Posts by Danielle Scheurer

Do Clinicians Understand Quality Metric Data?

The number and complexity of quality metrics within healthcare continues to expand, many of which are used to compare performance between hospitals, systems, and/or clinicians. To make these comparisons fair, many quality reporting agencies attempt to “risk stratify” these metrics, so as not to penalize those caring for higher complexity patients. Although laudable, these attempts also increase the complexity of the data and may reduce the ability of clinicians to understand and analyze quality performance. A recent article in the Journal of Hospital Medicine explores clinicians’ understanding of quality metrics using central line associated bloodstream infections (CLABSIs) as an example. The investigators used a unique Twitter-based survey to explore clinicians’ interpretation of basic concepts in public-reported CLABSI rates and ratios. I recently caught up with the lead author, Dr. Sushant Govindan, to better understand his team’s research and its implications for quality reporting. Dr. Govindan is a Pulmonary-Critical Care fellow…

THIS Is What Teamwork Looks Like

We talk a lot about teamwork in hospital medicine. Since the inception of the specialty, we have long been embedded in, and understand and respect the need for, a multidisciplinary approach to patient care. We heavily depend on our pharmacists, nurses, respiratory therapists, case managers, physical therapists, LPNs, etc. to develop and implement a care plan for our patients. Although hospitalists intrinsically understand the importance of teamwork, many of us let logistics and schedules get in the way of truly performing as a team. To date, few hospitals have implemented true team-based care. It is often too difficult to coordinate complex admission rules and differing schedules. And even if we can manage to coordinate locations and calendars, we still have to figure out how to communicate amongst our teams in a way that is efficient and effective. I recently ran across a series of award-winning healthcare photographs; this one struck…

Dum Spiro Spero

I was filling out my absentee ballot the other day, feeling despondent and uninspired at the choices that lay in front of me. Sensing my despairing emotion about the upcoming election, my 12-year-old daughter asked me what most Americans have been struggling with for months. “Mom, out of 325 million Americans, this is the best we can do?” I try to keep our kids informed about politics and leadership in the US and abroad (though admittedly, my husband is much better at this than I). We watch many of the debates together, and I try to explain leaders’ behaviors in ways that help them understand but that don’t taint their view of the humanity. Sometimes when I hear myself talking, I need to remind myself to believe what I am teaching my kids and to incorporate my own teachings into my own psyche! Here are a few key points I…

T-Minus 3, 2, 1…

Turns out that South Carolina is having a busy hurricane season. Just days ago, Charleston County was under a mandatory evacuation in anticipation of Hurricane Matthew. All I-26 lanes were converted into westbound traffic, gas stations were running low on fuel and the local Wal-Mart was out of bottled water. It was T-minus 3 days to the landfall of Hurricane Matthew, with very variable predictions on the trajectory, speed and strength. In the meantime, hurried preparations were being put in place for patients and care team members alike at the Medical University of South Carolina Hospital. It is times like this that I am reminded of the selfless and stoic nature of healthcare team members. Countless numbers of our team stayed in town and prepared to “defend in place” for an unknown period of time. Many of us were separated from friends and family, unable to look after our kids,…

Playing God

Last weekend, Charleston SC was faced with the threat of a category 1 hurricane. All’s well that ends well; the city barely faced winds over 40 mph and there was little to no flooding. But during preparations, I reminded myself of a recent Radiolab podcast, “Playing God.” The podcast recounts some of the triage decision-making that occurred during catastrophic events, including at Memorial Hospital during Hurricane Katrina and after the 2010 hurricane in Haiti. Many of the follow-up conversations after these events center on how and who should make healthcare decisions in the setting of very scarce resources. The podcast discusses harrowing situations of decisions having to be made for the “greater good.” In the end, they conclude that triage decisions cannot rationally be made by (compassionate) humans. They argue these decisions must be “systematized” without a human element, based on facts and measures of the value of human life.…