SOMEDAY I want to have the leverage to bring together doctors and other professionals from Boston-area hospitals with police personnel to facilitate ongoing conversations about innovative solutions and how you create them. The two professions analogize so closely, especially in terms of the consequential nature of the decisions they make and actions they take. Some of the similarities and analogies:
- The work of each matters tremendously and is central to the health and safety of society.
- Both get sued a lot.
- For both, prevention is laborious but financially cheap and pays huge dividends in terms of leveraging behavior change in large social groups. Intervention is very costly and affects only one individual at a time.
- Both undervalue prevention as a core strategy.
- Both try to manage that most unpredictable force in human nature: human behavior.
- Both professions default to applying technical and professional solutions because leveraging prevention is so hard (see #2).
- The embrace of the technical and of hurrying can create unintended negative consequences, such as preventable errors (Globe piece below).
- The humans who practice medicine and policing get damaged emotionally and spiritually over time by their experience.
- And etc. and etc.
They have a ton to learn from one another. The service delivery practices and outcomes in both professions would improve as a result. In my opinion it’s a true missed opportunity for all.
Alas and alack, that day is not coming. In its place, Corridor Conversations offers two pieces from today’s press. From The Boston Globe, yet another example of an innovation in medical practice that can be readily translated to police practice. From The Washington Post and the great Andrew Papachristos, epidemiology applied to violent crime. Enjoy.
Children’s Hospital creates system for safe patient handoffs; Researchers map strategy to reduce errors, By Chelsea Conaboy | Boston Globe, DECEMBER 4, 2013
It happens two or three times a day in hospitals: Doctors hand off their patients to the next shift, sometimes standing in the hallway with their pagers ringing and the frenzy of the hospital swirling around them. Important information about a patient’s condition and treatment needs can get lost in the shuffle, a known cause of medical errors.
On Tuesday, researchers at Boston Children’s Hospital provided some of the first good evidence that a more structured patient handoff improves care. After introducing a new system on two inpatient units at the hospital, the group found that preventable errors declined by more than half over three months.
Patient handoffs have historically been chaotic, shaped by bigger systemic issues and physicians’ ingrained habits, said Dr. Amy Starmer, associate scientific researcher at Boston Children’s and lead author of a study published in the Journal of the American Medical Association .
“We couldn’t do just one small, little thing and expect to have an impact,” she said.
The researchers did several things. They trained doctors on team-based communication strategies and introduced an acronym to help them remember key points to cover when discussing patients. They encouraged people to gather as a team, including senior physicians and doctors in training, to discuss patient care together in a quiet space, rather than the busy hallway.
One of the most important findings was that doctors spent more time at patients’ bedside after the system was implemented, as doctors spent less time running to the computer.
On one unit, they also introduced a computerized tool to create printouts with key patient information and to prompt doctors whose shift was ending to fill out a to-do list for those coming on.
They reviewed patient care before and after, and they tracked physician behavior. The new process resulted in doctors exchanging more complete information, but did not require additional time, the study found. Preventable medical errors fell to 1.5 per 100 admissions, from a rate of 3.3.
Patient safety specialists have known for years that patient handoffs were a key area for improvement. They have sharpened their attention in recent years as hospitals have imposed limits on how many hours doctors-in-training can work, to prevent them from working while drowsy. Shorter shifts mean more handoffs and a greater potential for errors in the process.
“What I think has been a challenge is finding effective tools to actually solve the problem,” said Dr. Kedar Mate, vice president at the Institute for Healthcare Improvement, a nonprofit in Cambridge focused, in part, on patient safety.
Mate said the study offers a good example of how to make the necessary changes. Like the study authors, he noted that because the decline in errors was so dramatic it is possible that other factors contributed to the change.
The authors noted that differences in patient populations and in the experience level of physicians in training before and after the introduction of the hand-off tools could have affected the results.
Still, the Children’s Hospital study is “by far the most comprehensive” look at how improved handoffs can reduce harm to patients, Dr. Leora Horwitz, associate professor of medicine at Yale School of Medicine, said in an editorial accompanying the study.
Dr. Christopher Landrigan, research director for the inpatient pediatric service at Boston Children’s and senior author of the study, said one of the most important findings was that doctors spent more time at patients’ bedside after the new system began.
It is not clear exactly why, but Landrigan said he suspects that doctors spent less time running back and forth to the computer to search for patient information.
“They just had it more at their fingertips,” he said.
Starmer said the computerized hand-off tool has been particularly popular and has been adapted to other units at the hospital.
The researchers are now studying the new hand-off procedure at nine pediatric centers around the country, with a $3 million grant from the US Department of Health and Human Services.
Mate said that more hospitals will probably institute programs similar to the one at Children’s, in part because the primary organization that accredits graduate medical education has placed a greater emphasis on patient safety programs and structured communication between physicians in training and other medical professionals.
Implementing the hand-off program does not cost much, beyond doctors’ commitment to do things differently, Mate said. Even if the actual reduction in medical errors is less than the study found, “you would still consider it a worthwhile investment.”
Social networks can help predict gun violence, by Andrew V. Papachristos, Published: December 3
Andrew V. Papachristos is an associate professor of sociology at Yale University.
Is it possible to predict who is most likely to die at the hands of a gun? Not shootings like those at Sandy Hook Elementary School in Connecticut , themovie theater in Aurora, Colo. , or the Washington Navy Yard , but the all-too-common shootings that occur in neighborhoods across the country.
The idea is not far-fetched if one drills down into the nature of gun violence, which, in the way it is transmitted, bears striking similarities to public health epidemics such as cholera in Haiti or HIV/AIDS in the United States.
Epidemics of any kind are not random. HIV is a blood-borne pathogen transmitted primarily through sex or intravenous drug use. Once its patterns of transmission and the communities most affected were identified in the United States, extensive public health campaigns helped transform AIDS from an always-fatal disease into one that is chronic and manageable for many of those infected.
Along the same lines, a cholera epidemic exploded in Haiti in 2010 when sewage from a base housing United Nations peacekeepers leaked into a nearby river that supplied drinking water. The transmission, far from random, ultimately killed more than 8,000 Haitians.
So it is with gun violence. There are patterns of transmission in the United States that go beyond aggregate factors such as race, age, gender and income. On an individual level, social networks — the people one hangs out with — can predict a given person’s likelihood of being shot and killed.
In a study published last month in the American Journal of Public Health, my colleague Christopher Wildeman and I applied the science of social networks to patterns of gun homicide in Chicago. The idea is straightforward: Treat gun homicide like a blood-borne pathogen, something transmitted from person to person through specific risky behaviors. Put another way, gun violence is not an airborne pathogen: You don’t catch a bullet like you catch a cold.
More than 40 percent of all gun homicides in the study occurred within a network of 3,100 people, roughly 4 percent of the community’s population. Simply being among the 4 percent increased a person’s odds of being killed by a gun by 900 percent.
These numbers tell us that gun violence spreads like HIV infection: You’re more likely to “catch” the disease if you engage in risky behaviors with someone who might be infected. And it’s not just people’s friends who affect their likelihood of getting shot, but also their friends’ friends. This is similar to the transmission of HIV: Your current partner’s past sexual partners affect your exposure, even if you don’t know them.
In the case of gun homicide, seemingly random victims end up “in the wrong place at the wrong time” by indirect exposure, such as getting a ride from a friend’s cousin or by going to the party of a friend’s friend. In these cases, victimization is tragic but not random.
Understanding the networked nature of gun violence has important implications for how it can be addressed. Prevention efforts can be directed toward those individuals and communities most susceptible to the infection. The solution is not broad, sweeping policies, such as New York’s “stop and frisk” or mass arrests, but the opposite: highly targeted efforts to reach specific people in specific places, akin to providing clean needles to drug users to prevent the spread of HIV.
By studying gun violence like we study disease, we, as a society, can improve our chances of discovering who has a greater chance of being shot and focus resources to police better, smarter and more fairly.