The learning around open, honest communications in healthcare can never begin too soon in any healthcare trainees’ career! Pictures from this week’s newest location for the Telluride Experience in Napa, CA provide a new look for our program.
By Roger Leonard, MD
I am grateful to Rosemary for eloquently guiding our visit to Arlington Cemetery – the visual images and mental reflection. I saw the changing of the guard at the Tomb of the Unknown and found another Tomb of the Unknowns for Civil War soldiers where 2111 remains were buried together. I thought of a Tomb of the Unknown Patients. How many patients did I harm during my 40 years of practicing internal medicine and cardiology for whom I am clueless?
Why am I clueless? Like many peers in my generation of physicians, I viewed complications as an acceptable risk in the care we provided. Indeed, by explaining those risks to patients & families, we may have felt absolved. I participated on many peer review committees and this was a common thread, rather than carefully analyzing the medical record and the details of our actions. Were there… Continue reading
Today is Day 2 of my Telluride patient safety and quality improvement experience. Overall it’s been a very informative and, more importantly, inspirational.
I expressed to colleagues today my struggles with applying these broad concepts, which often are discussed in the context of surgical and medication errors, to psychiatry. The most obvious application is engaging the patient in a conversation when proposing to start psychotropic medications. Shared decision making based on their personal values and goals makes complete sense when a patient has capacity as our psychotropic medications directly effect the brain along with other systems. Some of these effects include GI distress, sexual disfunction (SSRIs), weight gain (i.e. valproic acid), dermatologic reactions ranging from psoriasis (i.e lithium) to severe Steven’s Johnson Syndrome (i.e. lamotrigine), prolonged electroconductivity of the heart leading to ventricular tachycardia, (i.e. supposedly ziprasidone), oversedation (benzodiazepine), metabolic and extra pyramidal side effects (antipsychotic medications), some of which… Continue reading
Hereafter the first day, the term “premature closure” seems to be the concept that continues to resonate in my mind. In both stories we heard today, premature closure resulted in the death of the patient, not to mention the ripple that follows. I think I’m most bothered by this because I feel that I’ve been guilty of this myself. I’ve been lucky enough not to have had the outcomes like those we heard about today, but it’s just that: luck. I think it happens too often that when we aren’t certain, when symptoms don’t prompt us towards something more severe, when we want to avoid criticism for wasting resources, when we’re in denial that something bad could be happening, or for a multitude of other reasons, we reach towards a simple nonthreatening diagnosis and elect to watch and wait. While it’s not always the wrong thing to sit back and… Continue reading
Failure to escalate. That is one of the many concepts in Patient Safety that stood out to me today during the first day of our conference. I find this concept especially challenging in the environment of academic medicine. Unfortunately, a hierarchy as well as “tribes” or “silos” still do exist, as this has been so long-engrained in the culture of academic medicine. And this culture may often create a barrier to escalation.
I found myself thinking back to my first night of cross-covering the Family Medicine inpatient service at one of the community hospitals where our residents work. This hospital is a bit different than the University Hospital where there is always both an intern and a supervising resident in-house, and access to multiple specialists at all times. Because this is a smaller, community hospital, there is one resident (that night –me!) covering all the patients on our service, including… Continue reading
On my drive to Denver yesterday, after leaving Telluride, I thought much about our Telluride experience this week…as Tanya noted, it was an awesome experience. You students are smart, savvy, passionate, caring, curious, continuous learners, empathetic, with a wide variety of life experiences.
I want to reflect again the thoughts I shared when Wendy and I talked about Shared Decision Making on Wednesday afternoon, when y’all really got into your SDM role playing:
–It’s very PRACTICAL to include and engage the patient/family in clinical options and discussion — though some physicians have done this for a long time.
–The patient/family need to FEEL INVOLVED.
–Traditionally, we have a WELL INTENTIONED DOCTOR making/guiding the decision, w the patient not actively involved…too often this interaction has been condescending.
–Suggest a LOVED ONE also be involved, in addition to patient, as much as possible, just as 24/7 in the hospital.
–This SDM engagement… Continue reading
By Christine Galligan
My friend is allergic to gluten and can only eat the grilled chicken nuggets. One time on the way home from our internship, we stopped at Chick-fil-A and she ordered grilled chicken nuggets. However, when we pulled out of the drive-thru, she realized that she had been given fried chicken nuggets. This was a near miss as she could have had an extremely allergic reaction. We pulled around and parked, and she ran inside to report the mistake. We could have driven away and she could have gone hungry, but we decided to let the management know. At the very least, the cashier or the person wearing a headset at the drive-thru should be made aware. Human error exists. It is not a crime and it is typically not intentional. Chick-Fil-A is quite efficient at standardization. However, no one is perfect. Work one day in the food… Continue reading
Our third 2014 session for the Telluride Patient Safety Summer Camps is kicking off this morning with student introductions and safety moments. We have another impressive group of future patient safety leaders gathering to increase the growing size of our own Dumbledore’s Army of sorts. Many have been chosen to participate because of academic success and leadership, and a passion for patient safety, but the extracurricular talents never cease to amaze and impress. We have with us:
The group that has come to Turf Valley this week… Continue reading
by Shirley Conrad RN
Yeah, I know the World Cup has captured the world’s attention in recent weeks but for me the greatest sporting event is the Tour de France. Every year I worry about how to carry on with my life for the three weeks it takes the riders to ride the 2276 miles. I watch more TV in these three weeks than I do all year long.
This year, however, I am fresh from returning from the 10th Annual Telluride Summer Camp and therefore my safety and quality hats are still firmly planted on my head. Perhaps you know the feeling of running incoming data through a specific filter to see what comes of it. Actually, I am certain many of you do. Recently Roger took an unexpected emergency on his flight home from Telluride and turned it into a safety event complete with a debriefing, Richard found… Continue reading