I’ve been in Kijabe a little over three weeks. Yesterday I attended a special morbidity and mortality conference wherein we reviewed the preventable death of an orthopedic trauma patient. I was peripherally involved in his care and of course have repeatedly questioned myself about whether or not I could have should have predicted picked up on followed up on any number of details that were put together only too close to the time of his death. I sat through the discussion partially numb while so many glaring systems issues that contributed to this outcome reached out and slapped me in the face.
Quality improvement work is so cut and dried when presented as an academic topic – root cause analyses, PDSA cycles, systems-level reflection following carefully laid-out evidenced-based models with neat acronyms. But the sensitive nature of debriefing a bad outcome and preventing future similar ones is always messy. It takes more than an hour, and hinges on mutual respect and established relationships. I’ve been struck by the willingness of the staff here at Kijabe Hospital to discuss bad outcomes openly and often. It’s necessary. Complications happen everywhere, but talking about them is the first step.
Next week I return to Vanderbilt. Some of the resources I most look forward to include:
- Ubiquity of dressing supplies – no need to ask patients to purchase each piece of gauze from the pharmacy before dressing their wounds in clinic or the ward
- Medical receptionists – to avoid the frustrating experience of locating patients in the gray areas between the ER, outpatient clinics, waiting areas, and hospital wards without an up-to-date directory of patient location
- A serviceable EMR
- WiFi – for ready access to UpToDate, PubMed, society guidelines, etc.
- Nephrologists, gastroenterologists, interventional radiologists, all radiologists, psychiatrists, and all my other specialist friends not represented here
In contrast, things I will miss about my time in Kijabe:
Teaching junior residents here
A more relaxed surgical hierarchy
The option of not pan-CT scanning every acute and elective surgical patient
Reusable sterilized cloth drapes and gowns in the OR
The simplicity of hanging IV fluids on a nail on the wall behind a patient’s bed
Being a 5-minute walk from the hospital while on home call
Taking time to greet everyone good morning before getting “down to business”