The First Two Years – Pathways and Patient Outcomes

By Frank Zadravecz, MPH

The first two years of our medical curriculum are an introduction to the human body’s normal and pathophysiology, and an attempt to untangle the complex pathways involved in the interactions between self and non-self. We hope to make connections between our physical exam findings and the physiologic pathways we have at our educational foundation. We begin to realize that there is a fine line to walk when treating a patient – altering the inputs of a single system can drastically affect the outputs of another.

If we place patient outcomes in the context of the dance that occurs in clinical care for patients on the wards, similar to the downstream effects of disrupting biological pathways in illness, there is a multifactorial system underlying hospitalized patient outcomes.

Prior to medical school I worked for several years as a population health epidemiologist in the Democratic Republic of Congo and then as a research data analyst at the University of Chicago. During my work in both of these settings I quickly learned the relevance of contextual clues in complex systems-based problem solving. Over the course of my first year of medical school, I realized that nowhere is this creative use of information more important than in the inpatient setting, where we attempt to distill out the most important available information when assessing a patient.

But there are caveats to our interpretations of data points – are we recognizing the most relevant physiologic associations when making clinical decisions? Are patient data really telling us what we think they are? What systemic factors are at play when patients experience an adverse outcome?

In my exploration of the importance of contextualizing inpatient data, I have been incredibly fortunate to work with Drs. Dana Edelson and Matthew Churpek, two mentors at the University of Chicago who are equally as passionate about asking these same questions surrounding clinical care. Using ward patient data, we have investigated the importance of physician judgment in clinical deterioration, and documented the need for greater sensitivity in recognition of sepsis and organ dysfunction in ward patients. But what can be done to re-orient clinicians who are overwhelmed by and desensitized to data streams and bedside alarms?

Streamlining the data provided to clinicians by removing the noise of less critical measurements has the potential to free clinicians to practice at the peak of their training. By diminishing the noise of excess data, clinicians can hone in on providing the most appropriate and effective contextual clinical care possible. Like the basic science that all clinicians have at their foundation, we can look at quality improvement and patient safety from a pathway lens – Which inputs and outputs are associated with adverse outcomes? Are there markers appropriate for identifying these events before they occur? What is our “vital sign” for patient deterioration, and how do we find it amongst our troves of measurements and assessments?

While my time as an SHM Student Hospitalist Scholar will be spent investigating the impact of the quality and quantity of data on our inpatient outcomes, I realize that my research question doesn’t end there.

So I ask, what are the hurdles to translating inpatient research findings into hospital policy at your institution?

 

Zadravecz, FrankFrank Zadravecz, MPH, is an alumnus of the Columbia University Mailman School of Public Health, a rising second year medical student at the University of Illinois at Chicago College of Medicine, and a Society for Hospital Medicine Student Hospitalist Scholar at the University of Chicago Medical Center. You can follow Frank on twitter @frankzadravecz.

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