Grand Rounds Summary - July 1

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Dr. Miller - How to Give a Lecture

Keep your presentation simple. Remember that good artists borrow and great artists steal. Find presenters that inspire you.

Know your audience and environment

P3: Prepare, Practice, Pitch

Prepare: plan both your environment and your visuals and know the knowledge base of your audience. Your visuals matter, know where your audience is looking on your slides

Practice: visualize, practice presentation in the room to know the equipment

Pitch: punctuality - reengage the audience with participation and interaction, passion, and make it personal with eye contact

Dr. Hill and Dr. Miller - Medical Errors

Error Types:

  • Skill based - errors are slips/lapses
  • Rule based - rules are applied incorrectly
  • Knowledge based - Deficit in knowledge such that false logic was followed

All of these systems are based on decisions made by system-led cognition:

  • System 1 - Pattern Recognition
  • System 2 - Hypothetico-deductive reasoning

These types of errors and biases happen in cases all the time, not just cases in which there was a poor outcome and M&M event. Analyzing your own thought process and being on alert for mistakes like this is key.

Peer Review Exercise:

M&M and referrals trigger our peer review process which is our way to ensure quality in the department - we ran through some cases and our collaborative lessons:

  •  Document your impression of the patient and justify what you are doing. Especially document if you are deviating from the perceived standard of care.
  • Document conversations with the patients about either of the above

1% of cases enter peer review and only 1% of those end up as level 2 or level 3 (probable error or error), however you will have these and they are to learn from

18% of presented cases were dispositioned within 60 minutes of turnover, do it carefully

Dr. Knight - Procedural Complications

  • Focus is hard to keep in the ED: Average number of interruptions happen every 3 minutes
  • Sterile cockpit during critical parts of the procedure can minimize errors
  • Consider both the immediate mechanical errors and downstream errors (infection, occlusion, etc)
  • Subclavian risk of complications increases by 6 after 3 attempts
  • Operators with > 50 insertions decrease complications by 50%
  • If you have not had success after 3 attempts - try a new approach