Patient Safety and Quality

  • Quality Improvement or Human Research? Ethics in the Gray Zone

    By Marjorie Stiegler on March 1, 2017
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    Medical research on human subjects has substantial institutional oversight and regulatory assurances to protect patients. However, research is expensive and the insights gained from human research often takes many years to permeate clinical practice. In this modern age of healthcare focused on enhancing quality, value, and patient safety, a new paradigm has emerged - the 'quality improvement' project. These projects are subject to a much lower level of oversight, and enjoy more loosely defined protocols. The intent is to be able to rapidly implement better and safer processes for the benefit of patients. However, some projects share considerable similarities with traditional human research. Are their champions simply trying to circumvent regulatory hurdles by calling their experiments 'quality improvement'?
  • Why are kids dying at the dentist?

    By Marjorie Stiegler on July 21, 2016
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    Is pediatric dental anesthesia safe? Right on the homepage of the ADSA is a big box: “getting sedated at the dentist: there’s nothing to worry about”. Recent news, however, seems to contradict that statement. In Texas alone, there are at least 85 reported deaths of patients who died following dental procedures between 2010 and 2015. In these cases, anesthesia was reportedly administered by dentists with anesthesia training. But what is a 'dentist anesthesiologist'? In the FAQ section of the ADSA website, they state “Anesthesia is administered by a licensed anesthesiologist, who was trained in a formal anesthesia residency program.” No wonder people are confused...
  • Why is everyone so upset about the VA APRN proposed rule?

    By Marjorie Stiegler on May 28, 2016
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    The best outcome of research in healthcare quality and safety would be to make the practice of medicine and healthcare systems so safe and so good that we essentially make ourselves obsolete. Are we there yet? Some think so. Within the VA system, a new rule has been proposed: "expanding the pool of qualified health care professionals who are authorized to provide health care... without the clinical supervision of physicians" and "to exercise Federal preemption of State nursing licensure laws...regardless of individual State restrictions that limit such full practice authority". Let's look at the details...
  • Medical error is #3 cause of death – what does this mean?

    By Marjorie Stiegler on May 9, 2016
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    Recently, a paper written by researchers at Johns Hopkins and published by the British Medical Journal estimated that medical error was the third leading cause of the death in the United States. This received – as you might imagine – considerable coverage in the media. The researchers proposed that death certificates should include a qualifier or indicator that medical error was linked to the death, if in fact it was, so that better statistics could be obtained. I certainly can’t argue with the fact that we do not have good data about how frequently medical error occurs, or how frequently such errors contribute to serious disability or death. However, the paper also offered a case illustration which did show how un-illuminating the death certificate is, but in my view, did not actually demonstrate a preventable error.
  • Collaboration in Patient Safety: SPA and AAP lead by example

    By Marjorie Stiegler on April 4, 2016
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    While I'm sure that all physicians and other healthcare professionals want to collaborate in order to achieve the highest quality of medical care and enhanced patient safety, the Society for Pediatric Anesthesia and American Academy of Pediatrics are really leading by example. They hold a jointly sponsored academic meeting, and I had the privilege of speaking at one of the plenary sessions this year on quality and safety. This was a very special invitation, since I am not a pediatric specialist. The meeting was designed to focus on topics of pediatric anesthesia and sedation, as well as pain management and critical care services for infants and children.
  • Nudging toward safer healthcare

    By Marjorie Stiegler on March 15, 2016
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    A nudge is a form of social engineering to help people make the best decisions by also making the easiest, laziest choices – the defaults - the "right" choice. Example of success stories include helping people to save for retirement, increasing organ donation status for people who want to be organ donors, and healthier food choices by school kids in their cafeterias – even when the unhealthy choices were still readily available. The nudge represents an untapped source of innovation in patient safety efforts. How can we apply this concept to healthcare? First, let's look at some serious nudge fails:
  • What if Doctors and Nurses Could Support Each Other?

    By Marjorie Stiegler on December 4, 2015
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    Hostility among healthcare professionals seems to be escalating among physicians and nurses alike about pretty much everyone else in the hospital. Emergency medicine physicians are “GTNs” – glorified triage nurses. (Wait – are we insulting ER dos or triage nurses here?) Surgeons are "often wrong, but never in doubt!" Some guy in an elevator told me that the “ABCs” for anesthesiologists - referring to the life support mantra of “Airway, Breathing, Circulation” – are “Airway, Bagel, Coffee”. And who knows the difference between an optometrist, optician, and ophthalmologist anyway? The ICU nurses’ station displayed a cartoon portraying medical residents as babies dressed in diapers, sucking on pacifiers, their stethoscopes training behind them on the floor like a security blanket. I’m not sure why these insults are so pervasively embraced and tolerated in healthcare culture, but it is disheartening...
  • Stanford MedicineX Live Tweeting – Good or Bad?

    By Marjorie Stiegler on September 29, 2015
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    Cast your vote! According to symplur.com, Stanford's Medicine X conference #MedX had an incredible reach of nearly 219 million impressions and over 56,000 tweets in the past ten days. But, controversy remains about whether it is OK to tweet a speaker's slides without proper attribution. Many attendees snap photos of slides and live tweet the content, but without knowing speaker's twitter names, and without express consent to disseminate the actual intellectual creation, the question remains...
  • If You’re Reading This, You’ve Survived the”Killing Season.”

    By Marjorie Stiegler on September 11, 2015
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    It’s that time of year again – healthcare centers across the country experience a massive cohort turnover as newly graduated medical students become resident physicians, and new responsibilities and autonomy are given to existing trainees. It has long been advised to avoid seeking medical care in July because of the presumed increased risk to patients, so much so this changeover is sometimes called the “July Effect” in the United States and the “August killing season” in the United Kingdom. Indeed, studies show that mortality is increased and efficiency is decreased...
  • Communication Failure: More Common Than You Think

    By Marjorie Stiegler on February 16, 2015
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    Why is communication so pervasively difficult? We see year after year that communication failures top the lists of root causes for sentinel events reviewed by The Joint Commission. Few people would classify themselves as poor communicators, and yet, communication failures in healthcare are practically an epidemic in themselves.
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