Quality

Danielle Scheurer, MD: Hospital Providers Put Premium on Keeping Themselves, Hospital Patients Safe


 

Hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be?

It’s great to be a Tennessee Volunteer. I said, It’s great to be a Tennessee Volunteer!

The crowd, a sea of orange, packs into Neyland Stadium in Knoxville, Tenn., brimming with pride, dedicated to the team they call the Vols. Neyland Stadium, built in 1921, comfortably seats more than 100,000 brash fans on most fall weekends during the college football season. These die-hard fans pack the stadium regularly, hoping to catch a glimpse of victory.

Throughout the decades of Tennessee Volunteers football, numerous coaches have spent countless hours thinking about how to realize those victories. And they have also spent a lot time thinking about how to keep their players safe. Each coach has had different styles and tactics, but all had one thing in common: They were clearly invested in keeping their players safe. A safe player is a good player, one who can make the full season without injury. As such, before each practice and each game, the players don the gear required to play the safest game possible.

This gear is expensive, difficult to put on, difficult to keep on, makes them run slower, and makes them sweat heavier. When you think about it, it is a wonder that they wear it at all—unless you consider the fact that each precisely placed article takes them one step closer to surviving the game intact, and making it to the next victory. Just like any other type of protective equipment, football equipment has evolved over the course of time. The helmet, for example, is now custom-fit for each player with calipers, and then subsequent additions are applied to ensure durability, shock resistance, and comfort. Relatively new additions include eye shields (to protect the eyes and reduce glare) and even radio devices (to allow the coach to relay last-minute critical information to the quarterback). These helmets are all customized to the players’ position, to allow for the best balance between protection and visibility.

And the helmet is just the beginning. The remaining bare minimum amount of gear needed for standard player safety includes a mouthpiece, jaw pads, neck roll, shoulder pads, shock pads, rib pads, hip pads, knee pads, and cleats. All told, the weight of all this equipment is between 10 and 25 pounds and takes up to an hour to fully gear up. But nonetheless, it has become such a mainstay, of centralized importance to the game, that each team has a dedicated equipment manager. They are charged with providing, maintaining, and transporting the best gear for every member of the team. The equipment manager is a vital resource for the team and the sport.

Despite the extra weight and inconvenience that their gear can burden them with, you don’t see a single football player “skimp” on it. And it would certainly be obvious to all those around them if they ran onto the field without their helmet. Over the years, the football industry has not abandoned gear that they thought was less than perfect, too heavy, too bulky, or made the player perform with less agility. They just made the gear better, lighter, more comfortable, and more protective.

You Can Do This

In a similar fashion, hospital providers have become increasingly interested in keeping themselves—and the patient—safe. But have we come to consensus on who the coach and equipment managers should be, and what the essential elements of the gear should be? I would argue there are a number of coaches and equipment managers in the hospital setting whose mission is to keep their “players” safe. The players are both patients and providers, as generally a “safe provider” is one who makes and implements solid decisions, and who is housed within a safe, predictable, and highly-reliable system, is also one who can and will keep their patients safe.

We may not think of ourselves as such, but hospitalists can be extremely effective coaches and equipment managers. They can help create and maintain safe and effective gear for themselves and those patients and providers around them. They can be a mentor for displaying how vitally import this gear is and can work to improve it when it proves to be imperfect.

Although we don’t tend to think of these things as “safety gear,” these things do, in fact, keep us and our patients safe. Some of these include:

  • Computerized physician order entry (CPOE) with decision support (or order sets without CPOE);
  • Checklists;
  • Procedural time-outs;
  • Protocols;
  • Medication dosing guidelines;
  • Handheld devices (for quick lookup of medication doses, side effects, predictive scoring systems, medical calculators, etc.); and
  • Gowns and gloves.

Additional “gear” for the patients can include:

  • Arm bands for identification and medication scanning;
  • Telemetry;
  • Bed alarms;
  • IV pumps with guard rails around dosing;
  • Antibiotic impregnated central lines; and
  • Early mobilization protocols.

The Next Level

To take the medical industry to the next level of safe reliability, we need all providers to accept and embrace the concept of “safety gear” for themselves and for their patients. We need to make it perfectly obvious when that gear is missing. It should invoke a reaction of ghastly fear when we witness anyone (provider, patient, or family) skimping on their gear: removing an armband for convenience, bypassing a smart pump, or skipping decision support in CPOE. And for the current gear that is imperfect, slows us down, beeps too often, or reduces our agility, the solution should include improving the gear, not ignoring it or discounting its importance.

So before you go to work today (every day?), think about what you need to keep yourself and your patients safe. And get your gear on.


Dr. Scheurer is a hospitalist and chief quality officer at the Medical University of South Carolina in Charleston. She is physician editor of The Hospitalist. Email her at scheured@musc.edu.

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