Recently, I have mentioned many times the application of clinical work lists to work, and some small partners will be curious, what is a list? How do I make a checklist? Today I'm going to talk to you about the list and how American doctors use it.
In 2013, I read the American physician Atul. The book "List Revolution" written by Gerwende brought me great shock. At that time, I worked for more than ten years, and found that many of our doctors worked for decades, but they were still making some low-level mistakes, the evaluation and prediction of patients was always problematic, the treatment of patients was disorderly, and the treatment plan was very arbitrary. I have heard many times that patients who are intubated on a ventilator are intubated for too short a period of time due to improper evaluation, or too long a period of time to extubate the tube and cause airway damage. There is also the indication and timing of endotracheal intubation, and the concepts of different doctors are often very different.
Some would argue that life is complex and that the situation facing medical treatment is complex. But aren't those complex projects, such as skyscrapers and projects like the Hong Kong-Zhuhai-Macao Bridge, complicated? Isn't it complicated to maneuver a large airliner? Just think about these questions to see that the reasons for wanting to specialize in medicine seem reluctant in this day and age.
It is true that there are still many mysteries of life that we do not know, but in the past hundred years, the rapid development of science has accumulated a lot of knowledge for us, and we have accumulated a lot of experience and lessons. Dr. Gwynde argues:
Human error is mainly divided into two categories: the "mistake of ignorance"—the mistake we make because we do not have the right knowledge, and the mistake of incompetence"—the mistake of making because we have the right knowledge but not using it correctly. The former can be forgiven, while the latter cannot be forgiven. For most of human history, our lives have been dominated by the "mistake of ignorance", but in the past few decades, the rapid development of science has accumulated so much knowledge for us that we can not only deal with the challenge of the "error of ignorance", but also invest a lot of energy to deal with the challenge of the "error of incompetence".
In 2014, I had the privilege of going to Miami University Hospital for further studies, and in my clinical work, I noticed that they often use work lists. For example, in the ICU ward, whether a patient wants to wean off the extubation depends on a variety of indicators, the domestic situation is that the doctor relies on memory and clinical experience to predict, but the American doctor directly prints out a list and takes the list to compare the patient's situation.
The figure above is a list of regimens for the Adult Ventilator Spontaneous Breathing Test (SBT) with contraindications to SBT at the top, including:
Known or suspected conditions include unstable coronary artery disease, increased intracranial pressure, seizures, coma, life-threatening upper gastrointestinal bleeding, alveolar bleeding, or persistent bloody exudate from endotracheal intubation
Heart rate > 140 beats per minute or <45 uq beats per minute;
Oxygen saturation <92%
PH < 7.25
The ventilator is set to P EEP> 8 cmH2O or oxygen concentration > 0.5
Receive muscle relaxants
Rass scores < -2 or >3
Does not respond to nociceptive stimuli
Rely on a variety of vascular vasopressors
Despite the use of single-vessel vasopressors, the dose continues to increase over the last 24 hours .
Next, if there is no above contraindication, you need to take the following three steps, the specifics are not listed, I believe that the knowledgeable colleagues themselves will interpret the English.
Tracheoscopy, we usually have a very simple application form, and now there will be some detailed evaluation sheets for painless tracheoscopy, but compared with the assessment sheet before the tracheoscopy of American doctors, we may seem much simpler.
The record of past history in our current medical records is too simple, often with only two or three lines:
The medical records of U.S. hospitals are fully tabular, very detailed, and usually not omitted:
Diagnosis is divided into primary and secondary diagnoses, and treatment is divided into primary treatment and other treatments:
The course of illness written each day is all tabularized:
Doing coronary interventional angiography and treatment, that is a big thing, one by one, don't make a mistake.
Use of intravenous heparin with care and indications to be firm:
This is just part of the list I've seen, and I'm sure you'll be blown away when you read it. Of course, in the past ten years, we have also learned from these advanced experiences and continuously improved our work. But it is undeniable that the gap is still quite large .
We must have the courage to face up to our own shortcomings and constantly learn the good working methods of others to improve our work. Although our strength as individuals may still be small, this does not prevent each of us from starting from ourselves and cultivating the habit of making work lists to gradually improve our working methods and improve our work efficiency. And I also very much hope that you can deeply understand the list revolution that the medical industry must carry out and urgently need to accelerate from the book "List Revolution", so as to accelerate the improvement of China's medical quality.
Finally, once again recommend "List Revolution", a book that doctors and nurses in the new era must read, and the book purchase link: