Medical Malpractice Bulletin – July, 2016

Perspective: Bob Newhart or CRICO: Who can best reduce medical error?

By Charles A. Pilcher MD FACEP

July, 2016

If our goal is to reduce medical error and improve patient safety, which approach is better: Analyze “big data” or simply tell physicians to “Stop it!”

CRICO, the large Harvard based med mal insurer, believes in the former. However, comedian Bob Newhart, using the latter approach, may have the better answer.

A project done by CRICO in 2010-2011 found that mis-communication was a common element in med mal cases arising in the ED. They proposed several ways to improve that.

Bob Newhart, in the famous scene in which he plays a psychiatrist whose patient has a fear of “being buried alive in a box,” had a simpler solution: “Just stop it!”

The question is: Which approach works best? Read more here ->

[Editor’s Note: The articles highlighted below in this month’s issue of Medical Malpractice Bulletin all relate to lessons learned in healthcare from mass casualty incidents like the recent tragedy in Orlando. / CP]

Physician’s eye witness account of the chaos in the ED of the Orlando Regional Medical Center

This article from USA Today is a gripping story of what it was like to be on the front lines as dead and dying victims poured into the emergency department trauma center at ORMC the night of the shooting.

Nothing in trauma surgeon Michael Cheatham’s two decades in emergency rooms prepared him for the scene that greeted him as he walked into Orlando Regional Medical Center early on the recent Sunday. Dead victims lay on gurneys near the main entrance, another room overflowed with bleeding patients struggling to stay alive, doctors and nurses ran from one patient to the next, victims’ shoes and clothing were strewn across the floor, screams radiated through the hallways, chaos ensued. More ->

Gun violence as seen from the Critical Care Unit

For those victims lucky enough to survive, many end up in the CCU. No city in America has more experience with gun violence than Chicago. Here’s what it looks like from the perspective of a critical care physician, as told in the Chicago Tribune.

The critical care team making rounds — my team for today — stops abruptly in front of the next patient room, and I hear my co-resident present the story: The 18-year-old patient suffered a gunshot wound to the face. The circumstances of the shooting aren’t clear, but we heard it had something to do with “gang violence.” And we continue listening to the presentation: an update on any changes in the patient’s status that happened overnight, his vital signs over the past 24 hours, the input of different specialists, and, finally, the treatment plan for the day.  READ MORE

How hospitals are coping with mass shootings

Every hospital now must be prepared for the unthinkable. What might we have to do differently? This article from NPR details some of those learnings from Orlando and other mass shooting incidents.

Orlando Shootings Renew Attention To The Tourniquet As A Way Of Saving Lives.

Melissa Bailey, writing in STAT, describes the renewed importance of tourniquets in the treatment of  victims of mass shootings. The AMA has even adopted a new policy supporting their use, a major departure from standard care for the last 3-4 decades.

In the hospital or elsewhere: What if you yourself are caught in a mass shooting incident?

Dr. Howard Mell has an excellent article in ACEPNow on how hospitals and emergency departments can best prepare for an active shooter incident. And the City of Houston has produced a superb video entitled “Run! Hide! Fight!” on how to survive if you yourself are caught in a mass shooting incident. Even if you have seen it before, it is worth a second look, especially for those working in large offices in a potential target – like a law office doing work in medical malpractice.

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