Some time ago I read about the sad case of a toddler who underwent surgery for lazy eye correction, only the ophthalmologist “corrected” the good eye instead of the lazy one. Apparently she realized her error mid way and fixed the lazy eye as well. The child’s mother learned of this later.
I find many categories of lawsuits to be frivolous (that infamous hot, scalding coffee case anyone?) but if the parents ever had a strong case against a doctor, Jesse Matlock’s parents certainly did. But reactionary impulses aside, I’ve been thinking about how such errors can be prevented.
ICD-10 coding for example offers laterality info, but its implementation is still a-ways from becoming reality. Also ICD codes simply help you or your organization bill appropriately. If you need laterality information in any stage prior, you’re probably dependent on your trusty clinical notes.
Today Reuters had an article about patient photos as part of hospital records. Apparently it’s being tried at Children’s Hospital in Colorado. When a child is brought in for treatment, his or her digital image is added as part of the medical record.
Reuter reports that compared to 12 occurrences of mistaken orders in 2010 (in which treatment intended for one patient was performed on another) the number had fallen to 3 in 2011. All three of the cases involved children whose photos were not added to their medical records on arrival. There are similar feel-good statistics on near miss cases in which another worker caught a medical error put in place by a colleague (33 near misses in 2010, 10 in 2011).
The Reuters article notes CH, Colorado sees something like 13500 patients a year. The improvement in numbers after photo ids might not seem like much but each error prevented helps us gainthat much more confidence in our care providers. The article states that some parents refuse photo ids for kids out of privacy concerns. Let’s face it, this is for a loftier purpose than a child modeling. One workaround could be to discard the patient’s ID soon after the encounter is complete.
While the article doesn’t explicitly discuss laterality, that too could be a possible use for photo ids, if maybe the photo can be marked to point out surgery sites for example.
In terms of cost, digital photography has never been more affordable than now. For a couple of hundred dollars you can buy a good quality digital camera and its needed accessories. Basic photo editing software can assist with keeping image sizes manageable. The big downside I see is that it increases the workload somewhere along the encounter – someone needs to take these pictures and upload them, and knowing how things roll downhill, it might well be the already harried nurses and aides.
But the payoffs to quality healthcare could be enormous. So what do you think – has the time come for this idea?