The answer is likely not right or wrong. This is the conundrum of patient safety. It is multifaceted. Fixing one thing in isolation may do little. In addition, "fixing" may actually make things worse because of the unintended consequences of the fix.
There are several areas that are great examples of this: duty hours rules and the electronic health record (EHR).
First, a little more on the complexity of patient safety. If it was easy, there wouldn't be a problem. There wouldn't be a Quality Chasm to cross.
One of the better visual schema on medical errors is the Swiss cheese model. This was formulated in England by James Reason. The logic is that we have many fail safes in medicine to keep errors from occurring. Each process is like a slice of Swiss cheese - each has many holes. When the processes are put together - like a block of Swiss cheese - the holes do not line up and all is well. But, every now and then, the holes line up and bad things happen.
Near misses? The hole went almost all the way through, but one or more slices saved the day - maybe a timeout in surgery or a second nurse double checking the label on a bag of blood.
Think of trainees cognitive ability like a slice of Swiss cheese. Pretty solid, but some holes. The duty hours changes made the holes that represented sleepy, cognitively impaired trainees smaller. But they still make mistakes (holes).
The changes opened up big holes on other slices, namely situational awareness. This lack of situational awareness happened because there was a hand-off. This hand-off is generally poorly done. This was an unintended consequence. This is why the changes didn't improve patient safety.
We need to do a better job teaching and standardizing hand-offs!
We can do this - check out several publications and presentations by Vineet Arora. You can also check out her blog. In one recent publication she and colleagues showed that pediatrics interns only handed-off topics well 2/3 of the time - at best. It was about a third for knowledge items. In spite of this, they generally thought they were doing well.
The electronic health record is another mystifier. Again, it seems to make perfect sense that having a legible record that is readily available, and can offer some decision support, should make care safer. But...we all know that there are many unintended consequences. These are so numerous, that we have a taxonomy of EHR unintended consequences.
The EHR has also stifled consultant verbal communication. Why talk, it is in the chart?!?
Finally, the EHR has given us the millennial version of medical cheating: CoPaGA - Copy and Paste Gone Amok. This entails plagiarism of others notes and confirmation bias when erroneous information is carried forward without thought.
Are the holes winning?? It is a neck and neck race from my seat.
So, to bring this back around to osteopathic graduate medical education, it is our job as medical educators to keep the holes from lining up!!
We need to teach hand-off communication, both written and verbal. It needs to be taught formally and tested formally (I see an OSCE in your future).
We also need to teach how to use the EHR and the new professionalism that goes along with this tool. This is not typing 101. It is how to study and implement effective process changes. Another need is professional communication and the roles of each member of the healthcare team.
The alternative is 1 + 1 will equal zero, or, the will be many holes lining up in our Swiss cheese.
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