The Drive Home
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Diagnostic error is a recent common buzzword in healthcare, catching the attention of healthcare providers, media and laypersons alike. We’ve all seen articles with conclusions or commentary such as:
“…we estimate 15,000-165,000 misdiagnosed cerebrovascular events annually in US ED’s…”1
“…diagnostic error is the leading cause of medical malpractice claims in the US, and is estimated to cause 40,000 – 80,000 deaths annually.”2
“…Americans' health is even worse than we thought, ranking below 16 other developed nations.”3
So it’s nice to see the recent press release from the U.S. Department of Health and Human Services (HHS) that revealed improvements in safety of care based predominantly on reductions in pharmaceutical errors, falls and infections. Since most patients begin their inpatient hospital visit in the ED we should be proud that we are a part of a reduction in hospital acquired conditions such as ventilator associated pneumonia, falls, pressure ulcers and venous thromboembolic complications, amongst others.
Good Standards Gone Wrong
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Today at your department meeting, a new program is announced. Called 'pull to full,' it is described as a best-practice proven to decrease door-to-doctor times and increase patient satisfaction scores. Your director made the point that this was not an optional program, but rather something administration expected to be implemented. No longer will you be sitting around all caught up while patients are sitting around in the waiting room. It will be better for the patients and better for you. It will be to the docs to 'encourage' the nurses to follow through.
QIPS TIPS Danger : Night Shift at Work
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At the State University of New York in Albany, recent research demonstrated that rats that were forced to be sleep deprived at night (analogous to night shift workers), aged more quickly, had a shorter lifespan and demonstrated more tumorigenesis than rats that were not sleep deprived. It has been suggested that humans working the night shift may have an increased risk of developing breast cancer and other cancers, though the research is contradictory and inconclusive. On the other hand, we do know that night shift does take a toll on its workers. A recent article in Chronobiology International showed that night shift workers had an increased odds ratio of being obese, having central obesity (suggesting endocrine dysfunction) and hypertension.
A third article published in 2010 in Euro J Epidem showed an increased risk for cardiovascular disease in night shift workers. Numerous studies over the years have shown a shortened life expectancy, an increased risk of diabetes, increased risk of anxiety and depression, eating disorders and sleep. Night shift workers eat fewer calories but consume more fat and sugar and often resort to fast food, caffeinated drinks and energy drinks. The long term consequences of this diet are only beginning to be studied. Suffice it to say that night shift work is hazardous to your health.