Tuesday, August 20, 2013

Follow-up (lessons learned)

The June 9th, 2013 blog entry, 'The right lesson?', took issue with some of Atul Gawande's musings in the wake of the Boston marathon bombing, especially his contention that the hospitals there were "ready." This blogger noted that : "... although the medical response was a success, clearly the emergency response systems of the various Boston hospitals were found to be wanting...  Some work is clearly needed there to ensure that they are more responsive and will work in any future emergencies."

Now, with the passage of time and further reflection a realization has been made that not all went quite so smoothly - "The day’s utter chaos made missteps inevitable, but in the months since, the hospitals have found lessons to be learned from the moments of confusion and occasional miscommunication...  In particular, the bombings brought forward a problem that has vexed trauma hospitals for years: the identification of victims." As exemplified by an unfortunate case where the family of a deceased victim was told that she was alive and in the hospital...

However, lessons are being drawn and preparations made to do better the next time there is an emergency - "... The trauma centers are developing strategies to more accurately identify patients and reunite them with families faster...   the city is working with hospitals to standardize the reporting of patient identities to a central office that works to reunite victims with families. Hospitals did not all provide the same information and some lagged in reporting on April 15th..."

This blogger also observed that sometimes an element of luck is involved, and that processes need to be made robust for the occasions when this is not the case - "OK, so  one really can't complain about success and things were done extraordinarily well resulting in the optimum outcome... as is very often the case in healthcare.  From Katrina to Sandy, and many incidents before, in-between and after, extraordinary efforts by ordinary (and extraordinary) people have often 'saved the day.' However, it is a realization that this has usually been the case (i.e. a reliance on extraordinary efforts plus often a good measure of luck) rather than planning, processes, and systems that has led to the adoption of systems and processes to respond to emergencies."

Apparently this was the case in Boston. However this has been recognized and s being taken into consideration while looking to improve the system - "Trauma doctors said Boston was fortunate that the bombs exploded at an event where dozens of medical and public safety personnel already were stationed, and at an hour when shifts changed at the hospitals, nearly doubling the number of medical staff on site. But next time might be different, said Walls, of the Brigham. “We are analyzing every step now,” he said, “and trying to eliminate the element of luck.’’

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