I am a frequent reader of the Interventional News and most recently I read the issue distributed at the CIRSE congressin Lisbon a couple of week...
I am a frequent reader of the Interventional News and most recently I read the issue distributed at the CIRSE congressin Lisbon a couple of weeks ago. One of the articles that caught my attention was discussing the use of comprehensive checklists implemented per discipline and in this case targeting interventional radiology.
I am a frequent reader of the Interventional News and most recently I read the issue distributed at the CIRSE congress  in Lisbon a couple of weeks ago. One of the articles that caught my attention was discussing the use of comprehensive checklists implemented per discipline and in this case targeting interventional radiology.
Krijn P van Lienden, the publisher of the original article, highlights the challenges of new techniques, devices and technologies that are getting more advanced and complicated by the day. Checklists are a great way to avoid missing critical steps during procedures and are also a great tool for gaining knowledge from previous experience and aiding in the preparation of a procedure.
Quality of care and patient safety are on every hospital´s agenda but in combination, massive cost restrictions and a large amount of doctors in training to address the increasing demand for care. Due to this, the further increase of these issues is imminent. Already now, approximately 10% of all patients are exposed to some kind of adverse event and about 50% of these are related to invasive treatment.
One of the intentions with this blog entry, is to highlight the importance of more clearly separating the necessity of basic training during education from the requirement to expect structure and continuous training for the duration of an individual’s career. Mentice is heavily involved in training and education, and one of the biggest challenges we face is to assist hospitals and health providers to link continuous improvement to outcomes and productivity. We believe that linking the implementation of technologies such as endovascular simulation with daily use and productivity of a clinical unit will prove return of investment and drive improvement.
After reading the article, I watched an amazing TED presentation by Dr. Atul Gawande called “How do we heal medicine?”  Dr. Gawande highlights the incredible development we have experienced during the last century and contrasted the medical system to how it was during the pre-penicillin era. Doctors were looking for conditions that they could treat and with only a handful of cures. The hospital was viewed more as a warm roof over your head that provided food and caring nurses than a medical solution.
During the 70s, a medical team would consist of a nurse and a doctor and the patient would be visited once per day. Today all knowledge is specialized. Even primary care is a speciality. In most situations 10-15 specific specialists are required to complete one task. Dr. Gawande illustrates that our legacy defines a physician as the “self-sufficient daring cowboy” but in today´s environment we need “pit crews”. Such pit crews can only function if the system is based on humility, discipline and teamwork.
Checklists are routinely used in many other areas and the evidence from Dr. Gawande´s research involving 7 different hospital sites indicates positive outcome with double-digit % improvement and reduced number of complications and death. Still, adoption of checklists in the healthcare arena is extremely slow and we continue to depend on individual performances. Dr Gawande contrasted healthcare with the automotive industry; what if you decided to build a car based on the very best components available in the market; brakes from Porsche, engine from Ferrari, chassi from BMW and the body from Volvo? The result would be a combination of very expensive components with no guarantee that the outcome of a working car. Healthcare faces a very similar situation and the difficulty is the lack of focus on a working system.
Healthcare faces multiple issues and it is probably fair to state that there is not a single hospital or a government that does not argue about the cost of care. Dr. Gawande gives us comfort in knowing that it is not the most expensive care that produces the best result. The best care is provided by the units where the system is effective and is under constant improvement and scrutiny.
To date, medical simulation is seen mainly as a means to educate and train junior physicians. Combined with other techniques and technologies, such as checklists, simulation can serve as an invaluable tool to dry run and refine procedures and to process steps. Key individuals need to maintain and improve skills throughout their career and teams need to learn to act as a “pit crew”, just as Dr. Gawande was suggesting in his motivating speech on TED.
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