Philip Salen

By Philip Salen

The delivery of medical care relies on effective, succinct, and ongoing communication between healthcare providers, called handoffs. Handoffs involve the transfer of professional responsibility and accountability for aspects of care for patients to another clinician or clinical team on a temporary or permanent basis. Handoffs have the potential for deleterious clinical impact if inadequately done. Only recently has data become available that demonstrate improvements in handoffs reduce the rate of subsequent clinical care error. This clinical vignette and subsequent discussion focuses on physician, particularly the resident physician in training, transfer of care: handoff complications, barriers to effective handoffs, regulatory agencies’ input on handoff improvement, standardization of the handoff process, assessment of the quality of handoff, handoff error avoidance, and improving the quality of handoff.

Part of the book: Vignettes in Patient Safety

By Philip Salen and Kenneth Norman

Fatigue-induced medical errors and complications spark concern in patients, clinicians, and policy makers, as documented by the Institute of Medicine report in 1999 that approximately 100,000 Americans die annually secondary to potentially avoidable injurious events. Over the last 2 decades, multiple organizations have advocated for the implementation of labor hour restrictions to redress physician in training fatigue and enhance patient safety. Advocates for duty hour caps in physician training programs cite the potential for improvements in patient safety, whereas adversaries allege that curtailing duty hours compromises medical education and readiness for solo practice. Sleep deprivation impairs multiple aspects of cognition, function, and capacity, including many aspects essential to the practice of medicine, e.g., cognizance, recollection, and dexterity. Resident physicians’ traditional extended duty shifts for 24–30 consecutive hours pose significant hazards not only to patients but also to the physicians in training themselves. Burnout among physicians in training occurs commonly and results from work-related stress characterized by emotional prostration, depersonalization manifest as cynicism and detachment toward patients, and diminution of personal esteem. Curtailed shift duration correlates best with improved patient care of the strategies for managing physician fatigue. Adequate supervision of residents and medical students has the potential to improve resident education and further patient safety. Night float shifts improve resident’s well-being in terms of acclimating to a consistent nocturnal schedule. Data supporting capping physician work hours demonstrates evidence of amelioration of fatigue, thereby improving physician’s quality of life; evidence supporting duty hour restriction for enhancing patient safety, decreasing medical errors, and physician training, including surgical, is mixed and more nuanced.

Part of the book: Vignettes in Patient Safety

By Alex Alers, Philip Salen, Vikas Yellapu, Manish Garg, Charles Bendas, Nicholas Cardiges, Gregory Domer, Timothy Oskin, Jay Fisher and Stanislaw P. Stawicki

This chapter provides an overview of key topics in the area of radiation safety. Three clinical vignettes will serve to frame the review of the literature around both diagnostic radiation exposure and the risk of radioisotope contamination. Advancement in medical technology is rarely innocuous, and the use of radiation as both means to diagnose and treat certain conditions is not an exception. It is very important for clinicians to review the basics of harmful medical radiation exposure since, although seldom encountered, treatment, and outcomes are time sensitive. The advent of newer technology and the widespread availability of equipment will only serve to increase the prevalence of potentially harmful medical radiation exposure. Moreover, this chapter aims to explore current multidisciplinary endeavors to provide safe and efficient use of radiation in medicine. Solely relying on the medical profession for development of safeguards against harmful medical radiation exposure would be an impossible task. This is why it is crucial for professionals such as health physicists, radiation safety enforcement officers, and policy-makers at the state, national, and international level to establish consensus guidelines aimed toward safe, reliable utilization of radiation in medicine. Part of this interdisciplinary approach needs to focus on accurate education of patients. A thorough assessment of acute radiation syndrome, including diagnosis, treatment, and prognostic indicators is also part of this chapter. Furthermore, principles of screening for, and protection from, radiation contamination are outlined. Finally, areas for further research are identified throughout the chapter. The discussion takes into account both US-based and International research and practice guidelines.

Part of the book: Vignettes in Patient Safety

By Philip N. Salen and Stanislaw P. Stawicki

Part of the book: Contemporary Topics in Patient Safety

By Philip N. Salen and Stanislaw P. Stawicki

Patient safety is central to modern healthcare delivery systems, with ever increasing focus on delivering the best possible, safest care, at cost levels that are both reasonable and sustainable.(1) In this third installment of Contemporary Issues in Patient Safety, we explore a host of interconnected topics that directly and indirectly affect the value- and safety-driven, patient-centric dynamic of today. Among the various topics explored in this book, provider burnout as a contributor to medical and surgical error deserves a much closer examination. The Editors would like to devote this Introductory Chapter to burnout, its insidious nature, as well as the need for recognition and prompt management.

Part of the book: Contemporary Topics in Patient Safety