The practice of medicine is complex and work processes do not easily translate to the electronic models currently available. It is crucial that hospitalists, other specialists, all ancillary services, as well as administration be involved in the building and implementation of the systems to be used in our individual facilities. The systems and technology for effective CPOE in hospital settings—especially in pediatric settings—have yet to be developed. The implementation of CPOE for improved patient safety requires exploration given the exposed inadequacies of our current methods of practice.
Like any best practice this exploration will be continuous and require evaluation and improvement. While we must involve ourselves with the development and implementation of CPOE, we must not let the inadequacies of new systems negatively affect patient care. The dichotomy may be omnipresent: Use the system to gain protections from errors and bypass the system when its design or function interferes with good patient practice. This will require us to possess the wisdom to determine the correct path to follow in any instance.
Every day in our practice we make efforts to compensate for failures in our methods to prevent errors from affecting our patient’s care. Electronic systems do not excuse us from continued vigilance, communication, and action to protect our patients from medical errors. The authors appropriately state that “accurate evaluation of CPOE will require systems-based troubleshooting with well-funded, well-designed, multicenter studies that can adequately address these questions.”
Unfortunately, because of the proven inadequacies of the current system, CPOE, like other methodologies we use in the advancement of patient care, cannot wait for proof of perfection before being used to enhance the outcomes of our patients. Thus we need to be vigorous in our participation of the development and implementation of CPOE for our individual institutions and alert to the prevention of harm in all we do. Software companies cannot accomplish improvement in our practices without our involvement, and we cannot meet our demands for quality without good software companies.
The Link between Age and Orchiectomy Due to Testicular Torsion
Mansbach J, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med. 2005;159(12):1167-1171.
Testicular torsion is a urologic emergency that requires a four- to eight-hour window from presentation of symptoms until intervention in order to increase the potential for a viable testis. Steps to ensure a viable testis include timely presentation, rapid diagnosis, and curative intervention.
Chart review was done from a national database consisting of 984 hospitals in 22 states. The review included 436 patients ranging from one to 25 years. The incidence of torsion was 4.5 cases/100,000 male subjects with a peak at 10-19 years of age. Of the 436 subjects, 34% required orchiectomy. After all factors (race, insurance status, income, region, and hospital location) were evaluated, increased age at presentation was the only statistically significant factor associated orchiectomy. Male subjects were hesitant to seek medical attention for conditions associated with the genitals. Healthcare providers need to provide anticipatory guidance when educating males about testicular disorders. Testicular exam should be incorporated as part of every physical exam, especially if an abdominal complaint exists.
Heliox Aids Peds with Moderate to Severe Asthma
Kim K, Phrampus E, Venkataraman S, et al. Helium/oxygen-driven albuterol nebulization in the treatment of children with moderate to severe asthma exacerbations: A randomized controlled trial. Pediatrics. 2005;116(5):1127-1133.
Heliox is a 70%/30% helium/oxygen mixture. Heliox mixtures have a lower gas density than oxygen and, therefore, can increase pulmonary gas delivery. This study compared heliox versus oxygen delivery of continuous albuterol nebulization for patients with asthma treated in the emergency department.