I had a whole story ready to post about another very sick child that we treated, but decided to leave a more general issue instead.
When there are critically ill patients, the staff has to think quickly and act quickly. Interruptions are counterproductive to our job during those times. Think about trying to concentrate on something – whether it be driving and trying to find a street address, talking on the phone, or trying to figure out a crossword puzzle – and being interrupted by your kids. The interruptions knock you off track from the task at hand.
There was a 6 month old who was critically ill in our department. With children, tasks such as starting IVs and intubating them are more difficult, and you also need to check the dosages of medications that they’re being given since pretty much all medications for children are weight-based. All the medical providers really need to focus.
So how do we manage a situation in which the parents are interrupting the care of their infant child?
I understand that seeing all of these things happen to your child is a scary experience. I understand that parents want to be there with their sick children. I’m a parent. I’ve seen it with my children.
Should the physician trying to save a child’s life stop what he or she is doing to explain to the parents what is happening – which may affect the survival of the child – or should the physician get done what needs to be done and talk to the parents later?
Some parents are very good about staying out of the way and just watching what is happening. But some parents will push you out of the way to stand next to the child, holding the child’s arm and caressing the child’s head when you really need access to the arm and the head.
If the family’s expectations are not met while you’re trying to save the child’s life – whether it is because you didn’t answer questions to the family’s satisfaction, whether you asked them to do something they didn’t want to do, or whether you said something to the staff that the family took the wrong way, then you may find yourself at the end of a complaint to hospital administration.
If you everything necessary to meet the family’s expectations, but doing so causes delays in caring for the child and the child suffers a bad outcome, then you may find yourself at the end of a malpractice lawsuit.
I know that some people will suggest “meeting in the middle.” That is fine and usually works well in most situations.
However, there are times when “meeting in the middle” doesn’t work, and those times may cost a child his or her life.
Should we excuse all family members from the room during critical care moments to decrease the likelihood of medical errors related to interruptions?
If we’re talking about “patient safety issues,” situations like this occur a lot more frequently than some of the other things that JCAHO tries to regulate.
Does JCAHO need to regulate family visitation?