QUESTION
How does New York City Health and Hospitals manage misdiagnosis?
2:08:58
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147 sec
New York City Health and Hospitals address misdiagnosis through electronic health records, nurse empowerment, and medical resources.
- Mitch Katz notes a study indicating a 22% misdiagnosis rate among ICU transfers, emphasizing the challenge of healthcare accuracy.
- Electronic health records offer decision support, and resources like UpToDate are available for current medical knowledge.
- Nurses are encouraged to question doctors’ decisions, exemplified by a case where a nurse refused a medication order.
- Council Member Mercedes Narcisse highlights the importance of interdisciplinary rounds for better communication and patient care.
Mercedes Narcisse
2:08:58
And about how do you manage misdiagnosis?
Mitch Katz
2:09:05
Could I'm sorry.
2:09:05
Could you say the last word
Mercedes Narcisse
2:09:06
for that?
2:09:07
Diagnosis.
Mitch Katz
2:09:10
Misdiagnosis occurs.
2:09:12
There was a recent JAMA Internal Medicine paper that looked at patients who were this is national data looking at patients who had been transferred from an a regular floor to an ICU and found that 22% had a misdiagnosis or mistake, national data.
2:09:34
And I I mentioned that just to say, you know, doc those nurses were all human.
2:09:41
Health care is a very hard thing.
2:09:44
Even the best doctors, best nurses don't always get it right.
2:09:49
What we do have is we have great decision support from our electronic health record We have free and easy to use up to date, which is the modern textbook.
2:10:01
We're we try very hard to empower our nurses to question doctors.
2:10:06
We don't want nurses to say yes, doctor.
2:10:09
We're very you know, we want nurses to independently if the doctor says, and I I recently reviewed a case where I was so thrilled because the doctor ordered a medication and the nurse refused.
2:10:27
And, like, that's exactly what we want.
2:10:29
We want the nurses to feel fully empowered to say, no.
2:10:33
I'm not giving that medication.
2:10:36
So, I mean, I think that, you know, this is as much as the national, you know, people have come up with to try to prevent misdiagnosis, but it it does happen in our system and every other system I know.
Mercedes Narcisse
2:10:53
Well, I'm thinking about my days.
2:10:55
We didn't have much to say.
2:10:57
We don't have we did not have that autonomy, and I love that like, we can tell the doctor.
2:11:02
But at the same time, I think one of the things that improve us a lot, we start having round with the doctors.
2:11:09
Yes.
2:11:09
So that way, the communication is understanding and see where I'm going with you.
2:11:13
I'm here to care for the patient with you.
Mitch Katz
2:11:16
Not for you.
2:11:17
Well, we we're very big believers in equals.
2:11:21
That interdisciplinary rounds are rounds of equals.