The unfortunate tendency in society to mistrust professionals leads to bloated control structures that do reduce value and add paperwork. Anybody who works in care and health care can cite horrifying examples. Recently someone who works with mentally handicapped juveniles told me the amount of paperwork per juvenile has quintupled in 5 years time.
Fontunately there are other examples. In the blog “Running a Hospital” Paul Levy, President and CEO of Beth Israel Deaconess Medical Center in Boston (USA) describes the stunning results of a “trigger” program. A trigger is an early indicator of trouble. And as it turns out, if the nurse is worried, so should be you. Trust the instincts of a dedicated professional.
” The Triggers Program has various specific criteria mandating a response from providers. For example, if the pulse rate is acutely greater than 130 beats per minute, a Trigger is called and the team responds. However, we have one criterion which is much more subjective: “marked nursing concern.” When we implemented the Triggers program, many physicians were very nervous about giving this criterion. They were afraid that they might be called in the middle of the night for things that weren’t really important, and that nurses might use this as a weapon if they did not like the physician or if they disagreed with the plan of care.
Well, it turns out that nurses use this Trigger quite judiciously – only 15% of our Triggers are called only for nursing concern. (In another 27% of cases, nurses express “marked concern” but the patient also meets other criteria simultaneously.) It also turns out that if nurse has “marked nursing concern,” it means you’re really sick. The in-hospital mortality rate for a patient who has a Trigger called for “marked nursing concern” is 10.7%.
This is roughly twice as bad as showing up to the Emergency Department with a heart attack.
Literally.”
