another trauma update
on Random Uganda (Uganda), 21/Mar/2010 15:09, 34 days ago
Last Friday we had a case conference to discuss a trauma patient who sat around at IHK for over two weeks with an undiagnosed, unstable neck fracture. The conference, in itself is progress—actually getting doctors together to talk about a bad outcome and make plans for prevention of future occurrences is a huge step forward here. (I’ve been trying to get IHK to start having a monthly morbidity and mortality conference since I got here, but, as it turns out, nobody really wants to talk about minor details like how many patients died last month) Granted, if we had been having this particular case conference back home, we would have been sitting down with our insurance company to decide just how much money we should give the patient and the patient’s lawyer to keep them from suing the bejesus out of us.But, as it were, we sat down with the director of nursing, the director of OPD, the orthopaedist, the radiologist, the ward doctor, the head of physio, and the medical director (one of 3) for the hospital and talked about what went wrong. Well, okay, actually the discussion seemed to focus on what went right. We didn’t kill the patient (or worse, make the patient a ventilator dependent quadriplegic) despite having multiple opportunities and trying really hard several times. And the physiotherapist didn’t choke the living shit out of the ‘spine specialist’ even though she had every reason.It turns out, according to the orthopaedist who removed the patients stiff collar based on his‘clinical judgment’ (despite looking at an x-ray, which, albeit a pretty crappy excuse for a film, showed the fracture on the patient’s first night in the hospital), that missing neck fractures is an everyday occurrence and we shouldn’t make a big deal of it. He suggested that we ‘Googlemissed cervical fractures’ and we would find loads of them. I was going to do this, but the internet is down today.I tried to suggest how following certain protocols for patients with multiple trauma—such as the one where patients with head injuries or distracting injuries (another painful injury that might take the patient’s mind off their neck) similar to this patient had to have a complete series of neck x-rays (not done) and maybe a CT (not done) and have those films reviewed by someonewho actually knows how to read x-rays (not done) prior to the collar being removed—might keep this from happening again. But I was shouted down by the orthopaedist and the radiologist. They weren’t going to start ordering a bunch of extra films or CTs on patients just because we missed one little neck fracture.The general consensus among the doctors present seemed to be that the care was‘good enough for Uganda,’ and that my ideas for a trauma team, and protocols, and forcing the radiologist to actually look at all x-rays taken in the ICU, well, they were all well and nice for ‘over there,’ but they just weren’t practical for IHK.So my question of the other day has been answered. (see one of the updates posts where I mentioned that IHK/IMG has a new vision statement—to deliver medical care to ‘international standards’) To which international standards are we striving?Here’s to the international standard of being good enough for Uganda.