Safety Checklists in Healthcare- Use Them!

Here is a hot off the press article published in the Journal of Hospital Infection on the successful implementation of an infection prevention checklist. Nurse directed rounds with detailed infection prevention safety checklists were performed in operating rooms and hospital wards. By documenting adherence with infection prevention interventions, and by providing on-the-spot corrective education, a significant reduction in hospital acquired infections was observed.


For years, the science of infection prevention has studied and identified risk factors for hospital acquired in infections. The focus now, at least in part, is the implementation of risk reduction practices. Safety checklists serve to reinforce and ensure compliance with risk reduction interventions, making safety practices mandatory and not optional. Implementation science now provides empiric data that safety checklists work.


Important examples include:

• The central line checklist to reduce the rate of catheter associated bloodstream infections. To access this seminal paper, click here.
• The surgical safety checklist, to avoid errors and  minimize morbidity and mortality in surgical populations, as reported in the New England Journal of Medicine.

An engaging read on the use of checklists in medicine can be found in Atul Gawande's Checklist Manifesto.


Infection prevention and safety checklists work! Respect them. Use them.

Physician Grief and End of Life Care

Source: NY Times

I often struggle to understand why colleagues fail to address end of life issues or stop aggressive treatments and surgeries when palliative care would be a better course of action.  If one practices inpatient medicine, then end of life care is nearly inevitable.


This perspective, published in the NY Times, sheds light on the impact that death, dying and grief can have on a physician, and in turn on patient care. 


A paper published in the Archives of Internal Medicine qualitatively explored the nature and impact of grief on oncologists. In addition to sadness, crying, loss of sleep and feelings of shame, grief can impact the physician's patient management decisions. Feelings of guilt and failure motivated some oncologists to provide more aggressive care, even when such care was medically futile. Denial and disassociation motivated other oncologists to avoid end of life discussions with the patient and the family, distancing themselves further as the time of death neared. The potential impact on patient care in undeniable, and the study's authors call for physician education on grief and coping not only during training, but as continuing education throughout their careers.


Insightful.

Kate Pearson's Honduras Research Recognized in Alpha Omega Alpha (AOA)

VCU Medical Student Kate Pearson presenting her research

Kate Pearson's 2011 Honduras research is now posted in the prestigious Alpha Omega Alpha Honor Medical Society website.


The research has now been accepted for publication in the International Journal of Family Medicine. 


Stay tune for updates on the publication date.

Dodgy Antimalarials- Public Health Risk

It is bad enough that malaria afflicts millions of people in impoverished areas. Now we are informed that low quality, ineffective antimalarials are being manufactured and sold to resource poor countries.

Here is a disturbing report published in The Lancet Infectious Diseases highlighting the issue of substandard or just simply counterfeit antimalarials, many of them being manufactured in India or China.  The drugs were distributed in southeast Asia and sub-Saharan Africa. In southeast Asia, up to 36% of medications sampled were counterfeit.At present, no universal jurisdiction allows prosecution of international traders in falsified drugs. 


The fatal consequences of counterfeit antimalarials are described in this article from the Smithsonian. 


To quote the Lancet paper's authors, "Production and distribution of counterfeit antimalarials should be prosecuted as crimes against humanity."

Short Term Medical Relief Trips and Impact on Medical Students

VCU Internal Medicine 2011 Honduras Trip

Here is an article published in Academic Medicine on the effects of short-term, international service-learning trips on medical students.

The study cohort was small and consisted of thirteen 1st year medical students from the University of Michigan. By no means is this cohort representative of all medical student associated medical relief trips to developing countries. The findings, however, are intriguing.

Of the study participants, almost no students articulated issues such as social justice or disparities as motives for seeking international service-learning trips. Common expectations were acquisition of clinical skills and language competency. However, during a structured interview with formal reflection, an increased awareness of the complexities of global health delivery and the importance of partnership with local health authorities for sustainability and impact was evident. 


Albeit of limited duration, short term medical relief trips can increase medical student awareness of global health, health disparities and social justice, particularly if formal reflection is structured into the experience.


We have frequently been asked why our work in Honduras is valuable to us. The answer, in part, is found here.  


Short term medical relief trips are likely of greatest value for local communities when executed as a longitudinal, collaborative effort with local health authorities to meet the public health needs of a population. That is the focus of our Global Health and health Disparities Program.  

Probiotics and Antibiotic Associated Diarrhea

Lactobacillus species

Here is a clinical review article with meta-analysis in JAMA on the use of probiotics to prevent and treat antibiotic associated diarrhea.

The use of antibiotics can result in gastrointestinal upset and mild to severe diarrhea, including C.difficile.  Symptoms of diarrhea occur in as many as 30% of patients. There is mounting evidence that the use of probiotics (Lactobacillus species and Saccharomyces species) dosed concurrently with antibiotics may be beneficial in decreasing the the risk of antibiotic associated diarrhea by 30-50%. 


This seems promising however data is lacking to best determine which patient populations would benefit most from adjunct probiotic therapy. Not all people suffer from diarrhea when on antibitotics. 


When to 'pull the trigger' on probiotics remains an area of uncertainty and controversy. Until more data is available, perhaps probiotic therapy is best for patients requiring prolonged antibiotics (>2 weeks) who have a prior history of antibiotic associated diarrhea. 

Resident Workload and Patient Outcomes

Source: ENTToday

I am currently supervising a medical team at VCU Medical Center and am acutely aware of duty hour restrictions for residents (16 hour limit for interns) and resident workload (number of patients and number admissions per shift for an intern)


As with any intervention in medicine we should ask ourselves what evidence exists to support this? Here is a recent  review article published in the American Journal of Medicine. In brief, in a nationally representative sample of internal medicine programs, the investigators found no significant association between resident workload and patient outcomes for common inpatient diagnoses


I am not opposed to work hour and workload limitations and feel that they may lead to a more humane training experience for resident doctors. At present, however, no robust data exists to support that these measures results in safer care.


If only workload restrictions applied to attending physicians....