PGY 39, Day 61
FLASHBACKS: Katrina on my mind
On this date 6 years ago I was "Inside Katrina" ... and Irene, well, She reminded me - was I in the right place a the right time, or the wrong place at the right time, or the right place at the wrong time - that I was in the thick of it at Tulane University Hospital on Tuesday, August 30, 2005. This was the day that started with a tapping on my door at 12:32 AM, and a this message: "The water is rising. They say there is a breach in the levee." I went back to sleep ... nothing else sensible to do ... nothing I could do about it ... I went back to sleep, safely locked in my office on a mattress on the floor ... in fact, it was the third floor of the hospital, and I knew that the flood waters could not possibly reach that high. And, as I recall, my vehicle was parked on the fourth floor of the parking garage, or was it the fifth floor? In any case, I knew my stuff and I were safe from the rising flood water, which was ... expected. Yes, this was the day that they decided to evacuate the hospital. After the flood ... after the elevators failed ... after the flood waters started to enter the hospital on the first floor. The stupidity is just outrageous ... still disturbing to think about it. I was there, because I was on call for Critical Care ... for the patients. But, the hospital should have been evacuated before the storm and shut down for the storm. So, I had become a participant in this exercise in stupidity, because of my obligation to and for the patients. In other words, the failure to evacuate and close the hospital before the storm, a storm we had watched and expected for days put hundreds, if not thousands of patients and providers at risk ... not to mention the hundreds of people ... SOM faculty and families (including pets) who put themselves at risk by attempting to ride the storm out at the medical center. So, all in all, the pre storm planning was just plain stupid, and because of this, I was there at Tulane University Hospital on August 30, 2005, when the flood waters rolled in from the broken levees around the Lake. The contrast with Irene is striking ... but, is this just another warning?
To be continued ... MORE REFLECTIONS on KATRINA AND IRENE ...
Dr. Mike
Tuesday, August 30, 2011
Sunday, August 28, 2011
Mission: Healing August 28, 2011
PGY 39, Day 59 @ 14:46 hours
Irene
Late afternoon darkness ...
as before the night,
comes early today.
Irene brings this,
in waves of wind and rain.
Wind, calm, rain and mist ...
waters pour between
light, gentle breeze, sweet warm, wet air ...
Like spring rain,
She mesmerizes,
pushing in slowly.
Relentless, undaunted ...
a warm and rising tide,lures us ...
children into mother's warm arms and kind smile.
But, She, neither kind nor gentle,
teaches ... all lessons of life and love ...
Naked ... not wishes, desires and dreams ...
not madness, but truth.
Undeniable ... some try to resist, why?
No matter ... none escape.
For the world ... the message is clear.
This Mother's love, not gentle ... but strong ...
wraps around us.
We, in Her tight, wild embrace,
might see ... for a moment,
madness gone and peace in place.
Dr. Mike
Irene
Late afternoon darkness ...
as before the night,
comes early today.
Irene brings this,
in waves of wind and rain.
Wind, calm, rain and mist ...
waters pour between
light, gentle breeze, sweet warm, wet air ...
Like spring rain,
She mesmerizes,
pushing in slowly.
Relentless, undaunted ...
a warm and rising tide,lures us ...
children into mother's warm arms and kind smile.
But, She, neither kind nor gentle,
teaches ... all lessons of life and love ...
Naked ... not wishes, desires and dreams ...
not madness, but truth.
Undeniable ... some try to resist, why?
No matter ... none escape.
For the world ... the message is clear.
This Mother's love, not gentle ... but strong ...
wraps around us.
We, in Her tight, wild embrace,
might see ... for a moment,
madness gone and peace in place.
Dr. Mike
Tuesday, August 23, 2011
Mission: Healing August 23, 2011
PGY 39, Day # 54
Back into they recovery phase. It always takes a few days for me to take care of loose ends and to catch up on my sleep ... to restore "normal bodily functions" after a week in the ICU.
This week was busy as usual, but not brutal as was my last week in the ICU. My team included two very bright fourth year medical students, a mid level surgery resident, two PGY 2 anesthesiology residents, a mid level OB resident and a surgery intern. Performance was quite good despite the fact that we had, as usual, some very sick patients. Aside from some some routine administrative nonsense (that needs to be eliminated) capacity was not exceeded at any time, as best I can tell. It is still trauma season, and the students are now back in town, so we can get slammed at a moments notice.
But, this week, we had time to talk ... and my focus was on The Healing Mission: Specifically Healing in the ICU. From my perspective Critical Care means Patient resuscitation, prevention of accident or further injury, and protection & preservation of Life, Limb and Organ Function. From that big picture view, I brought the students down into the gritty world of Patient & Family, organism, limb and organ injury and preservation ... then down into the level of cell and molecule ... damage, pathogenesis of injury, opportunities for intervention and the need for precise, rapid intervention. And, I gave them my STOMPP(TM) check lists to help them StepWisely(R) & stay on target in this world of chaos we call patient care.
Key points of discussion included, distractions from the mission and how to stay on target, advanced directives, reasons why families interfere with advanced directives, reasons why families interfere with care, reasons why providers interfere with advanced directives and patient care, team development, including the family in the care team. Then, we dropped down to specific patient and organ injury and injuries, primary injury, secondary injury, progressive injury, prevention of progressive injury, brain preservaion, the vaue of hypernatremia, spinal cord preservation, perfusion and its importance, prevention of complications, cardiac protection and prevention of myocardial ischemia, treatment of acute myocardial injury and MI, renal protection and preservation, ADH, DI, Cerebral Salt Wasteing ... and on and on. Generally, I take a tutorial approach based upon the real patients in the unit, but this week there was enough time for me to give my lecture on respiratory failure. This included, diagnosis, treatment options, prevention of progressive respiratory failure by using non invasive airway management therapies. Then we went on to invasive airway therapies, endotracheal intubation, methods and optimal intubation strategies, early management after intubation, early ventilator management, analgesia and sedation after intubation and prevention of self extubation. I am sure that the students (and the intern) were overwhelmed ... but that is not bad at this stage, because they always work with supervision.
So, now, I take care of loose ends and R&R for a few days ... part of which includes writing this blog ... and other assorted moments of reflection.
Ciao for now,
Dr. Mike
Back into they recovery phase. It always takes a few days for me to take care of loose ends and to catch up on my sleep ... to restore "normal bodily functions" after a week in the ICU.
This week was busy as usual, but not brutal as was my last week in the ICU. My team included two very bright fourth year medical students, a mid level surgery resident, two PGY 2 anesthesiology residents, a mid level OB resident and a surgery intern. Performance was quite good despite the fact that we had, as usual, some very sick patients. Aside from some some routine administrative nonsense (that needs to be eliminated) capacity was not exceeded at any time, as best I can tell. It is still trauma season, and the students are now back in town, so we can get slammed at a moments notice.
But, this week, we had time to talk ... and my focus was on The Healing Mission: Specifically Healing in the ICU. From my perspective Critical Care means Patient resuscitation, prevention of accident or further injury, and protection & preservation of Life, Limb and Organ Function. From that big picture view, I brought the students down into the gritty world of Patient & Family, organism, limb and organ injury and preservation ... then down into the level of cell and molecule ... damage, pathogenesis of injury, opportunities for intervention and the need for precise, rapid intervention. And, I gave them my STOMPP(TM) check lists to help them StepWisely(R) & stay on target in this world of chaos we call patient care.
Key points of discussion included, distractions from the mission and how to stay on target, advanced directives, reasons why families interfere with advanced directives, reasons why families interfere with care, reasons why providers interfere with advanced directives and patient care, team development, including the family in the care team. Then, we dropped down to specific patient and organ injury and injuries, primary injury, secondary injury, progressive injury, prevention of progressive injury, brain preservaion, the vaue of hypernatremia, spinal cord preservation, perfusion and its importance, prevention of complications, cardiac protection and prevention of myocardial ischemia, treatment of acute myocardial injury and MI, renal protection and preservation, ADH, DI, Cerebral Salt Wasteing ... and on and on. Generally, I take a tutorial approach based upon the real patients in the unit, but this week there was enough time for me to give my lecture on respiratory failure. This included, diagnosis, treatment options, prevention of progressive respiratory failure by using non invasive airway management therapies. Then we went on to invasive airway therapies, endotracheal intubation, methods and optimal intubation strategies, early management after intubation, early ventilator management, analgesia and sedation after intubation and prevention of self extubation. I am sure that the students (and the intern) were overwhelmed ... but that is not bad at this stage, because they always work with supervision.
So, now, I take care of loose ends and R&R for a few days ... part of which includes writing this blog ... and other assorted moments of reflection.
Ciao for now,
Dr. Mike
Wednesday, August 17, 2011
Mission: Healing August 17, 2011
PGY 39, Day 48
Yesterday, the senior resident on the service said, "I'm bored." after which I promptly said, "Good. That means we are doing our job well." Then, I went on to explain ... "When we do our job properly, there is no excitement ... just good patient care ... even in the midst of the casualties and disasters." The message speaks for itself.
Dr. Mike
Yesterday, the senior resident on the service said, "I'm bored." after which I promptly said, "Good. That means we are doing our job well." Then, I went on to explain ... "When we do our job properly, there is no excitement ... just good patient care ... even in the midst of the casualties and disasters." The message speaks for itself.
Dr. Mike
Tuesday, August 16, 2011
Mission: Healing August 16, 2011
PGY 39, Day 47
Our current critical care team includes one surgery intern, two senior medical students, a second year OB resident, a PGY 2 Anesthesiology resident and a PGY 3 surgery resident.
Yesterday ... a 24 hour day ... rounds went OK. Our patient list includes mostly trauma casualties and a few SAH patients. Discussions focused on TBI and strategies for prevention of progressive brain injury, euvolemia, fluid and electrolyte management, diagnosis of DI, Hypernatremia and the differential diagnosis of hypernatremia, placement of central venous lines by the subclavian route and others. Everyone was pretty much organized by 10 PM and I left shortly thereafter. There were a few admissions during the night, but nothing drastic. The relationship between drugs & alcohol and trauma is STILL striking ... and disturbing ... even after doing this for so many years. Were it not for self abuse, we would have much less work to do.
We will see what today brings.
Dr. Mike
Our current critical care team includes one surgery intern, two senior medical students, a second year OB resident, a PGY 2 Anesthesiology resident and a PGY 3 surgery resident.
Yesterday ... a 24 hour day ... rounds went OK. Our patient list includes mostly trauma casualties and a few SAH patients. Discussions focused on TBI and strategies for prevention of progressive brain injury, euvolemia, fluid and electrolyte management, diagnosis of DI, Hypernatremia and the differential diagnosis of hypernatremia, placement of central venous lines by the subclavian route and others. Everyone was pretty much organized by 10 PM and I left shortly thereafter. There were a few admissions during the night, but nothing drastic. The relationship between drugs & alcohol and trauma is STILL striking ... and disturbing ... even after doing this for so many years. Were it not for self abuse, we would have much less work to do.
We will see what today brings.
Dr. Mike
Monday, August 15, 2011
Mission: Healing August 15, 2011
PGY 39, Day 46
Today I start another week of ICU coverage. Hmmm ... Interns on day 46 and peak trauma season. Will let you know how it goes.
Dr. Mike
Today I start another week of ICU coverage. Hmmm ... Interns on day 46 and peak trauma season. Will let you know how it goes.
Dr. Mike
Thursday, August 11, 2011
Mission: Healing August 11, 2011
PGY 39, Day 42
Morning Kiss
Shimmering Green Leaves Dance in Easy Winds
and
Dawning Sunbeams ...
Breaking through the shroud of darkness
and
Cool Morning Mist to Kiss ...
warmly and ever so gently ...
to bring another day.
Dr. Mike
Morning Kiss
Shimmering Green Leaves Dance in Easy Winds
and
Dawning Sunbeams ...
Breaking through the shroud of darkness
and
Cool Morning Mist to Kiss ...
warmly and ever so gently ...
to bring another day.
Dr. Mike
Monday, August 8, 2011
Mission: Healing August 8, 2011
PGY 39, Day 39
This is my latest post (today) to the American College of Physician Executives discussion on why physician leaders are not leading healthcare reform.
Here you go ... Dr. Mike
PS. We need some patients to join us in this effort!
Dear Doctor H...:
I understand your point of view, but disagree with your conclusion(s). This is a crisis ... and CRISIS = OPPORTUNITY.
If we take advantage of this chaos, put our personal needs aside, stop bickering, put the patients first and develop a united front with the patients, we can drive this whole thing in the right direction.
Millions of $$$ have been put up for development of COOPERATIVE insurance models. We could take advantage of this opportunity by realigning ourselves with our sworn obligation to the patients (The Hippocratic Oath), and joining together with patients to create some smart DOCTOR-PATIENT COOPERATIVES that will favorably compete with the junk that is avaiable out there. Patient needs are great and growing and the money is available, but we are stuck on trying to do things with the old models that don't work and waste too much money on profits, bandaids, categorical programs, low priority items, and bureaucracy. I figure we can reduce waste by 30 - 50% by eliminating the third parties ... the reason for a DOCTOR-PATIENT COOPERATIVE.
My position? It is better to try something new that might fail (or something more like the old thing that worked) than to give up. While most seem to be comforted by wringing their hands in misery, I saw at least three voices in this conversation that appear to echo my opinion. If those of us who agree can get together on this, we can take the next steps that are necessary to move from talk to action. Interested parties are welcome to contact me.
Dr. Mike
Michael F. Mascia, MD, MPH
dr.mike@ihealsolutions.com
This is my latest post (today) to the American College of Physician Executives discussion on why physician leaders are not leading healthcare reform.
Here you go ... Dr. Mike
PS. We need some patients to join us in this effort!
Dear Doctor H...:
I understand your point of view, but disagree with your conclusion(s). This is a crisis ... and CRISIS = OPPORTUNITY.
If we take advantage of this chaos, put our personal needs aside, stop bickering, put the patients first and develop a united front with the patients, we can drive this whole thing in the right direction.
Millions of $$$ have been put up for development of COOPERATIVE insurance models. We could take advantage of this opportunity by realigning ourselves with our sworn obligation to the patients (The Hippocratic Oath), and joining together with patients to create some smart DOCTOR-PATIENT COOPERATIVES that will favorably compete with the junk that is avaiable out there. Patient needs are great and growing and the money is available, but we are stuck on trying to do things with the old models that don't work and waste too much money on profits, bandaids, categorical programs, low priority items, and bureaucracy. I figure we can reduce waste by 30 - 50% by eliminating the third parties ... the reason for a DOCTOR-PATIENT COOPERATIVE.
My position? It is better to try something new that might fail (or something more like the old thing that worked) than to give up. While most seem to be comforted by wringing their hands in misery, I saw at least three voices in this conversation that appear to echo my opinion. If those of us who agree can get together on this, we can take the next steps that are necessary to move from talk to action. Interested parties are welcome to contact me.
Dr. Mike
Michael F. Mascia, MD, MPH
dr.mike@ihealsolutions.com
Saturday, August 6, 2011
Friday, August 5, 2011
MISSION: HEALING, August 5, 2011
LIFE IS LOVE (TM)
This is a fundamental guiding principle: LIFE IS LOVE(TM) Think about it.
Life without love is pretty much ... well, lifeless. In other words, love brings a dimension to life that is a quantum leap above survival. Don't get me wrong. I understand survival and striving to meet fundamental survival needs, but how much does that take. Human nature pretty much dictates our (animal) need to take care of ourselves first (selfish) but, face it ... how much do you really need ... REALLY NEED??? And, is that all you want for yourself and your kids? How much stuff do you need?
Maybe we can all spend a little more time striving to embellish those things that are special about human beings??? ... SPECIAL!!! Like, creativity, art, music, writing, listening to each other, playing ...
Sure, it is simple, idealistic and, perhaps unrealistic to think that grown people can live life by following this fundamental guiding principle, but not impossible. Sure, our lives are cluttered with all sorts of things that make it seem impossible ... but, it is entirely possible.
Sure, you say, there are all sorts of REASONS WHY "it can't work ... IT CAN"T BE DONE!!!" Well, if you are one of the folks who is saying "it can't be done", you are simply wrong. It can be done and this is one piece of how ... "IT CAN BE DONE!!!"
This is the start of a new series designed for children ... to help them understand the fundamental principle that LIFE IS LOVE(TM) and to help explain to them how to put that principle to work in their lives. Yes, "IT CAN BE DONE!" What is THE RIGHT THING to do and How to FIND AND DO THE RIGHT THING TO DO when there are so many options out there. While the guiding principle is fundamentally Love, the goals of this series include, but are not limited to individual health, public health, community health, world health & safety.
This is, in essence, a Set of Children's First Steps on the path to STEP WISELY(R) on the way to health ... as you are learning and growing your way through this world ... to know that LIFE IS LOVE(TM)
Ciao for now,
Dr. Mike
This is a fundamental guiding principle: LIFE IS LOVE(TM) Think about it.
Life without love is pretty much ... well, lifeless. In other words, love brings a dimension to life that is a quantum leap above survival. Don't get me wrong. I understand survival and striving to meet fundamental survival needs, but how much does that take. Human nature pretty much dictates our (animal) need to take care of ourselves first (selfish) but, face it ... how much do you really need ... REALLY NEED??? And, is that all you want for yourself and your kids? How much stuff do you need?
Maybe we can all spend a little more time striving to embellish those things that are special about human beings??? ... SPECIAL!!! Like, creativity, art, music, writing, listening to each other, playing ...
Sure, it is simple, idealistic and, perhaps unrealistic to think that grown people can live life by following this fundamental guiding principle, but not impossible. Sure, our lives are cluttered with all sorts of things that make it seem impossible ... but, it is entirely possible.
Sure, you say, there are all sorts of REASONS WHY "it can't work ... IT CAN"T BE DONE!!!" Well, if you are one of the folks who is saying "it can't be done", you are simply wrong. It can be done and this is one piece of how ... "IT CAN BE DONE!!!"
This is the start of a new series designed for children ... to help them understand the fundamental principle that LIFE IS LOVE(TM) and to help explain to them how to put that principle to work in their lives. Yes, "IT CAN BE DONE!" What is THE RIGHT THING to do and How to FIND AND DO THE RIGHT THING TO DO when there are so many options out there. While the guiding principle is fundamentally Love, the goals of this series include, but are not limited to individual health, public health, community health, world health & safety.
This is, in essence, a Set of Children's First Steps on the path to STEP WISELY(R) on the way to health ... as you are learning and growing your way through this world ... to know that LIFE IS LOVE(TM)
Ciao for now,
Dr. Mike
Thursday, August 4, 2011
Mission: Healing August 4, 2011
PGY 39, Day #35
The Business of Medicine: Follow the money
Health Information Technology: Top Ten Problems
A few days ago, I promised a Blog on the Top Ten HIT problems. Of course, this is just my opinion ... based upon more than 40 years experience in patient care, teaching, administration and research. That is ... experience in a cross spectrum of patient care from primary care to tertiary care and quaternary care ... from primary prevention to treatment ... from home to hospital ... treatment of some of the sickest patients in the nation. Granted, my experience is limited to the East coast. I have not worked west of New Orleans, but, I don't think patients are much different west of the Mississippi. When I started in Medicine around 40 years ago, there was NO technology available to help develop HIT systems. Now, we have all the necessary technology, but Mission: Healing is lost in the race for $$$ by the HIT providers. Ah, yes, greed again. I suggest that the Non Profit Doctor-Patient Cooperative could take this on as one of its tasks.
In any case, this is the way I see the TOP 10 Health Information Technology PROBLEMS today.
Report Card: Overall Score 2/10
1. Interphase: Too Cumbersome and too much time is used interacting with computers.
These machines should make it easier for us to spend more time with and take better care of patients. But, in fact, they interfere with patient care. They take precious time away from patient care activities. In other words, they add non patient care tasks to our daily activities ... far in excess of paper charting. According to my observations and estimates, 25% to 50% of provider time is tied up interacting with the EMR. That's not good.
These Systems should have to pass a risk/benefit test ... like all our drugs and procedures, before they are allowed to enter the Healthcare arena. HIT Providers charge outrageous prices, because they can ... and because they promise to improve reimbursement ... under the guise of better care.
Let's look at cost benefit and design systems to IMPROVE PATIENT CARE FIRST! Improve Quality First! And, while you are at it, prove that you are improving quality. A "from scratch" system would be in order ... without proprietary restrictions.
2. Data Entry: Too Cumbersome
Related to #1 above, but separate, the data entry points should duplicate our clinical flow sheets that have been developed over the last 50 years! Jumping around from place to place for the ease of developers is neither necessary nor acceptable.
3. Data Shareing: Too Cumbersome because proprietary systems don't talk to each other.
We can't add data from outside sources (EG images) very easily, if at all, and, no matter where the data comes from, it is difficult to find, or access some of it.
A Health Information Exchange Network (Health Internet) needs to be established ... preferably by the government. Similar to banking, private HEALTH INFORMATION BANKS kept in Doctors' offices and Hospitals, need to "store" the data, like banks store your money. And, in addition, each patient would have their data and data could be shared among patients and providers with permission ... over the secure Health Internet.
4. Security: Inadequate & related to #3 above
The health record belongs to the patient, so it should be given to the patient in electronic format and shared only via secure Health Internet & and between patient and providers.
5. Ease of USE: Non existent
Outlined above. Some combination of touch screen and voice activated data entry would work best, given today's technology.
6. Time dedicated to machine: Excessive
Outlined above
7. Redundancy: Inadequate In other words, when the power goes out, or the system goes out, the data is not accessible. A flow sheet summary should be printed on a regular basis one for the patient and one for the provider. This was a major problem during Katrina. We had critically ill patients with no patient information.
8. Reliability: Inadequate
Thses systems go down all the time ... for one thing or another. Automatic printing of flow sheets on a scheduled basis (depending upon severity of illness) is necessary and lacking, as outlined above in #7.
9. Comprehensiveness: Inadequate
These systems should be designed for patient care, administration, teaching and research. I will expand on these topics over time.
10. Flexibility: Minimal
The IT people have these systems locked up. (I believe that the EHRGuy was referring to this. Perhaps he will comment on my blog, once I publish it.) They should be simple enough to enable users (admistrative users) to make changes that will make them more specific to particular front line use anywhere in the world.
The Business of Medicine: Follow the money
Health Information Technology: Top Ten Problems
A few days ago, I promised a Blog on the Top Ten HIT problems. Of course, this is just my opinion ... based upon more than 40 years experience in patient care, teaching, administration and research. That is ... experience in a cross spectrum of patient care from primary care to tertiary care and quaternary care ... from primary prevention to treatment ... from home to hospital ... treatment of some of the sickest patients in the nation. Granted, my experience is limited to the East coast. I have not worked west of New Orleans, but, I don't think patients are much different west of the Mississippi. When I started in Medicine around 40 years ago, there was NO technology available to help develop HIT systems. Now, we have all the necessary technology, but Mission: Healing is lost in the race for $$$ by the HIT providers. Ah, yes, greed again. I suggest that the Non Profit Doctor-Patient Cooperative could take this on as one of its tasks.
In any case, this is the way I see the TOP 10 Health Information Technology PROBLEMS today.
Report Card: Overall Score 2/10
1. Interphase: Too Cumbersome and too much time is used interacting with computers.
These machines should make it easier for us to spend more time with and take better care of patients. But, in fact, they interfere with patient care. They take precious time away from patient care activities. In other words, they add non patient care tasks to our daily activities ... far in excess of paper charting. According to my observations and estimates, 25% to 50% of provider time is tied up interacting with the EMR. That's not good.
These Systems should have to pass a risk/benefit test ... like all our drugs and procedures, before they are allowed to enter the Healthcare arena. HIT Providers charge outrageous prices, because they can ... and because they promise to improve reimbursement ... under the guise of better care.
Let's look at cost benefit and design systems to IMPROVE PATIENT CARE FIRST! Improve Quality First! And, while you are at it, prove that you are improving quality. A "from scratch" system would be in order ... without proprietary restrictions.
2. Data Entry: Too Cumbersome
Related to #1 above, but separate, the data entry points should duplicate our clinical flow sheets that have been developed over the last 50 years! Jumping around from place to place for the ease of developers is neither necessary nor acceptable.
3. Data Shareing: Too Cumbersome because proprietary systems don't talk to each other.
We can't add data from outside sources (EG images) very easily, if at all, and, no matter where the data comes from, it is difficult to find, or access some of it.
A Health Information Exchange Network (Health Internet) needs to be established ... preferably by the government. Similar to banking, private HEALTH INFORMATION BANKS kept in Doctors' offices and Hospitals, need to "store" the data, like banks store your money. And, in addition, each patient would have their data and data could be shared among patients and providers with permission ... over the secure Health Internet.
4. Security: Inadequate & related to #3 above
The health record belongs to the patient, so it should be given to the patient in electronic format and shared only via secure Health Internet & and between patient and providers.
5. Ease of USE: Non existent
Outlined above. Some combination of touch screen and voice activated data entry would work best, given today's technology.
6. Time dedicated to machine: Excessive
Outlined above
7. Redundancy: Inadequate In other words, when the power goes out, or the system goes out, the data is not accessible. A flow sheet summary should be printed on a regular basis one for the patient and one for the provider. This was a major problem during Katrina. We had critically ill patients with no patient information.
8. Reliability: Inadequate
Thses systems go down all the time ... for one thing or another. Automatic printing of flow sheets on a scheduled basis (depending upon severity of illness) is necessary and lacking, as outlined above in #7.
9. Comprehensiveness: Inadequate
These systems should be designed for patient care, administration, teaching and research. I will expand on these topics over time.
10. Flexibility: Minimal
The IT people have these systems locked up. (I believe that the EHRGuy was referring to this. Perhaps he will comment on my blog, once I publish it.) They should be simple enough to enable users (admistrative users) to make changes that will make them more specific to particular front line use anywhere in the world.
Monday, August 1, 2011
Mission: Healing August 1. 2011
PGY 39, Day 32
It has been a brutal week ... lots of casualties. We had a few hours of down time yesterday afternoon, before last night's "bolus" of new trauma patients. I always tell folks to enjoy the down time, because it never lasts long ... always more patients out there. The need is great.
Most are very sad stories for patients and their loved ones. They are truly casualties ... many victims of self abuse ... drugs, alcohol, lifestyles that breed pathology, momentary stupidity and bad decisions. And there are the many "innocent bystanders" who are victims of the fall out from the bad behavior. So sad, but, no time for emotional and big picture considerations during the heat of the moment. But it does take its toll for the patients, the families and the providers ... forever. We are all changed forever.
My focus on defining, treating the precise and most important targets of care is intense ... undivided attention must be given to the patients and their problems to enable precision, timely intervention where seconds and minutes can mean the difference between life, loss of limb, organ damage, or death. That is Critical Care.
Between driving inexperienced people in the right direction, keeping them focused on the key targets, engaging families, avoiding distractions and sleep deprivation, by the end of my week I am all used up.
This is my recovery time ... my time to sleep, decompress and to think about the emotional impact on me & larger picture ... problems and solutions. Always thinking about ways that we can make it better for the patients and the proviers ... the many people who need our services. Healing is a labor of love.
Ciao for now,
Dr. Mike
It has been a brutal week ... lots of casualties. We had a few hours of down time yesterday afternoon, before last night's "bolus" of new trauma patients. I always tell folks to enjoy the down time, because it never lasts long ... always more patients out there. The need is great.
Most are very sad stories for patients and their loved ones. They are truly casualties ... many victims of self abuse ... drugs, alcohol, lifestyles that breed pathology, momentary stupidity and bad decisions. And there are the many "innocent bystanders" who are victims of the fall out from the bad behavior. So sad, but, no time for emotional and big picture considerations during the heat of the moment. But it does take its toll for the patients, the families and the providers ... forever. We are all changed forever.
My focus on defining, treating the precise and most important targets of care is intense ... undivided attention must be given to the patients and their problems to enable precision, timely intervention where seconds and minutes can mean the difference between life, loss of limb, organ damage, or death. That is Critical Care.
Between driving inexperienced people in the right direction, keeping them focused on the key targets, engaging families, avoiding distractions and sleep deprivation, by the end of my week I am all used up.
This is my recovery time ... my time to sleep, decompress and to think about the emotional impact on me & larger picture ... problems and solutions. Always thinking about ways that we can make it better for the patients and the proviers ... the many people who need our services. Healing is a labor of love.
Ciao for now,
Dr. Mike
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