.

Human limitations/structural concerns

I’m thankful for Carole Hemmelgarn bringing her story and background in communication to Telluride, and demonstrating to us the ways our human minds are perfectly capable of interpreting the same images and words we hear, see, and read in different ways. In order to become a healthcare professional, we have all had to demonstrate the high level of skills in abilities like memorization of vast quantities of materials. We focus a lot on the skills we have or will acquire with little direct thought regarding our human limitations. I am thankful to have had this exposure to learning about the things I inherently cannot help but get wrong, or otherwise have an inability to see the same way as all people in a room. While optical illusions are a great example, there are similar things that can happen in clinics or hospitals.

I came away today with a lot of… Continue reading

Reflections from Day 1 and 2 from Telluride Experience: Napa

Over the course of the past two days, in which I have had the privilege to learn from the wonderful faculty and colleagues at the Telluride Experience: Napa, many ideas, thoughts, and emotions have come to my mind, and I would like to share them with you through this post.

Prior to the Telluride Experience, I have learned about quality improvement and patient safety while working on a hospital process improvement team and while attending a series of interprofessional workshops in medical school. Consequently, coming into this experience, I felt that I had a grasp of the important principles within the realm of patient safety such as communication, just culture, teamwork, medical systems, and more. However, in just these past two days, my experience here in Napa has taken these concepts beyond what I ever thought I knew. The stories and activities have added tremendous depth and context to my… Continue reading

Minding the Gap

A colleague of mine posed an interesting question earlier today about how outpatient providers and nurses can contribute to patient safety.  His comments conjured up something that I too have been mentally noodling since arriving here at the Telluride Experience.  I was instantly reminded of an interesting observation made by one of my clerkship directors right before starting an ambulatory internal medicine rotation, in which he drew a line of an individual’s health over the course of their lifetime. The primary take-away from this diagram was that a very small percentage of an average person’s “health timeline” is spent as a hospitalized patient. Fortunately, most people are healthy, and can manage there health as an outpatient. Does that mean they are not the victims of medical error? Probably not. Yet our discussions have not addressed this issue. In particular, our patients are at greatest risk… Continue reading

Teeter Totter game provokes anatomy flashbacks

“Dead or alive?  Dead or alive?  That’s all that matters!”  we would often chant at our anatomy table.  It is hard to express this inside joke to anyone who was not there, and especially in writing, without cadence or tone of voice.  However, we would often chant this mantra when we were stressed, usually before our weekly oral quizzes.  “It didn’t matter if we knew the answer,” we would say coyly, “it only matters if the patient is dead or alive!”  Quite frankly, I don’t even remember the origins of this inside joke, but I do recall that it had something to do with making fun of bottom-line, outcomes-focused physicians.

I reflected on this a lot today during the Teeter Totter game, in which we pretended the seesaw was a ward, and we had to enter and leave the ward as a team… Continue reading

Day 2, psych exam findings, bias, misses

Warning: Long post and a little “soapbox-y”

When I work in the ED, I document exam findings such as “appears anxious”, “dysphoric”, etc often.  While moved by the story of Alyssa’s death, I don’t think the lesson I take away is that documenting “anxious” in her chart was a true contributing factor, and I will continue to document psychiatric exam findings.

My rational is this:

#Though not all physicians are trained or qualified to make psychiatric diagnosis, I do believe that all are trained and qualified to perform an at least basic psychiatric examination and find/document findings such as mood, affect, speech, though process and content (the basic elements of a psych exam).

#The exam findings are IMPORTANT.  A patient who appears anxious may be anxious from their supra-ventricular tachycardia, thyrotoxicosis, cocaine intoxication, or hypovolemic shock.  Anxiety as an exam finding or symptom and does not equal… Continue reading

Day 1

As someone who seldom has time for reflection and writes prose even less frequently, this blog post or subsequent blog post will not be a shining achievement.  With that disclaimer aside, the first day of the Telluride Experience Summer Camp has been an important start to re-invigorating my energy and determination to improve the quality of care at my own institution.  Residency is demanding and it is easy to allow the fatigue and complacency with systems that never seem to budge overcome whatever passions for change you have.  While the formal lectures have been great, the moments before, between and after lectures talking with the esteemed faculty one-on-one has been my most valued time at Telluride so far.

Telluride Napa Day 1

After wrapping up day one of the Telluride Summer Camp in Napa, I felt extremely grateful for getting the chance to come hear the stories and experience the knowledge of the enthusiastic staff and speakers. Helen’s video was truly eye opening to me as I’m personally often guilty of premature closure. Being conscious of this and understanding how detrimental it can be will without a doubt be my major takeaway from the morning. I also want to thank Helen for having the courage to continue the patient safety fight by reliving this awful experience over and over so people like us can learn from her tragic experience.

As we moved into the afternoon, I’m going to say my favorite activity was the domino game. Being a nurse, experiencing the lack of direct communication between physicians and nurses is just something we have to prepare ourselves for and hope we’re getting… Continue reading

Day One Thoughts- Napa

First official day of learning was immensely informative. It took me through a roller coaster of emotions; sadness, anger, excitement, curiosity for new ideas, ect. The team building exercises preformed on day one have really opened my eyes as to what’s currently wrong and what’s a good start to fix communication in a hospital setting. With all the new ideas I’m ready to bring back to my Nurse Practice Council just after day one I am extremely looking forward to learning from day two. 

Culture for Change

The first day of Telluride has been an amazing experience filled with great ideas and thought provoking conversation.  However, throughout the day I became increasingly worried.  How could I bring this information back to my home institution to impact real change when just a couple days ago my colleagues could not understand why I would want to attend something like a patient safety conference?  A simple yet resounding comment at the end of our first day gave me my answer.  “Put the patient first.”  Of course this is obvious.  We all entered health care so we could help patients but somehow we lose sight of this to some extent.  We are taken over by fear of not succeeding in our professional endeavors or of losing the respect of our colleagues if we are wrong.  If we think of the patient as… Continue reading