tag:blogger.com,1999:blog-32053362.post4121238601838265334..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Joris explains CRM in the PICU @UMCNPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-32053362.post-51776652464545311562012-11-27T06:53:09.533-05:002012-11-27T06:53:09.533-05:00I might add a comment to the concerns about docume...I might add a comment to the concerns about documentation. Documentation has taken over medicine mainly because it is necessary to get paid under the current system. Just imagine a system where one no longer has to document all the steps because they are reliably performed in every hospital as a matter of course. The current payment system is nothing more than a reaction to the current chaotic 'system' of medical care delivery. We must keep our eyes on the ball of where we are trying to go, and why.<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-14880076322533561492012-11-26T18:21:29.754-05:002012-11-26T18:21:29.754-05:00True, what is shown is the front and the back of t...True, what is shown is the front and the back of the laminated protocol sheet. Versions adapted to the most common procedures (intubation, central line insertion, chest drain insertion, etc) are kept in each patient room and are ready to use whenever required. There's no documentation as such involved, a team member reads out loud from the laminated sheet to other team members. Not only is it a checklist, but the mere act of reading it out focuses the team to the procedure they are about to carry out.L. Frijns (PICU fellow to dr. Lemson)noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-74278743191730439682012-11-26T17:16:06.549-05:002012-11-26T17:16:06.549-05:00This is not documentation, Rob. This is the proto...This is not documentation, Rob. This is the protocol. Following a standardized approach tends to save time, not take more time.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-80031349050357999472012-11-26T14:39:54.705-05:002012-11-26T14:39:54.705-05:00Thanks for sharing Paul. Definitely an interesting...Thanks for sharing Paul. Definitely an interesting approach. I wondering how this eventually gets carried over into less critical settings. As a new nurse and someone that has worked in educational settings with students there are lots of times within nursing teams I can see this approach being useful.<br /><br />There are times that a simple catheterization does not go well. Although it is unlikely to have immediate negative consequences there is a lot of potential for infection. It would be helpful for the learner to have these sort of organized approach, with a briefing and debriefing. <br /><br />On the other hand I worry about the challenge of documentation and completing all these requirements when as teams we are all time constrained. Although documentation as close to time of care is ideal often we complete it hours after delivering care, I wonder what the negative side of implementation of more documentation can be. Since we are further distracted from care by since it happens hours afterwards and is only being completed to be filed. <br /><br />Thanks as always for sharing your thoughts.<br />RobRob Fraser MN RNhttp://robertfraser.ca/wordpressnoreply@blogger.com