I'll be presenting at an M&M conference on Monday-- M&M referring to morbidity and mortality-- where we talk about recent patient situations that did not go entirely smoothly-- that's a gentle way of saying it-- and where there are potential lessons to learn.
The lesson from the case I'll be presenting is:
Patients should not stop breathing at night, because there aren't enough people in the hospital to notice.
There are more lessons to learn than that one, of course. But that's the big one. You show up in the morning to a patient doing far worse than when you left the night before and the first inclination, of course, is to blame the night team. But then you remember when you were on the night team, and it was you and 75 patients you'd never met, and your pager is going off every three minutes with something new, and the elevator isn't working, and the notes aren't clear, and you can't be in two places at once, and the nurses are changing shifts, and--
"How long has he been like this?"
"Doesn't say anything in the chart."
"I think we need to get him to the ICU."
"There aren't any beds."
"I think we need to get him to the ICU anyway."
"I'll call for transport."
"I think we need to get him to the ICU now."
"I'll page the attending."
"I think we need to get him to the ICU right now."
I think it's possibly a jinx to know you're scheduled to present a case at an M&M conference that week. Trouble comes looking for you. I thought I'd be able to skate by with a guy who choked on a bone in his hospital food, but ended up okay. A bone in the food. Served to a guy on a purees and liquids diet. That's an easy Powerpoint slide to make. All sorts of clip art available online. Very straightforward. But, no, instead I get to figure out what kind of graphics I can use to depict "not breathing" and "no one's watching."