Thursday, May 20, 2010

Innovator's Prescription

Thanks to one of my mentors, I have been tasked to read The Innovator's Prescription by Christensen, Grossman and Hwang, and assigned to speak with one of the authors.  This book has a fantastic vision of where health care needs to move in order to improve by uncomingling business models and service lines that have nothing to do with one another.  As a caveat, I am only 5 chapters in.  I will get more out as I read more. 

Tuesday, May 4, 2010

Blood Culture effect

Stepped out of M&M (Morbidity and Mortality Conference) for a second to get this one out...
I am sure there is a better name for this in the quality/process improvement literature, but there is a strange phenomenon in medicine where we react all aggresively to the notification that blood cultures have turned positive.
To give you a little background- blood is taken from ill patients in whom we suspect infection, and grown on culture media (think buffet for bacteria).  In the next 12-36 hours, bacterial colonies will grow (if present in the blood) and become large enough for us to see, identify and test.  By the way folks, that's why blood cultures take so long to come back relative to other tests, the things have to grow.
Anyway, it is common practice to receive a call from the Micro lab that your patient's cultures are positive for something.  Upon getting this news, the typical thing to do is have a small moment of panic, then go check on the patient.  Now, think this one through.  The blood was taken 2 days ago.  They have been fine/stable/sick the entire time.  But now that we have received the information, we are all of a sudden worried.
I am unsure why this phenomenon exists, but it seems that alarm bells bother us because they are sometimes all we have to know that a system is malfunctioning---even though it has been doing so for the last two days!  Illogical, yes, but I also wonder how responsibility/liability comes in, because positive blood cultures tend to become a hot potato.

Back to M&M...


Not to start too many thoughts with... "I Can't believe it is 2010 and..." but I have to say, what a surreal weekend in the Boston area, with the basic concern of clean water taking up so much of our time.  Saturday morning, after a busy night shift, I spent a good 3 hours in the process of boiling, cooling, and filtering water, while attempt to locate bottled water in my neighborhood.  Feels strange in 2010.

The Joys of Working Nights

I love working nights, because it allows my brain to wander and in its fatigued state, think things like-- "Maybe it is so humid in Boston because everyone is boiling water."

Back to days, reality and accountability.... sigh