Blog & Articles

[4 MIN READ]

Every day, ED physicians, physician assistants, nurse practitioners and nurses are confronted with pediatric patients suffering from infections. Thankfully, most are self-limited respiratory or gastrointestinal viral infections.

Symptomatic and supportive care may be necessary, but antibiotics are not usually indicated; minor infections such as otitis media, impetigo, pharyngitis and uncomplicated urinary tract infections usually respond well to either oral antibiotics or a single parenteral dose of an antibiotic.

When treating an infant or a child with an infectious process, it is important to check for and recognize the subtle warning signs and symptoms of a more serious infection – whether viral or bacterial. When overlooked in their earliest stages, several types of infections can progress to life- or limb-threatening situations. Failing to consider and test for the possibility of serious infections in children can lead to serious, even fatal, outcomes.

7 minute read

It appeared to be a typical, run-of-the-mill board meeting at Hospital System “X.” Patient admissions had been slowly on the rise; healthcare teams seemed to be handling the increasing demand for services as the hospital facility continued to display an inviting appearance.

Early in the meeting, the hospital CFO presented the data requested by board members; suddenly things took a dramatic turn. Several months of data had revealed that a profit drain had developed within the system. And worse news was that month-to-month figures showed this was not just a temporary “blip” in financial performance, but that it had become a consistent and expanding downward trend. Hospital System “X” still was operating in the black, but not to the satisfaction of the board. They immediately called upon top management to identify the problem areas and propose appropriate solutions.

[4 MIN READ]

Every patient – regardless of the time of day or department to which they present – needs to encounter a high-quality experience. Improving patient experience and ensuring its consistency involves reducing the variability between departments, clinicians and shifts.

To achieve this high goal, you need to get buy-in from the entire clinical community – an effort led by clinicians for clinicians to help all truly understand and buy into the mission and purpose of providing a high-quality patient experience.

Using the industry analyses to galvanize organizational support for defining a provider-patient communication model is a great first step.

[7 MIN READ]

Among physicians, surgeons are at increased medico-legal risk compared to non-surgeons; they also have more medical malpractice claims and claims paid per year. Jena et al.¹ found that the probability of facing a claim varied from 15.3% in general surgery to only 5.2% in family general practice. In a recent review of National Practitioner Data Bank (NPDB) records, Schaffer et al.² noted that the number of paid claims per 1,000 physician years was 30.0 for general surgeons and only 7.1 for internal medicine. Although there are a number of factors responsible for this wide variation, the correlation between the physician-patient relationship and the risk of a medical malpractice suit is well established.

A recent study by Tibble et al.³ explored the incidence and classification of complaints about physicians, finding that surgeons attracted 2.3 times as many complaints as non-surgeon physicians. Although the thrust of the article remains valid and the implications are concerning, there are a few factors that modify the severity of the concern. 

[8 MIN READ]

We are all fallible. Despite their best efforts, physicians, nurses, other healthcare workers, and indeed all humans, make errors. It is an essential component of our being. It is widely accepted that a systems approach to error prevention can counteract this fallibility. Nonetheless, errors do occur. These failures can often be explained by the “Swiss Cheese Model” of error. Multiple processes are designed to prevent a type of error. Each individual process may be imperfect but used in combination one process will succeed where another may fail. Like the holes in Swiss cheese, when these imperfections are aligned and multiple processes fail, errors occur.

Below I present three cases from which we can gain perspective on how poor communication, systems errors, and cognitive bias contribute to surgical errors.

[3 MIN READ]

After investing in an ongoing triage training program, some emergency department (ED) managers and educators become frustrated due to gaps in the application of that education. The goal of triage is to rapidly identify and sort patients to ensure they receive the appropriate care in the right amount of time. Updated triage practice protocol and ongoing triage training helps ensure optimal patient triaging. Implementing changes though does not always come easily.

[9 MIN READ]

Updated: March 18, 2020

Working on the front lines of an obstetric unit is fraught with vulnerability and uncertainty during these early stages of the unprecedented COVID-19 pandemic. Your obstetric team has never before been so codependent in maintaining safety for you and your entire community. Arming yourself and teammates with the most current knowledge will help to keep you, your family, and your patients as safe as possible.

Since much is unknown about the novel coronavirus, review of daily updates and evolving information from our health experts is important. Staying knowledgeable and well-informed will require ongoing review of CDC updates and government notifications, as well as guidelines from our own health professionals like AWHONN and ACOG. All healthcare providers and frontline OB staff should work together to help ensure that everyone is practicing using the most current information. Teamwork along with shared learning will help everyone stay informed.

To keep yourself and your obstetric peers current on COVID-19, The Sullivan Group is providing this summary of recent information from the CDC and ACOG (last updated March 18, 2020).

[3 MIN READ]

As concerns for COIVD-19 continue to escalate in many areas of the country, it is imperative that triage staff remain alert to their role in early identification of potential infection. 

[3 MIN READ]

Apology laws have always been a quandary. I have repeatedly said they make docs feel more comfortable about apology but have little legal value. Most would assume apology laws reduce medial malpractice claims but a study by Stanford Law Review shows that this is not the case. In states with apology laws, non-surgeon physicians saw higher rates of medical malpractice lawsuits and dollars paid out. Defense lawyers should want to use the evidence created in a disclosure process if a case goes to trial.

[3 MIN READ]

Do your clinicians have a plan for how to address a patient’s family if a medical error occurs?

Consider this true case that was shared with me by a California risk manager – a routine test that goes tragically wrong:

"Mrs. Woods is a 53-year old woman who goes to the hospital for a CT-guided biopsy of the liver. The staff assures Mrs. Woods the test is ‘no big deal’ so she tells her husband to go across the street to do some shopping during the test. The clinical team assures Mr. Woods they will call him when the test is complete. Mr. Woods is standing in Macy’s when his cell phone rings … he answers to hear a nurse frantically screaming, 'Come quickly!' Mr. Woods races across the street to the hospital where he learns his wife is dead."

After reading this case in my training programs, I challenged my healthcare audiences with the following: