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Feedback for Emergency Doctors (FED)
Learning from experience, systems not people, the need for timely change in the NHS
Dr Carl Reynolds www.medicdojo.com
Learning from experience
James Lind 1747
Controlled clinical experiments
Lemon juice rations and reduction of scurvy
Learning from experience
Ignaz Philipp Semmelweis 1847
Hand washing reduces puepural sepsis
"saviour of mothers"
Learning from experience
John Snow 1854
Removed the handle of a water pump shortening a cholera epidemic
“Father of epidemiology and public health”
The cost of not learning
Historically slow to learn on a macro scale
Perhaps getting better
Micro scale variation largely ignored at present
Systems not people
“The safety profile of the aviation industry is the envy of the medical profession”
Aviation is a leading industry in Risk Managment Wilf-Miron, Quality & Safety in Health Care (QSHC) 2003.
Blame free reporting culture, event analysis, and system change are key.
Systems not people
Blaming the person vs changing the system
Learning from near misses and adverse events – continuous feedback
Key safety making features are a reporting culture and focus on error provoking properties of system rather than individuals. E.g IV KCL
The NHS is changing
Patient safety organization
Central collation and analysis of local incident reports
But must do more
The super-doc fallacy
There is a lot to know
Reliance on the unaided human mind is an anachronism
Your doctor probably could do much better (Weed 1999)
Maintaining and improving your performance – the rhetoric
a. maintain a folder of information and evidence, drawn from your medical practice
b. reflect regularly on your standards of medical practice in accordance with GMC guidance on licensing and revalidation
c. take part in regular and systematic audit
d. take part in systems of quality assurance and quality improvement
e. respond constructively to the outcome of audit, appraisals and performance reviews, undertaking further training where necessary
f. help to resolve uncertainties about the effects of treatments
The present reality
Unless little David dies or you complain or sue
Super-doc won’t ever find out he just made a big mistake
There is no routine feedback system in place
Levering technology - FED
Using the data that’s there
A monthly report
Hard to set up but well received
Why so hard?
Hierarchy
Tradition
Learned helplessness
Lack of support for innovation
Benefits
Doctors get a log book of their activities for free
Facilitates reflection on activities and stimulates further reading
Raises awareness of the audit trail and the importance of accurate coding
Allows self assessment of diagnostic activity
Next Steps/Wishlist/Predictions Wider roll-out, improved usability, mechanism for
patients to give individual private feedback
Personal computing revolution comes to healthcare (and facilitates learning from experience)
Utilization of data for professional development/improving patient care
Greater transparency – open data, standardization, lower barriers to entry for innovation and improvement
An RCT, more quality research in general
Systems that make it easy to do the right thing
Help from you guys
Feedback for Emergency Doctors (FED)
Learning from experience, systems not people, the need for timely change in the NHS
Any Questions?Any Questions?
Dr Carl Reynolds www.medicdojo.com
