In 2015, three medical students received the first SHM Student Hospitalist Scholar Grant to complete scholarly work related to patient safety in the hospital. Earlier this summer, they began presenting their work on SHM’s blog, The Hospital Leader.
The following are excerpts of those posts.
Why We Should Care about Alarm Fatigue
By Mimi Zander
When I arrived back at the Children’s Hospital of Philadelphia (CHOP) after my first year of medical school, I knew what was awaiting me: thousands of alarms from physiologic monitors, most of them inconsequential, lined up neatly in spreadsheets, splattered all over research databases, lighting up on video screens, chirping down hallways and up elevators. Of course, they were incessantly firing at the bedside, but when patient care is video recorded for Dr. Bonafide’s research study on alarm fatigue, those patient care hours turn into data points that live on hard drives and servers waiting to be classified, annotated, and cataloged by a team of research assistants, including me.
I began working at the CHOP while attending the University of Pennsylvania’s post-baccalaureate premed program. What started as a temporary summer research position turned into an almost three-year endeavor. The pilot that I helped design uses video cameras in hospitalized patient rooms to record patient care. We download the video, edit it so we can review multiple viewing angles at one time, download a spreadsheet of all of the alarms that fired during the study period, and then, with a little patience and some subtraction, we can line up every alarm that fired with the video clip. That’s the easy part.
This small pilot has transformed into a much larger study with a much larger volume of alarms. Since I started medical school last July, the research team has steadily collected video data all year. With support from SHM’s student scholar grant program, I have been able to return to CHOP for the summer. And now the video review begins.
The First Two Years—Pathways and Patient Outcomes
By Frank Zadravecz, MPH
The first two years of our medical curriculum are an introduction to the human body’s normal and pathophysiology and an attempt to untangle the complex pathways involved in the interactions between self and nonself. We hope to make connections between our physical exam findings and the physiologic pathways we have at our educational foundation. We begin to realize that there is a fine line to walk when treating a patient: Altering the inputs of a single system can drastically affect the outputs of another.
If we place patient outcomes in the context of the dance that occurs in clinical care for patients on the wards, similar to the downstream effects of disrupting biological pathways in illness, there is a multifactorial system underlying hospitalized patient outcomes.
Prior to medical school, I worked for several years as a population health epidemiologist in the Democratic Republic of Congo and then as a research data analyst at the University of Chicago. During my work in both of these settings, I quickly learned the relevance of contextual clues in complex systems-based problem solving. Over the course of my first year of medical school, I realized that nowhere is this creative use of information more important than in the inpatient setting, where we attempt to distill out the most important available information when assessing a patient.
But there are caveats to our interpretations of data points: Are we recognizing the most relevant physiologic associations when making clinical decisions? Are patient data really telling us what we think they are? What systemic factors are at play when patients experience an adverse outcome?