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Feedback for Emergency Doctors (FED)


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Innovative project to leverage routinely collected data to provide feedback to healthcare professionals

Published in: Health & Medicine
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Feedback for Emergency Doctors (FED)

  1. 1. Feedback for Emergency Doctors (FED) Learning from experience, systems not people, the need for timely change in the NHS Dr Carl Reynolds
  2. 2. Learning from experience <ul><li>James Lind 1747 </li></ul><ul><li>Controlled clinical experiments </li></ul><ul><li>Lemon juice rations and reduction of scurvy </li></ul>
  3. 3. Learning from experience <ul><li>Ignaz Philipp Semmelweis 1847 </li></ul><ul><li>Hand washing reduces puepural sepsis </li></ul><ul><li>&quot;saviour of mothers&quot; </li></ul>
  4. 4. Learning from experience <ul><li>John Snow 1854 </li></ul><ul><li>Removed the handle of a water pump shortening a cholera epidemic </li></ul><ul><li>“ Father of epidemiology and public health” </li></ul>
  5. 5. The cost of not learning <ul><li>Historically slow to learn on a macro scale </li></ul><ul><li>Perhaps getting better </li></ul><ul><li>Micro scale variation largely ignored at present </li></ul>
  6. 6. Systems not people <ul><li>“ The safety profile of the aviation industry is the envy of the medical profession” </li></ul><ul><li>Aviation is a leading industry in Risk Managment Wilf-Miron, Quality & Safety in Health Care (QSHC) 2003. </li></ul><ul><li>Blame free reporting culture, event analysis, and system change are key. </li></ul>
  7. 7. Systems not people <ul><li>Blaming the person vs changing the system </li></ul><ul><li>Learning from near misses and adverse events – continuous feedback </li></ul><ul><li>Key safety making features are a reporting culture and focus on error provoking properties of system rather than individuals. E.g IV KCL </li></ul>
  8. 8. The NHS is changing <ul><li>Patient safety organization </li></ul><ul><li>Central collation and analysis of local incident reports </li></ul><ul><li>But must do more </li></ul>
  9. 9. The super-doc fallacy <ul><li>There is a lot to know </li></ul><ul><li>Reliance on the unaided human mind is an anachronism </li></ul><ul><li>Your doctor probably could do much better (Weed 1999) </li></ul>
  10. 10. Maintaining and improving your performance – the rhetoric <ul><li>a. maintain a folder of information and evidence, drawn from your medical practice </li></ul><ul><li>b. reflect regularly on your standards of medical practice in accordance with GMC guidance on licensing and revalidation </li></ul><ul><li>c. take part in regular and systematic audit </li></ul><ul><li>d. take part in systems of quality assurance and quality improvement </li></ul><ul><li>e. respond constructively to the outcome of audit, appraisals and performance reviews, undertaking further training where necessary </li></ul><ul><li>f. help to resolve uncertainties about the effects of treatments </li></ul>
  11. 11. The present reality <ul><li>Unless little David dies or you complain or sue </li></ul><ul><li>Super-doc won’t ever find out he just made a big mistake </li></ul><ul><li>There is no routine feedback system in place </li></ul>
  12. 12. Levering technology - FED <ul><li>Using the data that’s there </li></ul><ul><li>A monthly report </li></ul><ul><li>Hard to set up but well received </li></ul>
  13. 13. Why so hard? <ul><li>Hierarchy </li></ul><ul><li>Tradition </li></ul><ul><li>Learned helplessness </li></ul><ul><li>Lack of support for innovation </li></ul>
  14. 14. Benefits <ul><li>Doctors get a log book of their activities for free </li></ul><ul><li>Facilitates reflection on activities and stimulates further reading </li></ul><ul><li>Raises awareness of the audit trail and the importance of accurate coding </li></ul><ul><li>Allows self assessment of diagnostic activity </li></ul>
  15. 15. Next Steps/Wishlist/Predictions <ul><li>Wider roll-out, improved usability, mechanism for patients to give individual private feedback </li></ul><ul><li>Personal computing revolution comes to healthcare (and facilitates learning from experience) </li></ul><ul><li>Utilization of data for professional development/improving patient care </li></ul><ul><li>Greater transparency – open data, standardization, lower barriers to entry for innovation and improvement </li></ul><ul><li>An RCT, more quality research in general </li></ul><ul><li>Systems that make it easy to do the right thing </li></ul><ul><li>Help from you guys </li></ul>
  16. 16. Feedback for Emergency Doctors (FED) Learning from experience, systems not people, the need for timely change in the NHS Any Questions? Dr Carl Reynolds