Justin's HOPE healthcare tumblelog
In loving memory of our precious child~by dale ann micalizzi
Healthcare Openness Professionalism Excellence
Contact and Comments to: micalizzidag@aol.com Justin's HOPE at the Task Force For Child Survival and DevelopmentCompassion in Healthcare-The Heart of Healing
Doctors Within Borders
“The Virginia Dental Association’s Dickinson says that education of the next generation is key in changing the culture in this part of Virginia, where knowledge about dental care and nutrition is poor. The dire dental situation among the low-income populations of southwest Virginia, and parts of Kentucky and West Virginia, is emblematic of the larger health-care crisis—the region has higher rates of tooth loss than almost anywhere in the United States. (Nationally, 108 million people don’t have dental insurance.)”Injured? Horsing Around With Stem Cells May Get You Back in the Saddle
“Doctors might soon be able to regrow injured muscles, tendons and bones without invasive surgery, simply by injecting a person’s own stem cells into the site of an injury. Veterinarians are already doing it with injured horses, and research into human applications is well under way.”DOCTalk Magazine interviews Don Berwick
I couldn’t agree with him more! Politicians and leaders, are you reading this?Hospital death rates unveiled
“Finally, patients who were transferred from one hospital to another for more sophisticated care were credited to the first hospital. That’s to avoid penalizing hospitals that get the sickest patients.”
This was my concern when I heard about reporting hospital death rates. I’ve seen it up close and personal, where patients were transferred to a hospital more equipped to care for them but the first facility never reported that the patient died or had complications so I’m pleased that that was considered in this data.
A Letter from a Hospital CEO
“I was one of the participants at the recent conference in Orlando where you spoke. I have been a nurse for 28 years and have heard many terrible stories of bad outcomes in health care. But, I found yours to be the most compelling. I had always been committed to quality and compassion in providing care. I have already shared your experience in front of 4 audiences since the day of your presentation. I want you to know, I am on your side… You have created yet another voice to get the message out there. Justin’s photo is in front of me as I write this, and I am committed to telling his story at least once a week the for the rest of my career. Just know, I will be there to support your message.”Team building skills
“The skillful, dedicated work of a hundred experienced gardeners and their enthusiasm enables them to put together this giant floral jigsaw in under four hours.”
This story reminded me of a an anesthesiologist friend who felt most treasured as a team member when in college on a winning crew team. Can we, or do we, use such team building skills in management? Are those, that have participated in sports or teams the ones hired to lead? Is this considered when hiring staff?
Living with Uncertainty
Learning from adverse medical events is imperative to surviving family members. The clinical challenges involved in our case have never been validated by Justin’s providers so this has been a difficult task for me, to say the least. It’s not that we haven’t tried to gain the knowledge that we needed to educate medical professionals on the circumstances surrounding our son’s death and save another child. A physician from Boston Children’s Hospital tried tirelessly to publish what we knew of Justin’s story in medical journals several years ago which were rejected citing factors that didn’t place all physicians in a glorious light. I decided to take my story to social media teaching from the newsfeed and group applications. The following combined results may prove significant and may very well be the best that I’ve got to give for now.
Here is the case, I wrote on facebook: a healthy 11 yr. old child presents with positive staph aureus infection of his ankle joint. Temp, ankle sl sw and warm, nausea, vomit, low bp. No injury, no break in skin. On motrin and cephelexin x 2 days prior to ankle tap. Sedrate and WBC elevated. Child given general anesthesia w/suc (a known triggering agent) for I&D of ankle joint. Cardiac arrest and simultaneous severe bleed from ET tube (at the end of case). Any thoughts?? What would you do differently? What went wrong?
An Orthopedic Surgeon from South Africa writes:
“Thanks for having the courage to question and to demand compassion. Your efforts are commendable. Regarding your child’s case, the clinical picture you paint is that of a septic arthritis of the ankle. Typically in children these can occur spontaneously and without warning. They all need surgical debridement (drainage). In some cases the infection can be overwhelming and can cause a condition called shock syndrome where there is systemic compromise of the patient, in the form of cardiac or pulmonary dysfunction. Because the child generally has a healthy underlying condition, the organ systems tend to compensate very well up to a point, making it easy to underestimate the severity of the disease. In retrospect, the low BP probably could have alerted us to a more severe situation. Be that as it may, these very ill children need to be managed by experienced anesthesiologists and orthopedic surgeons. I hope that this case will lead to more openness, better preparedness and compassion.”
Sepsis was definitely involved but there was more that only the anesthesiologists would be able to answer. Were the meds correct? Was the airway secure?
Thoughts from an Anesthesiologist:
Since we now having a family history of anesthesia complications, our pre-op appointments are agonizing and will forever haunt us unless more light is shed upon the circumstances that lead to Justin’s death. The fear, the devastation and the anxiety all return to us each time someone needs even minor surgery. We all become quiet and nervous. We have learned that every surgery can be life threatening no matter how minimally invasive.
My anesthesia consult, last week, proved debilitating but also enlightening as the physician was quite adamant about the cause of Justin’s death. It seemed so clear to him. After verifying that our case was dropped, my anesthesiologist offered his opinion that the ET tube was removed too quickly. Since the bleed and arrest were at the end of surgery, all was going well until the anesthesiologist tried to remove the ET tube before it was time. In an athletic child with an increase in muscles formed at the neck (which Justin had as he raced BMX bikes and had significant upper body strength), you MUST wait to maintain an airway as it takes longer because the muscles are tighter there and they will open slower. In his hurry and lack of knowledge, he states, that the airway was lost causing the arrest and the hemorrhage with the movement of the tube. An obvious error in judgment, he implies. The x-rays will show a movement in the ET tube placement and also bi lateral pneumonia, which they did.
The scenario of a lost airway had been mentioned by other anesthesiologists in the past but they never explained it so clearly or maybe I wasn’t ready to understand it. Muscle volume and consistency were never mentioned in athletic children as needing further precaution with a general anesthetic and more importantly when accompanied by a staph infection. I’ve consulted with the best anesthesiologists in the world. I had only heard of problems with muscle rigidity in Malignant Hyperthermia cases, which I also researched and was discounted. But, can we learn more from this correlation? Did the Succinylcholine (muscle relaxant and triggering agent) cause further problems? Is there a connection with athletes and anesthesia deaths, heat stroke, etc.? Should a child be stable before introducing general anesthetic? We need to learn more.
Did anyone consider the lasting affects on a family?
I now feel relief and despair simultaneously but a bit more closure, if this new information is even accurate. I did not agree to general anesthesia in my case and this new etiology of muscle block has since been disputed. It will take more convincing for us anyway. Families that live with uncertainty and loss will need time to trust again. Please be patient with us. A little empathy, honesty and kindness will work wonders. If only silence weren’t an accepted explanation of why a child died…this isn’t fair.
Courage “implies firmness of mind and will, in the face of danger and extreme difficulty.” When we heard Justin’s anesthesiologist speak at the depositions, 3 years later, this handsome, young, muscular physician now was over weight, balding and had aged 30 years since our contact in the OR. His gait was slow and without confidence. During discovery, he stated that Justin was aware and alert after transport which was discounted by the PICU physician and us. Did he know what really happened? Did Justin suffer? He has been the only one not to apologize for our loss. Maybe he just can’t do it, yet. Does he live with uncertainty, as we do? My family is waiting.
Addendum from Anesthesiologist in India:
“I got the main points in this story. there r only 2 possibilties. first is as u said ET placement was wrong. but there is one another possibilty is that patient was in sepic shock before.. i mean in preoperative status and if such patients receive succnyl choline.. which was given„, can cause cardiac arrest.” So, what can we teach about the case to save a child? Who wants to write the paper for me…or maybe I just did.
New Release: Taking the HELL out of Healthcare by Nick Jacobs. My friend, Nick, invites you into his stories as if you were a character experiencing them. His knowledge and common sense approach to healthcare management will spark your interest and propel you to follow. He has been an excellent teacher and mentor to me since our meeting at a healthcare conference a few years back. His book will surely bring us where we need to be.
New era of preventing birth-related deaths
“One of the more troubling statistics in U.S. health care is the relatively high incidents of perinatal and maternal deaths and injuries that rank this country among the lowest-performing industrialized nations. Although the CDC says current perinatal mortality rates of 6.69 per 1,000 deliveries represents an improvement from the mid-1990s, gains have stalled since 2000. To spur further improvements, Premier, a purchasing and information network for not-for-profit health care facilities, launched a 21-month initiative in May with 16 hospitals to formalize care practices designed to eliminate preventable birth-related injuries and deaths. A number of the best practices used in the project have shown encouraging results in smaller-scale efforts at individual hospitals, says Maureen Bisognano, executive vice president and chief operating officer for IHI, which is part of the new initiative’s advisory committee. Bisognano adds that the goal of eradicating preventable birth injuries and deaths could be attained in this country if hospitals concentrate their efforts in three key areas.”Superbugs by Jerome Groopman in the NEW YORKER
“Nobody has the answer right now,” he said. “The fact of the matter is that we have found all the easy targets” for drug development. He went on, “So the only other thing we can do is continue to work on antibiotic stewardship.” Meanwhile, new resistant bacteria, Moellering asserted, aren’t going to go away. “We can temper things, we might be able to slow the rate of emergence of resistance, but it’s unlikely that we will ever be able to conquer it.”Hospitals try to calm doctors' outbursts-Medical road rage affecting patient safety
“The national group that accredits healthcare organizations issued a safety alert to hospitals last month, saying outbursts threaten patient safety because they prevent caregivers from working as a team. The organization, The Joint Commission, for the first time is requiring all hospitals, nursing homes, and other healthcare facilities to adopt “zero-tolerance” policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders.
Dr. Peter Angood, chief patient safety officer for the commission, said most hospitals have tolerated healthcare road rage to the point where it has become an accepted part of the culture. That can be particularly true, others said, in high-stakes surgery, a field that can attract high-intensity physicians who are used to being in charge.
Many hospitals have already adopted civility policies, including Massachusetts General Hospital, where leaders of the hospital’s patient safety initiative saw a link between errors and disruptive behavior, said Jeff Davis, senior vice president for human resources.”
I presented at a conference with Dr. Peter Angood in LA last fall where this topic was spotlighted. A nurse leader spoke of intolerable behaviour and advised nurses to call 911 if they felt in danger in the hospital. Managemnent was ignoring their continual complaints. Nurses often confide stories of “medical road rage” to me and hopefully this JCA initiative will make hospital working environments safer for all concerned.
They are being robbed of their childhood
“Until the core problem of safety on the streets is solved, schools must address the needs of children who walk in their doors, scarred by violence, Radner said.”
I attended an inservice on violence and gangs last week. The police officer educated us on the details of how to keep us and our staff safe as we complete home visits and therapies in these “hot bed” areas. Be aware of your surroundings and trust your instincts. The children did not choose this environment but are stuck there until the cycle changes through the compassion of a mentor.
You may not think that this article is healthcare related, but it is. Know the environment that your pediatric patients come from. It may assist you with a diagnosis and also may provide them with a safe haven while they’re a guest at your facility. Invite a local police or child protective officer to a CME. It takes a village…