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Graduate Medical Education and Patient Safety
- Kaveh G. Shojania, MD;
- Kathlyn E. Fletcher, MD, MA; and
- Sanjay Saint, MD, MPH
- From Ottawa Health Research Institute, Ottawa, K1Y 4E9 Ontario, Canada; Clement J. Zablocki Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee, WI 53295; and University of Michigan Medical School, Ann Arbor, MI 48109.
IN RESPONSE:
We thank Dr. Fine for his kind remarks about the Quality Grand Rounds series. Our article highlighted the importance of clear communication and the ways in which failure to explain key aspects of the care plan contributed to several errors in the case. We focused on physician trainees because of space limitations. However, we agree that poor physician–nurse communication contributed to the mistaken insertion of a feeding tube instead of a nasogastric tube, and failings in this area are an important source of medical errors.
We agree with Dr. Griner that the use of simulation promises to improve the acquisition of key procedural skills by trainees. A rapid response team may also have helped in the case, but the physicians' responses to the nurse's pages were in fact quite timely and the nurse seemed satisfied by the physicians' assessments. In other words, even if a rapid response team had been available in the hospital at the time, there was no indication that the nurse would have called for it. Moreover, despite widespread enthusiasm for rapid response teams, the only randomized, controlled trial to evaluate their efficacy showed no benefit (1) and other studies that have reported benefits suffer from important methodological limitations (2).
Dr. Workman highlights our characterization of the treating clinicians' impression of “mild pancreatitis” and their expectation of an uneventful recovery. As part of our preparation of the case discussion, we reviewed the study cited by Dr. Workman, which reported outcomes of pancreatitis stratified by age (3). Although it is not clear what proportion of patients who died had initially appeared clinically stable (as in the case we discussed), we agree that the possibility of adverse outcomes from pancreatitis should never be underestimated, especially in elderly persons.
Kaveh G. Shojania, MD
Ottawa Hospital and Ottawa Health Research Institute
Ottawa, K1Y 4E9 Ontario, Canada
Kathlyn E. Fletcher, MD, MA
Clement J. Zablocki Veterans Affairs Medical Center and Medical College of Wisconsin
Milwaukee, WI 53295
Sanjay Saint, MD, MPH
Ann Arbor Veterans Affairs Medical Center and University of Michigan Medical School
Ann Arbor, MI 48109
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
