Mt Doc wins my esteem for the most important comment in some time. He finishes the comment with this paragraph:
In my humble opinion, the way to be safe is to allow people to be focused and not rushed. “Haste and error go hand in hand.” A system which prevents unnecessary interruptions, that assures adequate nursing staffing for the patient load, that gives doctors adequate time to reflect on their decisions rather than being forced to “shoot from the hip” because there are other tasks that are urgently pressing on the attention of the MD, would go a lot to improving safety. I am a fan of checklists – they help prevent errors when people are rushed and distracted. I am a proponent of EMR – our institution uses one, and while it prevents some medication errors it causes other problems. But I think this all misses the major problem. There is a reason that it is not permitted to interrupt a pilot doing a preflight checklist. There is a reason pilots only fly one plane at a time, and don’t have other duties to do while the plane is in the air. And there is a lot to be said for the KISS principle.
My frequent posts on quality often focus on the multidimensional aspects of quality. As internists we must work on diagnoses, bedside communication and manners, evidence based treatments, and treatments when evidence is inadequate. We must balance the patient and the diseases. Hippocrates once said, “It’s far more important to know what person the disease has than what disease the person has.”
This week’s posts on safety really only start the discussion. Some aspects of safety are easily measured, yet other errors occur infrequently. Many of these errors occur because physicians, nurses, pharmacists and others do not have time to do their jobs properly.
As Mt Doc reminds us, we waste too much time buffing the chart for billing purposes. We see patients too quickly because seeing patients quickly makes us more money.
We will not solve either the quality problem, nor the safety problem if we do not devote enough time to each patient and each decision. Inadvertently, Medicare started the ball rolling in the wrong direction. Our payment system has significant negative externalities. Our notes are lengthy, but rarely do they impart our understanding of the patient. We no longer write about our impressions and plans, but rather we document 10 point ROS and daily physical exams. Our notes and the time we spend on them are inadvertently hurting patients.
We cannot do our jobs properly unless we can devote adequate time. That rarely happens in 2010.
