12 September 2008

Training

We got new monitors in the ER. They are nifty, gee-whiz gadgets that have more functionality and better monitoring capacity. They are multi-colored, five-lead, omni-capable devices that can monitor heart rate, rhythm, respiratory rate, oxygen saturation, temperature, exhaled carbon dioxide, mixed venous oxygen and the stock price of Google, all in real time. And they go "Bing!"

The nurses got trained exhaustively by the company representatives, with special required meetings and classes to learn all the knobology and features and functions. They had to pass a little test at the end, and it was all very well done and now we have spiffy new monitors, Hooray!

Of coure, the docs did not get trained. We never do on any of the new toys. Most of us didn't even know that new montors were coming; we just noticed one day that the tone of the "Bing!" was different than before. At the department meeting, after the monitors had been in place a few weeks, there was a very brief introduction for the docs which basically consisted of how to turn the machines off and how to silence the alarm. (Bing!)

This seems typical of how physicians are introduced to new technology in the hospital. While the nurses, techs, and other (hospital employee) personnel are carefully and seriously trained how to use the new gadgets, the doctors are just somehow assumed to have this awesome brainpower that we can pick it up and go to town with it. And frankly, that's how we ususally do it. New intubating scopes? Fiberoptics cameras? Minimally invasive tube thoracostomies? Just figure it out at the bedside. Hopefully, a nurse will be there to show you how to turn it on, and which end to hold.

It's like in residency, the teaching mantra was "See one, Do one, Teach one." Only we omit the "see one" and proceed straight to "Do one."

Do I exaggerate? Yes. A bit. Do I have a solution? Not really. Our docs, I think, are not unlike other physicians in that there are many many demands on our attention and limited time and limited capacity to receive incoming information. We have one marathon 6 hour meeting a month, where usually 40-60% of our docs can attend: should we spend the on the new CMS core measures, or the new CHF pathway we have developed, or the process changes for lab results, (etc etc etc), or the new monitors? That's in addition to the risk management and QA we do, the finance management, HR and scheduling, and maybe a little time for CME if you can swing it.

Try to tack all that on top of a full-time job with rotating shifts. Something's gotta give, and training seems to be the one we can get away with most easily.

The funny thing is that we do seem to get away with it. My group has seen over a million patients in the time I've been here, and we haven't had an adverse event due to misuse of a medical device by a physician. I think that's due to the low numbers bias. The aviation industry (and the cult of six sigma) view the error rate in terms of errors per million, and of that million patients we have seen, only a small fraction have been subject to use of a medical device, whether it's a suture kit, or laryngoscope or a defibrillator. So the "n" for the patients at risk is low enough that statistically we shouldn't expect to see an error yet, and when we do the error rate will be several logs worse than six sigma.

As a counterbalance to that depressing post, I offer you this guilty pleasure:

5 comments:

PharmacistMike said...

I am sure it is different in the Northwest than it is in south Florida. However, down here only about 1% of the physicians would even be interested in any training. There are probably about 10% of the physicians that won't even go into a patients room when they round and if they do enter the room they never get close enough to touch the patient.

I commend you for taking a deep interest and wanting to learn. I wish we had more physicians like you in south Florida.

RevMedic said...

Did you get the most expensive monitor, in case the administrator comes?
Wonderful what we can do nowdays...

Anonymous said...

about half the time we get new technology, it just shows up. Nobody ever seems to know where it came from, how to calibrate it, or where the on-switch is.

Rachel said...

Great video, very funny (I think the humor is enhanced by the British accents).

Apparently it must be very important that all new equipment be able to go "bing!" or it is totally worthless.

lmao.

make mine trauma said...

I especially like the "cutting" of the umbilical cord.