Sunday, 13 March 2016

Why I have a record of my outcomes, good and bad

Recently I led a crisis team that was required to intubate a patient with severe pneumonitis.

Ultimately the process went well enough - the patient was established on mechanical ventilation and we set about implementing the strategies required to treat his underlying condition.

Later that day, I took the time to record the procedures I'd performed in my logbook on Osler.  Intubation, induction of anaesthesia, arterial line, central line, bronchoscopy, transportation of a ventilated patient.  It's what happened then that is the reason I'm telling this story.

I was forced to acknowledge that things hadn't gone as smoothly as I would have liked.  The patient had desaturated below a level I was comfortable with.  An IV was accidentally dislodged as we moved the patient onto the CT scanner.  There was nothing catastrophic, but to me, it was a trigger to examine what had occurred.

Importantly, it gave me the opportunity to review all my intubations and see if there was a signal - was this a once off event?  Or do I have a bigger problem?

But it left me wondering whether this was just me or does everyone have these issues?  In reality, I have no way of knowing because I can't benchmark myself against anyone else.  Perhaps I'm great at this, perhaps I suck.  Or perhaps I'm doing as well as anyone.  But it would be nice to know, because it changes how I see my performance.

Recording my complications doesn't mean I've failed or am negligent.  It might not even by my fault.  But it did happen, and that's the point.  If there is a way of stopping it happening again, then I need to find it.

With this in mind, I can now set my attention to figuring out why things had not gone as well as they could.  I found a few issues, both personal and team based, and have set about fixing them so I can reduce the chances of this happening next time.

And while I would love for things to have gone better the last time, it's the next time I can do something about - and I feel good about that.

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