Reading The Checklist Manifesto
is a mind expanding experience. I can’t stop thinking about its implications and how I can help my patients by eliminating “errors of ineptitiude.” (Which I learned as the difference between errors of omission as opposed to errors of cognition, where the latter is an error because the condition requires care beyond the skill level of the individual and the former is when the patient is harmed because of a lapse in applying standard care.)
Good blog post on the Gawande. A negative review of the book in the Wall Street Journal. A positive review on Amazon by Malcolm Gladwell.
My emphasis on teaching as my personal niche in medicine is from the idea that more important than pushing boundries of science is to learn the lessons of what has already been discovered.
After reading a couple of chapters I searched for Gawande in the NEJM and was delighted to see the breadth of contributions he has made as either scientist, editorialist or subject.
Right now I am busy crafting checklists for nephrology. I am focusing on the outpatient CKD care and routine admissions for hemodialysis patients.
Is anyone aware of checklist implementation in nephrology?
Fabulous idea….crafting checklists referable to Nephrology (also Renal Transplantation). I'm planning to read Gawande's book and perhaps will get inspired in the renal arena!
Could not agree more. Quite a chasm between what we do and what we know,
I did a small CKD care quality assessment project looking at an inpatient population and while doing so came across quite a bit of material from the Kaiser Hawaii Nephrology group.
They actively solicit referrals from their generalists by sweeping the electronic medical for high risk CKD patients (low eGFR, proteinuric so on).
Here's a paper describing one of their projects…
http://www.bmj.com/cgi/content/extract/339/jul08_3/b2395
In poking around they then have algorithms for generalists to follow for identified CKD patients and those that are deemed low risk and not longitudinally followed by nephrologists…
http://www.delfini.org/ckdguideline012009final.pdf
Great comments. Thanks.