Kids can do it! Paediatrics leading the way in documenting critical information

Chicago airport 19:00. The flight back to Manchester is delayed by an hour. And then another one. And then three more. Reason: the plane is unwell. In fact it is being changed. Thankfully we are not taking chances with the safety of the equipment.

Dana Edelson and team have hosted a fantastic 13th International conference of Rapid Response Systems (https://isrrs2017-sites.uchicago.edu/) with patient safety experts from Australia, the Netherlands, Denmark, Finnland, the US, New Zealand, the UK, Ireland, Korea etc etc And the global challenges are remarkably uniform: the enthusiasts can see where the problems are, intelligent processes and tools are in place … but culture eats strategy for breakfast.

There were a few real high lights:

Helen Haskell was one of the key note speakers. Helen lost her son at a young age due to medical error. She is president of ‘Mothers for patient safety’ and a world leading campaigner and expert for patient safety. Helen is lists the traps that are catastrophes for patients:

  • false reassurances,
  • bureaucratic thinking,
  • groupthink in the health care team,
  • not being listened to,
  • psychiatric labelling,
  • the label of being a disruptive family.

And stereotypes are plain lethal as they lead healthcare professionals to abandon critical thinking: there is not such things as a ‘healthy child’, ‘anxious mother’, ‘minor procedure’, ‘routine monitoring’, ‘ethnic minority patient’, ‘terminal patient’, ‘overweight patient’ or ‘elderly man’.

Helen also suggests a number of concepts solutions: She believes that continuous monitoring would improve the fate of many patients. Patient could own their own monitoring devices. They will need access to health care records and records should allow interaction.

In the afternoon we are hearing from Patrick Brady what these solutions might look like. Patrick is a paediatric hospitalist and patient safety researcher from Cincinnati Children’s Hospital.  His group is trying to better understand what makes patients tick: what do they feel about their care and how do they want to get involved? From the literature it is pretty clear that those who know our patients hold really important information: Where families are empowered to call for help if they are concerned about their child they can add to safety. In a review of published evidence by Fenella Gill (https://www.ncbi.nlm.nih.gov/pubmed/27258792) three of these children were even admitted to Intensive Care. Intuition matters. If a clinician feels that a child is ‘just not right’, then the risk of serious illness is …. Now hold on and listen to this, the risk of serious infection is twenty five (25!!) higher (Ann van den Bruel http://www.bmj.com/content/bmj/345/bmj.e6144.full.pdf). The same is almost certainly true for those who know the patient even better.

From the conversations that Patrick and his team have had with their young patients and their parents we are learning some important home truth: Patients are confident that they often understand what is normal for their child better than their healthcare team. After all they are with their child 24/7 whereas nurses might only spend an hour per day with the little patient (and doctors even less). They are competent to monitor! On the other hand side families are struggling to convey their intuition to the professional health care team. In a sense they are competing with the expertise of the medical expert. Not always a comfortable situation – for either side.

From their learning the team in Cincinnati is now devising interventions that allow families to access key safety information about the little patients and to get actively involved in setting goals of care. Impressive and encouraging work.

But how long will it take for systems to grow up from children to adult medicine? Are paediatricians more patient centric and it that is the case why?

 

 

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