12 episodes

From the JAMA Network, this is JAMA Performance Improvement: Do No Harm, the podcast about performance improvement and medicine that aims to elevate the quality of care, one patient at a time, with host Ed Livingston, MD.

JAMA Performance Improvement: Do No Harm JAMA Network

    • Medicine

From the JAMA Network, this is JAMA Performance Improvement: Do No Harm, the podcast about performance improvement and medicine that aims to elevate the quality of care, one patient at a time, with host Ed Livingston, MD.

    The Aging Clinician: When Should Older Clinicians' Cognitive Abilities Be Evaluated?

    The Aging Clinician: When Should Older Clinicians' Cognitive Abilities Be Evaluated?

    More than a third of the physician workforce is older than 60 years, and 10% are older than 70 years. Cognitive abilities may decline with age but how cognition affects clinical practice is unknown. It is also not clear how clinicians’ cognitive ability can be measured and acted upon when diminished without committing age discrimination. Two major academic hospitals launched programs to test cognitive abilities in older physicians applying for renewal of their medical staff privileges. It went well for one and not well for the other hospital. Yet, in the hospital where the testing program was carried out, several clinicians who were not suspected of having any problems had profoundly affected cognition. Leo Cooney, MD, from Yale-New Haven Medical Center, and Anne Weinacker, MD, from Stanford Health Care, discuss their experiences in dealing with these difficult issues.
    Read the article: Cognitive Testing of Older Clinicians Prior to Recredentialing

    • 32 min
    How to Reduce Emergency Department Dwell Time

    How to Reduce Emergency Department Dwell Time

    Chaos in the emergency department is common. How to fix it is not always clear. Mary P. Mercer, MD, MPH, from the University of California, San Francisco, discusses how they successfully fixed their long dwell times at the emergency department at San Francisco General Hospital. Their solution was to create a fast-track unit that managed low-acuity patients separately from the rest of the emergency department cases. The most important aspect of this quality improvement effort was the ongoing and regular engagement of executives from the medical center with frontline staff.
    Read the article: Reducing Emergency Department Length of Stay
     

    • 24 min
    Poof – It’s Gone – The Disappearing Order That Led to a Patient Getting an Unnecessary Procedure

    Poof – It’s Gone – The Disappearing Order That Led to a Patient Getting an Unnecessary Procedure

    Electronic health records are the bane of most clinicians’ existence. They were supposed to help us but not only have they made life more difficult for clinicians, they are the cause of medical errors. Described here is a case of the patient receiving an unnecessary procedure because an order was not canceled in an EHR where it had disappeared from the clinicians’ view. A second theme in this case that is consistent in nearly all of the JAMA Performance Improvement articles to date is inadequate communication among clinicians.

    • 20 min
    EMRs Gone Bad: How Order Sets Can Result in Medication Errors

    EMRs Gone Bad: How Order Sets Can Result in Medication Errors

    One promise of electronic medical records (EMRs) was to reduce medication errors. That may not have occurred since one type of error, illegible orders, has been replaced by another: Order sets may incorrectly match a patient and necessary treatments. In this JAMA Performance Improvement podcast, we review a case in which guideline-based care was incorporated into an order set, then the guideline changed but the order set did not, resulting in a post-STEMI patient receiving β-blockers when they were contraindicated. Interviewees included Arjun Gupta, MD, University of Texas Southwestern Medical Center, and Jennifer L. Rabaglia, MD, MSc, Parkland Health and Hospital System, Dallas, Texas.
    Learning Objectives: To understand the role of β-blocker treatment in patients with acute myocardial infarction; to understand how EMR order sets should be developed and maintained.
    https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.0845

    • 25 min
    The Not-So-Good Idea of Sedating Patients Who Have Obstructive Sleep Apnea

    The Not-So-Good Idea of Sedating Patients Who Have Obstructive Sleep Apnea

    One-third of the US population is obese. Obesity is a major risk factor for obstructive sleep apnea. This condition is very common, and patients with sleep apnea are at risk of major complications from sedation. This JAMA Performance Improvement podcast reviews a case of a patient who did poorly after he was sedated for a medical procedure. Interviewees include Joshua Pevnick, MD, MSHS, from Cedars-Sinai Medical Center, and Jason R. Farrer, MD, from Northwestern Medical Faculty Foundation.
    Related article: Oversedation of a Patient With Obstructive Sleep Apnea Prior to Imaging
     

    • 26 min
    What to Do When There Is an Overdose of Insulin

    What to Do When There Is an Overdose of Insulin

    It is very easy to confuse drug concentrations and vials containing different amounts of drugs in the hospital setting. It is not uncommon to have dosing errors occur. In this podcast, we discuss how to manage an overdose of insulin and also how to implement preventive measures in the hospital environment to minimize the risk of drug dosing errors. Interviewees include Cynthia Barnard, PhD, MBA, MSJS, from Northwestern Memorial HealthCare, Lara K. Ellinger, PharmD, BCPS, from Northwestern Memorial Hospital, and Keith Hemmert, MD, from Northwestern Memorial HealthCare.
    Read the article: Insulin Dosing Error in a Patient With Severe Hyperkalemia
     

    • 32 min

Customer Reviews

Atieh ,

Valuable information

This is the only podcast that I enthusiastically wait for the next episode. Every health care professional should be familiar with the situations that they discuss and the best way to approach and manage them. I am a pre-med student working as a medical assistant and this podcast helped me personally to be more cautious and aware of my workplace ethical concerns. Thanks for all your valuable work.

PathMax ,

I took their advice on

being exposed to dishonest superior physicians and got counseling. I think it's helping.

Fromthestage ,

Engaging and interesting presentation

I really enjoyed the first episode of this podcast, so much so that I just subscribed. Ed is a terrific host and moderator. In fact, all of the recent JAMA podcasts have been interesting, informative and fun to listen to during my commute. Looking forward to the next episode.

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