Reflections Day 1 and 2 at Telluride Experience in Napa

I have thoroughly enjoyed my time here at the conference so far and have been fortunate enough to be surrounded by an incredible group of healthcare providers that each bring their own story and perspective to our discussions. From the residents to the nurses, I have been able to see how each professional approaches problems in patient safety and care, all the while maintaining the goal of patient-centered care. As a rising second-year medical student, I haven’t found myself on the wards quite as much as I am eager to yet and so it has been a little difficult imagining in what capacity I can be the most effective influencer of change in the field of safety and quality. I’ve learned from our vivid and open discussions that anyone and everyone from hospitality staff to the chief medical officer can be a force for change and that healthcare systems work at their best when everyone feels empowered to speak up and feels as if they are on a level playing field and equally valued. This is especially important when it comes to the field of patient safety where non-clinical staff members might be even better at catching near-misses than the very same clinicians that are assigned to care for their patients.

Two of the most interesting things that have piqued my interest so far have been the topic of handoffs and interdepartmental/inter-shift communications as well as the topic of informed consent. As someone who only has experience handing off patients as an EMT to an awaiting ER Nurse or Physician, I found it interesting to hear from the residents how they often have to handoff upwards of 50 patients at a time to the night team. I was particularly interested in hearing how much of the handoff allows the provider to maintain their autonomy in making their own general impression of the patient’s severity and how much fo the handoff might bias and even mask underlying problems that wouldn’t be found simply by reading through the patient’s charts. In our session today regarding our future QI goals, I was able to get some ideas to begin my search and exploration to see where I can potentially help improve the quality of communication and prevent medical errors or sentinel events that occur as a result of handoffs.

The topic of informed consent was also excellently presented in our lectures and film today. One of the things that stuck with me is that informed consent is not a singular event, but rather a serious of dynamic conversations that changes as the patient’s condition and goals change throughout the course of treatment. It is not simply the signing of a form, but more importantly is the ensuring that your patient is able to appreciate the benefits of a procedure while maintaining perspective of the potential harms and the possibility of negative outcomes even in the lowest risk settings.