(Kenny Louie/Flickr)
National data suggest that up to 70 percent of sentinel events—the most serious errors in hospitals—stem at least in part from miscommunications. Communication problems are especially apt to occur during hospital shift changes, when a patient’s care is transferred to incoming doctors and nurses—known in health care as the “handoff.”
More than a year ago, a team led by Amy Starmer, MD, MPH, of the Division of General Pediatrics at Boston Children’s Hospital, developed and began testing a bundle of interventions to ensure that the hospital’s residents were thoroughly and accurately briefed on each patient’s medical history, status and treatment plan in a standardized way.
Through measures such as communications training, a mnemonic to help residents remember key information to pass on and a computerized handoff tool that integrated with the patient’s electronic medical record, they managed to move the needle: Medical errors fell by 40 percent—from 32 percent of admissions at baseline to 19 percent of admissions three months after the program started.
But that wasn’t all. Full story »
Some children with autism are "bloomers" and are able to move to the high-functioning category. They're also more likely to have mothers who are white and educated.
A child with autism is more likely to do well if his mother is white and educated.
This is the message of a study just released in the journal Pediatrics, and it’s something we need to pay attention to—now.
Researchers from Columbia University wanted to find out what happens to children with autism over time. So they looked at the records of more than 6,000 children with autism who were enrolled in California’s Department of Developmental Services (DDS). To get into DDS they had to be referred, and their diagnosis had to be confirmed by someone with expertise in autism.
What they found was that when it came to social and communication skills, for the most part the kids fell into groups ranging from low-functioning to high-functioning. The kids did make progress; the most rapid gains were before age six, and the high-functioning kids tended to make more progress than the low-functioning ones. Even as they made progress, they tended to stay in the group they started in—with one notable exception. That exception was a group the researchers called the “Bloomers.” Full story »
Do the cells in this blood harbor a potentially harmful gene? If the answer is yes, but the person it belongs to donated it for unrelated research, it's not yet clear when - or how - to tell them. (JHeuser/Wikimedia Commons)
Snippets of tissue, vials of blood and tubes of DNA from hundreds of thousands of people sit in freezers and liquid nitrogen tanks right now in laboratories across the globe. They come from people like you and me, donated in the hope that our genes researchers will be able to glean insights for the next breakthroughs for diseases common and rare.
Whenever we sign a consent form and roll up our sleeve, we don’t just join the community of research. We also become part of a debate that has been raging among researchers, clinicians and ethicists for years: What if our DNA sequence turns up bad news unrelated to the research we signed up for?
“There is an emerging consensus among genomics researchers that we have an ethical responsibility to tell participants if we find, in the course of a research study, genetic variations that could impact their healthcare decisions,” says Kenneth Mandl, who directs the Intelligent Health Laboratory (IHL) in the Children’s Hospital Informatics Program (CHIP).
This responsibility can quickly turn into a numbers problem – a massive administrative burden. Consider that there are more than 104,000 human genetic variations now cited in the medical literature with links to human disease. Full story »
(Karl-Ludwig Poggemann/Wikimedia Commons)
Recently, in the hospital cafeteria, I overheard a group of researchers discussing the upcoming availability of whole-genome sequencing to physicians. “We should devise a way to study how physicians will use this,” said one of them—underscoring the disruptive nature of the transformation that is currently happening in medicine.
The ability to immediately obtain whole-genome sequences from patients holds enormous potential for understanding and treating human disease. The list of studies reporting successful diagnosis of otherwise elusive orphan conditions is already too long to recount—more than 600 articles in PubMed as of the date of this posting—including poignant examples of advancing clinical care. Full story »
"Buffalo Bill's Wild West" show poster (cliff1066-TM/Flickr)
The business of smartphone health apps is growing exponentially. Here at Children’s, I coordinate and supervise a team of software developers who are helping our clinicians build apps. While I love the innovation and excitement health apps bring, the regulation is just starting to catch up with the industry. That makes the future uncertain.
The Food and Drug Administration’s proposed mobile health app guidelines, published in July, are a step in the right direction. But many concerns remain. In taming the Wild West, will the FDA go too far into overregulation? Will the new rules stifle the growing industry of app development by small startups or internal hospital developers? Can we continue innovating in the current state?
Consumers feel the uncertainty too. When considering the use of an app, how do you know whether it’s providing correct information? Full story »
Here once again is Vector’s take on some exciting trends we’ve been watching in the pediatric health arena and what we expect to see more of this year. If you’ve got others to propose, scroll to the bottom and let us know!
Genomics is starting to provide clinically actionable information (Michael Knowles/Flickr)
Whole-genome sequencing enters the clinic
In 2000, with our genome deciphered, the Human Genome Project promised to transform medicine, predicting and preventing all that ails us. The project spawned next-generation technologies, accelerated the development of bioinformatics and shaped new perspectives on research. But if, say, a stroke patient was asked the question, “Is your life any better than 10 years ago thanks to advent of genomics?” the answer would have to be “no.” Hence the New York Times’s assertion in 2010 that the project yielded few new cures.
Now that paradigm seems to be shifting. Whole-genome sequencing has begun moving into the clinic, sleuthing out problems, offering hope for a medicine that’s more effective and more personal. 2011 saw genomic information provide biochemical insights timely and actionable enough to improve the treatment of individuals with cancer and dystonia, and, in a case at Children’s, failure to thrive and severe kidney calcification. Full story »
President Obama signs the Patient Protection and Affordable Care Act, March 23, 2010 (Pete Souza/Wikimedia Commons)
National healthcare reform, including President Obama’s Affordable Care Act of 2010, is being driven by widespread dissatisfaction with the high cost and limited accessibility of care. Although we’ve yet to feel the full impact of these national reforms, the reform experience in Massachusetts indicates that mandated universal coverage, by itself, has failed to drive down costs.
So, in Massachusetts, we’re now in the next phase of healthcare reform, focusing on how to control and cut costs while still providing nearly universal access to high quality services and care. The need to bring down costs is stimulating healthcare innovation in three major areas – perhaps offering some lessons for the nation as it moves toward universal care. Full story »
Context can create bias: Squares A and B are the same shade of gray (created by Edward Adelson, professor of vision science, MIT)
Before you read this post, look at squares A and B in the image to the left. Which is darker?
Next, answer the following questions:
- A bat and a ball cost $1.10 in total. The bat costs $1.00 more than the ball. How much does the ball cost?
- If it takes 5 machines 5 minutes to make 5 widgets, how long would it take 100 machines to make 100 widgets?
- In a lake, there is a patch of lily pads. Every day, the patch doubles in size. If it takes 48 days for the patch to cover the entire lake, how long would it take for the patch to cover half of the lake?
Did your mind leap to these quick answers — 10 cents, 100 minutes, 24 days?
Such errors on this Cognitive Reflection Test are quite common, and not so different from the lapses in thinking that underlie medical errors. Full story »
(Andreas Gohr/Flickr)
When patients are sick enough to require hospitalization, medical decisions often involve nontrivial tradeoffs between risks and benefits. They require discussions with patients and families from a variety of cultures and backgrounds. And sometimes these discussions break down.
Patient-clinician communication is increasingly recognized as an integral part of clinician competency. Indeed, family-centered rounding, increasingly practiced at Children’s Hospital Boston, is a critical step in this direction. Fully adopting this practice surely will enhance communication quality.
Yet, I suspect we’re still missing cues from patients and families, signs that our alliances with them are not sound. We can’t be maximally perceptive all of the time. It is busy, we are tired, we want to teach, we want to be efficient, and we want to get to the noon conference to learn to be better doctors. Full story »
(image: Sandyhombre/Flickr)
In the past few decades, what used to be considered medical miracles have become expected and everyday. More children are surviving prematurity, even extreme prematurity. Congenital heart defects are routinely repaired, leukemia has largely become curable, and conditions like sickle cell disease and cystic fibrosis have become manageable chronic conditions with a greatly increased life expectancy.
That’s created a new problem: young adults entering an adult healthcare system that isn’t ready for them. Many have cognitive disabilities or emerging coexisting conditions like obesity, asthma and type 2 diabetes. Many are used to having their care managed by their parents.
A national study of patients aged 19 to 23 with special health care needs – the first to draw on interviews of young adults themselves – finds many of them ill-prepared to assume lifelong responsibility for their health. Full story »
