Caring for patients is fraught with hazards and risks. As physicians, every time we approach the bedside we bring the potential for benefit and the possibility of harm. Benevolent intentions do not guarantee safe and effective care or highest-quality outcomes. Problems with our systems and processes of care, as well as personal lapses, often result in preventable and even death.
Improving Diagnosis in Health Care, a new report by the Institute of Medicine, inspired artists at VisualDx to produce the infographic shown below. VisualDx is a widely used web-based clinical tool used to enhance diagnostic accuracy, aid therapeutic decisions, and improve patient safety. Art Papier, MD, co-founder and CEO of VisualDx, is a member of the board of the Society to Improve Diagnosis in Medicine, which petitioned the IOM to produce the report.
Although nurses and physicians support evidence-based care in principle, barriers to adoption include resistance from colleagues, nurse leaders, and physicians and more than one-half of physicians do not use available guidelines
Some hospitals use McKesson’s InterQual admission criteria; some use MCG (formerly Milliman). Some managed care plans use InterQual, and some use MCG. The Centers for Medicare & Medicaid Services (CMS) has said it and its contractors may refer to either InterQual or MCG, but they don’t recognize either as the deciding factor in establishing payment.
Patient and family advisory councils (PFAC) are groups of patients, family members, community members, and hospital staff who work together to bring the unique perspectives of patients and families to a hospital’s operations, especially its efforts to improve care. According to one estimate, more than 2,000 hospitals in the United States have PFACs. They are also slowly becoming more common in outpatient settings.
For patients with severe, disabling rheumatoid arthritis (RA), oral methotrexate is often the preferred disease-modifying antirheumatic drug, unless it is specifically contraindicated (Bykerk et al., 2012; Saag et al., 2008; Singh et al., 2012). compared to dosing for antineoplastic indications, methotrexate for RA is administered once weekly as low-dose therapy (Sing et al., 2012). According to official prescribing information, the recommended starting dose is a single oral dose of 7.5 mg once weekly or divided oral doses of 2.5 mg every 12 hours for three doses per week. The dosing schedule may be adjusted to achieve optimal response, with doses up to about 25 mg weekly.
Ask 10 healthcare leaders if they’ve heard of high reliability, and it’s almost certain all 10 will say they have. Ask those same 10 to define high reliability, and things get interesting.
Many healthcare leaders have a genuine interest in high reliability but often do not know exactly what it means or how to incorporate it among their organization’s other priorities. They just know it sounds right to say their organization is working to “get to high reliability,” and they hope it will be the silver bullet that solves all problems. Unfortunately, the term “high reliability” can become a buzzword when used without understanding what it is. Employed this way, it may sound great but lack substance—all sizzle and no steak.
As I approached the end of my first postgraduate year (PGY1), one of the chief residents asked me to participate on the “LMP PCC project.” He explained that LMP PCC referred to a multidisciplinary labor-management, patient-centered care project where representatives from different disciplines would work together to enhance patient experience. At the beginning, I wasn’t sure what that actually meant, but I was excited for the opportunity to work on something that promised to make a difference, especially in my patients’ lives. As a PGY-1 resident, my days were usually occupied with floor work, didactic activities, and clinic schedules, so I looked forward to working on my first quality improvement project.
During the transition from hospital to home–or a skilled nursing or long-term care facility–patients with complex medical needs are at risk for sub-optimal outcomes due to issues with medication adherence and errors. Of particular concern are patients who, once discharged, do not obtain the medications prescribed for them during their hospital stay.
Recently I sat patiently in an examination room while my physician typed notes into a computer terminal. After a few moments, he paused and asked, “You know what electronic medical records are good at?” I smiled politely. “Federal compliance and billing,” he said. I didn’t have to wait long for the follow-up I knew was coming. “You know what they’re bad at? Caring for patients.”