Oct 17, 2008

My day with the IHI Open School team

I'm a 6th year student at high school in Scotland. Having a day at the IHI was great.

I started by meeting various staff members and learning a bit about the IHI Open School. They were all very nice and I was really impressed with what I heard.

Being a potential medical student, I spent my day getting a better understanding of quality improvement in healthcare and helping the Open School team by being a sort-of 'focus group' .. the group consisting of only me.

I started with reading a couple of case studies, and following the guidelines for case study questions, I made up some questions for a few of the case studies.

I then started the course in quality improvement on the IHI Open School website. I was really impressed by the course. I never knew courses like this existed and it was a great way of learning for me. After completing the first lesson I felt that I had gained a good understanding of errors and how they can happen anywhere, to anyone and ways to go about responding to these errors. Although I only got through a small section of the course, I intend on doing many more in the near future.

In the afternoon I was filmed being interviewed by Deepa. It was my first ever interview and was quite scary, but I enjoyed it. I was asked questions about what I want to do in the future and why.

I then gave my feedback from the courses and we discussed each part.

I feel that I have had a very successful day at the IHI and I have developed a good understanding of health improvement.

Thank you all the team who made my day so successful :-)

Oct 15, 2008

Unfortunately, a familiar story...

**NOTE: names and locations have been changed or omitted to protect the privacy of those concerned**

Just over a week ago, my friend's little brother, Sam, was hit by a car while riding his bike. The accident was very serious. Sam and four of his competitive biking friends were riding together when a car hit him from behind causing him to fly through another car's windshield. Upon arrival in the hospital, Sam was unconscious, had difficulties breathing on his own, and had deep lacerations on each of his knees. Thankfully, his internal organs were stable and he did not suffer from any fractures.

After a few very tense days in the Trauma Center, CT scans had revealed that the bleeding in Sam's brain had stopped and the brain swelling was slowing getting under control. He remained on a ventilator to regulate his breathing. While Sam was starting to look better, he ran a high fever and developed signs of pneumonia. In order to allow his body to recuperate and avoid other complications, he was given sedatives to keep him unconscious.

Sam, originally from Charlotte, is a college sophomore studying in Springfield. His family dropped everything to travel to Springfield to be there with him. Once Sam's had regained consciousness and his condition had stabilized enough to move him to the ICU, his mom and dad would read to him is favorite books, tell him about some of his favorite trips to South America and Europe, and read to him excerpts from the bible. This was to try to calm Sam as he would always wake-up very agitated and attempt to yank off all of the tubes that were connected to him. Things just had to be taken a day at a time with such severe head trauma.

Very slowly Sam was coached on how to breathe on his own. After a few more days, Sam progressed from only saying "hurt" and crying uncontrollably, to being able to answer basic questions such as, "what is your name?" and "how old are you?" Every night, Sam's parents would write an e-mail to Sam's best friend David. David would then post the e-mail onto Facebook so that all of us could keep up with Sam's progress in the hospital. Without any medical training to offer medical advice and residing far enough away that visiting was not feasible, all I could do was pray for the best and monitor Sam's progress via Facebook. Reading about Sam's positive progress allowed me to breathe a momentary sigh of relief every night.

But after a week of incremental steps of good news, Sam's parents' latest post sent me tumbling back down to the same emotional state I was in when I first found out that he had been hit by a car. The e-mail:

Another sleepless night set in last night. Sam's condition was stable yesterday. When he was awake, he was crying most of the time. The doctor does not know if he shows his true emotions or if he is just that way due to a severe shear injury. Sam was transferred to a regular room at 9 P.M. The first room that he was transported to had air conditioning problems. He then got switched to another room. Sam was sweating profusely and his heart rate went up drastically. The nurse gave him medicine. However, he became more agitated. At one point his body was stiff and he shook profusely. I was extremely upset and frustrated since clearly, the nurses were not equipped to deal with Sam's condition on this floor. He was supposed to go to the Progressive ICU but, the floor was full. Dr. Thompson decided to send him to a regular neuro floor. Sam got a very nice nurse but, she had 4 other patients to attend to. In addition, she was not allowed to administer certain kinds medicine in her unit. After both Jim and I could not get Sam to calm down and his heart rate went up to almost 150. I asked the nurse to call the doctor. When Dr. Fulton came, I expressed my concern that the unit that Sam was currently in was not quite ready to know how to handle Sam's condition. I requested him to get Sam to the Progressive ICU for better care. He was not empathetic to my plea. Since I figured that Sam is at his mercy, I insisted that he must come up with a plan to deal with Sam's situation if he does not move Sam to the Progressive ICU. He promised me that he would look at Sam's medical record and let me know what type of medicine he can give in the unit to help Sam with his medical condition. Sadly, he got called to the Emergency Room to take care of two other patients and did not have a chance to look at Sam's record right away and later ordered the nurse to give Sam Valium every 6 hours.

It has been a very frustrating and exhausting experience dealing with some of the doctors and nurses in this hospital. The sanitation conditions could be improved. I had to buy Lysol wipes and Lysol spray to try to keep Sam from getting infections. When Sam had the MRI, I asked for a copy of the report. The Medical Records Office refused to furnish it and cited that the hospital policy is to not release any records, even from doctor to doctor, until Sam was discharged. I was flabbergasted at the refusal. Regardless, I did not give up and finally they caved in. Dr. Morton, Dr. Fulton, and Dr. Lee finally came around noon today. We asked them to come up with a coherent plan to help Sam adjust to the new environment. It is very difficult to go from a lot medication to practically very little. I asked them to find a happy medium to help Sam adjust slowly. We need to work together in order to help Sam continue his progress and avoid any set backs. They agreed, so we are hoping that Sam will feel better soon. It is very ironic that we have to face two battles, one with helping Sam recover from his severe injury and the other with constantly fighting for Sam's rights of treatment. The latter has exhausted us more. Take care and God Bless.

Karen and Jim

Unfortunately, Karen and Jim's e-mail is a familiar story. Doctors and nurses are not to be blamed because they are operating in a system that requires more than every ounce of effort that they can contribute. Sam's familiar story calls for a immediate need for a cultural change in the health care industry; to one that emphasizes patient safety and the quality of care delivered.

When patients and families seek medical care, they are inviting doctors, nurses, and the medical institution into their lives. Patients and families' emotional strings are already stretched thin as they hope for a speedy and full recovery. The last thing they would ask for is to be placed in a situation where they feel that they have to fight the very system they are requesting help from.

Even though we have made considerable and commendable progress in improving the quality of health care by reducing the number of patients with hospital acquired infections, pressure ulcers, and wrong-side surgeries, our work is far from over. Sam's story and many others just like it, remind us that we still have lots to do.