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lzipperer

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About lzipperer

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    Lorri
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    zipperer
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    Patient safety and knowledge sharing entrepreneur that helps experts "get things done!"
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    Zipperer Project Management
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  1. Content Article Comment
    Thank you @Helen and to all hub members for their continued contributions to the work of improving patient safety!
  2. Content Article
    I had been trying to get my Mom to do video calls on her computer for a decade. Pushback and inexperience with new technologies just didn’t give her the confidence she needed to step over that line. A lack of trust in the systems to work right and in her ability to navigate the hiccups minimised her willingness to give it a shot. And then along came covid. Due to necessity and front-line assistance (my sister and niece get a hat tip here), Mom finally began to see how beneficial the tools were for improving her state of mind and increasing our awareness of how she is from a long distance during the lockdown. There also has been hesitancy in healthcare to fully embrace communication technologies that can optimise and energise processes. Uncertainty and optimism are certainly warranted in the use of electronic mobile connections in healthcare and the devices that support it. These new approaches touch facets of training, appointments, personal health monitoring and overall system reliability. Beyond the changes necessitated by the pandemic, the need to embrace new technologies in healthcare is now essential and will be for the future despite expected challenges to universal adoption. The covid pandemic has motivated healthcare to broaden its vision of the potential for remote technologies. Now telemedicine, telehealth, telecoaching, digital therapeutics and mobile patient outreach has become absolutely necessary. They are here to stay. Changes in reimbursement policies have provided coverage for telehealth services that, before the pandemic, was much more restrictive. While patients and physicians may appreciate the convenience of this “new normal”, there are quandaries associated with its uptake. At a time when relationships are so vital to our lives, having technology to either build them (granted in a new way), inform them (via a new set of communication tools) or damage them (dependent on the willingness, system robustness and comfort of the individuals involved) is worth considering. For example, worries about diagnostic accuracy, limitations of the virtual physical exam, concerns about privacy, usability and the loss of the person-focus of patient/physician communication. The effectiveness of telemedicine and telehealth is also impacted by health literacy, access to reliable networks and patient comfort with using digital tools. Physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients. On another level, Dissent Magazine discusses a range of economic concerns stemming from the accelerated adoption of telehealth, including the primary worry that services have the potential to be structured as profit centres shifting the focus of decisions toward stakeholder and executive compensation rather than effective care. Then there are questions surrounding the apps and tools patients are using to make decisions about their health. Dr. Google has known weaknesses. Patient-facing diagnostic apps, wearables and symptom trackers, while showing promise still require appropriate risk evaluation before patients should fully trust them to track and manage their health without clinician guidance, and protect against worry and overuse of health services. The Skeptical Cardiologist shares reasons to resist the temptation to rely on, for example, the blood oxygen monitoring accuracy of a much anticipated product for reasons that include lack of reference to primary data and cost. Use of symptom trackers could proliferate as patients remain hesitant to visit physicians due to covid concerns. One project from Georgetown University was forthcoming about its rapid development strategy when sharing the results of a covid symptom tracker pilot test. Areas covered included size of the beta test (48 students), use of unique identifiers to address privacy concerns for both patients and organisations involved, access to condition-relevant patient-centered educational information and instructions to seek medical care should symptoms indicate that necessary step. It is this sort of transparency that aids the healthcare community and patients to appropriately select and trust tools to manage symptoms and situations for public and personal health safety. Voice activation technologies, so convenient for getting the latest news and listening to music, are seen as having great potential in healthcare monitoring as well. Voice characteristics are being explored as a diagnostic indicator. As covered recently in Nature, vocal biomarkers can track mental status, pulmonary function and coronary distress. But a myriad of factors could affect verbal characteristics reducing voice as a reliable mechanism for diagnosis. While promising, teasing out these differences in vocal diagnostics is still an emerging opportunity being explored in the US and around the world. Also, the use of voice-activated technologies in certain care settings can impact the privacy of the patient and may therefore not be suitable. On a systemic scale, the growing dependance on technologies leave patients, clinicians and organisations vulnerable to purposeful or accidental incidents or outtages, such as cyberattacks, that create disruptions and compromise patient safety. Recently a large health system in the US was crippled due to a ransomware attack. Patients needed to be rapidly moved to another out of system facility to ensure their safety. Experts caution that this is not the last of these situations and advise systems to train their staff and create awareness to recognise the early signals of a cyberattack to quickly reduce the extent of the damage and corresponding interruptions to healthcare services. Mom is now expanding her use of technology to make life better. She is exploring her first streaming service and becoming comfortable with its capabilities to binge on popular programmes. Who knows if that will lead the way to virtual visits with her cardiologist, or being able to track her vital signs from across the country and her personal use of a smart watch to monitor her heart? Let’s hope for all moms and other patients the adoption of technologies in the health space can be folded into our daily lives with minimal harm and negative disruption.
  3. Content Article
    Meredith Wilson’s “The Music Man” is an American musical set in 1900’s River City Iowa. First seen on Broadway and then as a 1960s film, the story rests on hope that arrives in town on the shoulders of a con man, Harold Hill. There are lots of themes we could track from this story into our times today – but one scene in particular is on point for this month’s letter. Hill distributes music and instruments to his students with instructions to practice on their own and they come together to play for the town. Let’s just say it doesn’t go so well. Although committed to the goal, the kids can’t play the music without solid instruction, synchronised development, collective practice and effective leadership. A band needs to follow the same score of the same tune in order to MAKE music that works. The COVID response in the US seems to have put patients, the public and clinicians in a situation similar to that of the River City kids. States, schools and cities seem to be playing from different arrangements of the same tune resulting in a lack of coordination and consistency across the country. The result is not just noise but profound failure. Ed Yong in The Atlantic summarises the systemic discord that has contributed to an estimated 183,000 deaths in the US. He highlights how despite ample warnings the country was unprepared for a pandemic, and suggests it remains unprepared for the next one. Weaknesses in leadership, testing, state policies, data capture and dissemination, public health infrastructure and information inaccuracies set the stage for the spread of COVID. Lack of respect for science, ingrained bias against people of colour and an ineffective health system perpetuated much of what could have been prevented. The situation Yong describes in his article has led the USA to a patchwork response to the pandemic. Across the country a variety of populations are being put at risk. For example, students and teachers at colleges and universities are having to navigate their way through the crisis – sorting through local concerns and statistics to devise a course that will serve their communities best while serving a mobile population of students who come from home to learn while potentially carrying or picking up the virus to take home or to their dorms. As examined in Kaiser Health News students arriving for classes are experiencing varying approaches to testing, hybrid online/in person class models and stay-at-home and masking orders. And should students become ill, universities may not be well equipped to keep those patients safe. Strategies to address these problems from politicians, researchers and healthcare abound. There is a recognised need of a national policy that aligns efforts to manage the COVID situation. As noted in USA Today, countries that have had relative success in managing the virus, such as Germany and Denmark, have a collective approach to address the problem they have committed to. The article compares international responses to those of the US to illustrate gaps and highlight areas where coordination and collaboration are desperately needed to move the country’s effort forward. Healthcare seems particularly suited to offer suggestions for improving the situation. The American Association of Medical Colleges recently published a guidance to set a direction for a safer future. The Way Forward on COVID-19: A Road Map to Reset the Nation’s Approach to the Pandemic outlines 11 recommendations to support and motivate the nation to adopt a systemic, collective plan to reset the country. Informed by expert insights from a variety of fields, the document shares actionable suggestions on topics such as testing improvement, national standards on face coverings and other safety protocols, and vaccine deployment planning. Suggestions include undertaking research to determine efficacy of face coverings to reduce transmission of COVID-19, distribution data to compare the impact of school reopening and designing a government-funded vaccine distribution and use process that involves a wide range of providers. The Music Man ends with a rousing performance of “76 Trombones.” The kids in the band follow a course toward success, resplendent in full uniform, high stepping and proud, seamlessly working together. The families and townsfolk people beam with accomplishment and join in on the celebration of collective achievement. When will we be ready to take up our instruments and perform cohesively together with no one left behind due to having a different COVID-19 score?
  4. Content Article
    There is a lot to be uncertain about these days: school, work, health, family. However, in July one thing was certain: the streaming release of “Hamilton” in the US was going to be epic. The acclaimed musical production tells the story of a U.S. founding father Alexander Hamilton, intensely American, exploring themes of love, anger, arrogance, heroism, betrayal, mistakes, politics, policy, devotion, family, sacrifice and death. In some ways, it sounds like healthcare in the era of COVID-19. While months of the coronavirus pandemic are behind us, the uncertainties caused by the pace of change and the expected surge of further infection spread bring continued stress, fear and frustration. Disruptions to services, processes and relationships are rampant. They demand continued experimentation across healthcare to address concerns to keep patients, communities and healthcare workers safe. And the lack of a coordinated collective policy response to the crisis only perpetuates discomfort about the unreliability of actions to improve safety and the substantial costs the future holds in store. Ambiguities and dread due to the pandemic are problematic and will be for some time. Continued patient avoidance of care is evident and could be contributing to lack of timely care and diagnosis. An ImproveDx article summarises how fear is keeping patients from getting the care they need, and highlights the importance of recognising that rebuilding trust will take time. To anchor this effort, leaders must view risk as individuals see it rather than just an academic exercise to inform reentry strategies in the months to come. The unsettled nature of care and access to loved ones during COVID can make end-of-life planning particularly fraught with uncertainty. Stanford University School of Medicine has developed the GOOD framework for clarifying steps forward when working with patients and families facing palliative care decisions during the pandemic. Its four elements – Goals, Options, Opinions and Documentation – provide an effective structure for clinicians to have conversations with patients and families to address care management when the path forward is unclear. Prolonged uncertainty can degrade healthcare staff mental and physical health. In Hawaii, one health system sought to make antibody testing available to staff as a strategy to decrease anxiety and improve sensemaking around the crisis. Hawai`i Pacific Health in NEJM Catalyst explores the reasons why those who were tested opted into the programme. The authors found “curiosity” to be a primary motivator. Knowing something – whether positive or not – can reduce one aspect of uncertainty, which the article posits will help clinicians and their community think beyond the doubt to achieve a modicum of control. This single piece of stability will enable a willingness to gather information, to plan and to act. Despite the challenge uncertainty brings, there are individuals who consistently believe the future holds promise. People who are able to act and make a difference despite uncertainty. Much has been said about those in the midst of the COVID-19 crisis, but others continue to address persistent uncertainties and unreliableness of care – beyond the pressures of the pandemic. There are many whose tenacity shores up the foundations of the healthcare system to improve its safety. One such leader from the US, John Eisenberg MD, is celebrated every year through an award programme in his name. John was a founding father of patient safety in the US. Through his leadership, national research and improvement programmes were developed and funded to lead government efforts to improve quality and safety. In July for the first time, the John Eisenberg Patient Safety and Quality Awards were bestowed virtually. These awards recognise individuals, local efforts and national programmes whose work provides evidence of the value and commitment to engage in work to improve safety. This year’s recipients demonstrated values core to improvement and perseverance in their work toward achieving healthcare that is safe. The awardees have accomplishments that focused on diagnostic error and sepsis reduction. Each of these stories started in tests and trials motivated by commitment to getting healthcare to a better place. For example, Tennessee-headquartered HCA Healthcare was recognised for its SPOT (Sepsis Prediction and Optimization of Therapy) algorithm as a mechanism to identify sepsis quickly to enhance quality and patient safety. Through this enhanced use of technology, SPOT uses basic laboratory and clinical data in real time to provide teams with the information they needed to reduce sepsis mortality across their 173-hospital system. Data triggered alerts that initiated actions to decrease response times by approximately 6 hours rather than relying on shift change as the information sharing mechanism. The SPOT algorithm enhancement to the electronic medical record partnered well with existing sepsis management processes to arrive at improvements. In the climax of Hamilton’s first act, the battle of Yorktown culminates in a chorus of “the world turned upside down”, with the hope that the cacophony will ultimately result in a new country with new freedoms only imagined prior to crisis. It is certain that COVID disruptions will continue to test us all worldwide. Can we challenge ourselves, our peers and our leaders to experiment as necessary to confront COVID-19 while guaranteeing that what was learned will be used to create something better?
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