2016 Scholarship Winners
The law firm of Baker & Gilchrist hosted their first ever scholarship contest this year. We asked applicants to answer the following prompt in an essay or video:
Preventable medical errors are the third-leading cause of death in the United States, according to researchers at Johns Hopkins Medicine. Claiming more than 250,000 lives per year, medical errors rank just below heart disease and cancer as a leading cause of death in the U.S. In an essay of 350 words or more or a video, please describe an idea to help combat this serious problem.
We received 50 fantastic entries but could only choose three winners. Our three scholarship winners are:
Mary is a student at Texas A&M pursuing a degree in Community Health, she hopes to work outside of the US developing and evaluating health programs. She describes herself as a financially independent youth who has overcome hardships that have a made her a stronger, wiser, compassionate and dedicated person.
Watch Mary’s Video:
Brandy is a graduate student approaching the final year of her degree program for the advanced practice Doctorate in Clinical Laboratory Science. Having spent the last 14 years in healthcare she is pursuing a career program and path that would enable her to help improve patient care by working with physicians and other practitioners to ensure appropriate test utilization and correct test interpretation. In order to complete this degree which culminates in a full-time, unpaid, clinical residency year, she will have to quit her current employment and move her family across the country.
Read Brandy’s Essay:
Clinicians Do Not Know What They Do Not Know
In the 2015 Institute of Medicine report regarding diagnostic errors in healthcare, it was determined that 17% of medical errors in hospitalized patients were related to incorrect patient diagnosis, that 9% of all patients have experienced major diagnostic errors at least once in their lifetime, and that thousands of patients die every year due to diagnostic error. Given the accepted statistic that 70% of medical decisions for both diagnosis and treatment are based off of laboratory data it would be easy to point the finger at the laboratory for cause of these deaths. Laboratories, however, are the most regulated areas in healthcare and are a prime example of continuous quality improvement. Many studies in recent years have identified that the vast majority of laboratory errors are in the pre-analytic and post-analytic phases of testing; specifically, in clinicians ordering the incorrect test or misinterpreting the test results.
More than 50 years ago, pharmacists identified a similar problem in the incorrect prescribing, dosing, and monitoring of medications causing insurmountable patient harm. They created the clinical pharmacist to ensure patient safety when came to prescription errors. Most clinicians would agree that the addition of clinical pharmacists to the healthcare team have fundamentally changed the way medicine is practiced in hospitals today and many studies have shown that having a clinical pharmacist participate in patient medication management will dramatically decrease the probability of medication errors.
So how does the laboratory address the diagnostic errors pertaining to clinician incorrect test ordering or result interpretation? One could assume that the pathologist is an obvious choice to fill this void. This assumption, however, would be misguided. For many years the American Society for Clinical Pathology has been urging its membership to leave the proverbial basement and join the healthcare team, but many pathologists have been reluctant to do so. In a presentation at the American Society for Clinical Laboratory Science National Meeting in August 2016, Dr Michael Laposata, a clinical pathologist, identified some reasons as to why many of his pathologist colleagues have been unwilling to step up. These reasons included that most pathologists are anatomic and not clinical in their training, therefore, they often do not have the knowledge base in order to answer the majority of the questions that would be presented to them regarding the most appropriate test to order and how to interpret the results. He also mentioned that pathologists are in very short supply with more than 25% of all residencies going unfilled every year thus requiring each pathologist to work faster to keep up with an ever increasing demand for their services. So what should the laboratory do to address this gap in patient safety and decrease medical errors?
The idea of an Advanced Practice Doctorate in Clinical Laboratory Science (DCLS) began shortly after the publication of the Institute of Medicine’s “To Err is Human” report in 1999. This advanced practitioner would have both fundamental experience in performing the testing but also advanced education at the doctoral level in all areas of clinical laboratory medicine. They would eagerly join patient-centered healthcare team to provide consultation and ensure both appropriate test ordering and test result interpretation. This individual would also participate in patient education on their laboratory tests, results, and explaining the importance of future laboratory monitoring of their medical condition. Additionally, this doctorate level scientist would perform outcome based research as a part of continuous patient care quality improvement. This may sound like a myth or a dream but it is finally becoming a reality.
Rutgers University opened and accepted the first student into the first Advance Practice Doctorate in Clinical Laboratory Science in the country in spring 2014. That student will begin their clinical residency year this May 2017 and is scheduled to graduate May 2018. I am that student. I may be the first, but I will not be the last as there are others in the program behind me at Rutgers, as well as other programs beginning to open across the country including at University of Texas Medical Branch – Galveston and at University of Kansas Medical Center. Several others are in various stages of developing their own programs.
With currently more than 4,000 orderable laboratory tests, each with their own limitations that can result in inappropriate interpretation, there is a critical need for laboratory consultation. As the first DCLS scheduled to graduate in the country, this is a new path to address patient safety and medical error issues. I plan to show the medical community what an asset we can be and that our participation in the patient-centered healthcare team will decrease medical errors and improve both patient safety and satisfaction.
Michael is a newlywed who is excited to embark on the next chapter of his life. The rigors of pursuing a master’s degree has required him to make the tough decision of solely focusing his efforts on his studies and relinquishing his steady income. Michael says he is eager to finish his master’s degree to progress my career, provide a solid foundation for his family and become a leader for positive change in my community.
Read Michael’s Essay:
According to the Institute of Medicine, errors in administrating patient medications affects an estimated 1.5 million people per year. Incorrect medication dosages, lack of information surrounding previous medical history and allergies or disregard for possible fatal medication interactions are important factors to consider when searching for potential solutions. The combined effort of improving medication dosage packaging as well as creating a centralized, national Electronic Medical Records database could help to combat common medication errors.
An area of potential improvement of patient management and subsequent medication error avoidance lies in multi-dose vial medication packaging. Currently, numerous medications are packaged, often times, in larger finite quantities. Correct dosages rely heavily on practitioners drawing up the appropriate amount from these larger vials for the patient. As a result, the potential for human error is much greater. By creating vial dosages in smaller increments, it could reduce the potentiality in human calculation error. Furthermore, quality assurance research could be conducted to determine the most common dosages for particular medications to maximize efficiency and productivity of medical personnel. For example, creating smaller, perhaps more common, cubic centimeter dosages, it could reduce human error as well as create more efficiency departmentally with less time spent calculating these smaller increments from a larger quantity. Presumably, pharmaceutical companies would baulk at this repackaging notion due to the potential increase in cost. An adequate risk-benefit analysis would likely need to be conducted. Based on how common these errors are in the medical field and the potential improvement in patient outcomes, from a broader perspective, it would seem this change would be more beneficial. Collaboration between medical professionals and pharmaceutical companies could make this improvement a reality.
With each passing year, collaboration across industries, economies, and borders become more important to foster innovation and progress; the opportunity for the medical field to improve efficiency lies in a more collaborative EMR database. With more people insured due to new legislation, the need to have a highly efficient system in place is much greater than it ever has been in years past. Presently, a centralized, database where medical professionals can access patient records across geographical or hospital walls for that matter does not exist. Each hospital utilizes record systems from independent vendors, therefore, limiting access to important medical information. Should the need arise for a patient who is traveling or switching hospitals need medical attention, often times, medical personnel are going off of little past medical history to provide care. By creating a national database, this could foster much more collaboration, and in many instances, more efficient care. For example, if a patient comes into a hospital unconscious without any prior visit to that particular facility, with a national database, the doctor would be able to get a more holistic picture of the patient’s health without having to hypothesize on what care or medications to administer. While there are clear benefits to a national database, the obvious negative bi-product of establishing a central EMR would be the destruction of the medical records vendors industry. Again, a macro risk-benefit analysis would need to be conducted to weight the potential effects on these organizations. Conversely, these organizations could begin the conversation amongst their industry peers on how to collaborate with one another to increase the flow of information for the greater good of patient outcomes. Regardless, the information barriers between facilities are placing medical personnel and patients at risk for error.
In summation, the healthcare industry has undergone some major changes in recent years garnering a plethora of both negative and positive feedback; gaps still exist as exemplified by the unfortunate stability of medical errors. Improving how dosages are packaged and creating a national database to small actions we can take to continue progressing in this industry. Improvements cannot be made without first recognizing the issues properly. Innovation cannot happen without first breaking out of habitual, sometimes archaic, ways of thinking, Amongst all industries, the medical field must never stop asking themselves how they can improve.