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June Is Scoliosis Awareness Month! The Under 30 degree Green Zone… Screening at Home… and Need for Life-Long Scoliosis Follow-up

Jun 3, 2020

This is a guest post from Colleen Skeete and Jonathan Revoir, scoliosis patients and CareGuard Institute interns.

Welcome to Scoliosis Awareness Month! Our spine is the core of our body that holds us up for our lifetime, and we can take it for granted. Early screening in children and life-long monitoring in adults is important to take care of your spine, so that you can maintain a good quality of life.

It is easy to screen yourself, your children, or your friends from home by using a scoliometer or a bubble-level app on your smart phone to measure the degree of rotation. Simply have the person bend over, and measure the two greatest areas of rotation. If the angle of trunk rotation (ATR) is greater than six degrees, it is a good idea to get physician evaluation, and a full-length x-ray taken to see if scoliosis is present. If scoliosis is present, conservative methods such as Schroth therapy, a physical therapy technique focusing on elongating the spine, and 3D-CADCAM (Rigo-Chenau) bracing can help to stop and/or reverse the scoliosis. This may prevent later quality of life issues, and life-long curve progression. and possibly prevent the need for invasive surgical treatment. Weinstein found that curves under 30 degrees tended not to progress during adulthood — so we want to FIND scoliosis under 30 degrees, and try to “KEEP IT IN THE GREEN ZONE” – under 30 degrees if possible, with conservative therapies.

Life-long monitoring of scoliosis, even after adolescent years, is just as important as early screening. Natural progression history research shows 68% of patients with adolescent idiopathic scoliosis (AIS) will experience curve progression as adults, as shown in the figure below. Curves under 30 degrees, shown in green, tend not to progress [Weinstein et al 1981, 1983 — see figure below].

For more information about Scoliosis Awareness Month and the steps you can take to decrease the chance of life-long effects of scoliosis, watch this video from Dr. Hey and his team.

You can also find more information at National Scoliosis Foundation and the Scoliosis Research Society — Please support both of these important non-profits!!!!

The SRS website allows you to “Find a Scoliosis Specialist” near you.

Jonathan Revoir and Colleen Skeete
CareGuard Institute Summer Interns with Dr Lloyd Hey
http://www.CareGuard.org
Hey Clinic for Scoliosis and Spine Care
http://www.heyclinic.com

Industrial Engineering

Oct 28, 2019

We want to create a system that minimizes the chances of error. Using the techniques of Six Sigma and Lean Manufacturing, we want to anticipate and avoid sources of error by standardizing work and eliminating waste.

“One of the biggest obstacles in the pursuit of improved patient safety is variability. The problem with variability (especially when it comes to patient care) is that the quality of care often suffers as a result–the more variability, the more likely that something bad could happen. What we want to strive for at BSI is the opposite of variability, something called “standard work”. Let’s look at this idea with the metaphor of a product assembly line.

“The book The Machine That Changed the World is a great example of how the Toyota motor company employed standard work to address the problem of variability. Automotive companies of the time cared little about the concept of variability as their products came off the assembly line. This led to tremendous waste and a wide range of quality found in these products. But industry leaders just assumed this was the cost of doing business. The Toyota company disagreed. They set out to improve the system by cutting out anything which was inefficient and anything which would keep them from tightly controlling the quality of their product. The result: a standard, high quality product which has made Toyota a world leader in both production and quality.

“What was so different about their approach? Virtually all of the success Toyota had came from their determination to root out inefficiency, variability, and decreased product quality (though there are many other things which also made them successful). These are the same principles we at BSI want to apply to healthcare. Our goal is to help change the culture of healthcare like Toyota model did for the automotive industry–reducing variability and improving quality through standard work. By controlling the quality of care we provide, we can work to reduce the incidence of preventable medical errors and improve the outcomes for all patients. ”

Austin Vegas, Campbell University School of Osteopathic Medicine, ’22

Gabriel Brotzman, Campbell University School of Osteopathic Medicine, ’22

Why we pursue excellence in healthcare

Jul 10, 2018

The motive for why we pursue excellence in healthcare is compassion. All people are precious and deserve the highest standard of treatment.

Stanley Saju in Jamaica during his volunteer medical mission trip

“Why is compassion important in patient-centered care? It’s been said that people don’t care about how much you know until they know how much you care. The same is true within the doctor-patient relationship. Patients understand that physicians have amassed a great wealth of knowledge in medical science, spent years training to perfect their craft as diagnosticians; but without developing and incorporating compassion and empathy, patient will not feel they are receiving the care that they are due.

“In a complicated, fragmented healthcare system where doctors now spend more time dealing with administrative burdens, billing and insurance claims, one-on-one time with patients is compressed. Subsequently, patients feel reduced to their medical condition. Many leave unsatisfied, with a deeper sense of hopelessness because their care provider seemed impersonal, and hard to trust. Which is why we need to come back to the basics of compassionate care. Being a good doctor means more than just accurately prescribing the right medications at precise dosages. It means more than attaining a vast understanding of human anatomy and achieving mastery of various surgical competencies. Ultimately, the essence of practicing medicine is practicing compassion. It is to have an intense feeling of conviction when another is stricken by suffering, accompanied by a strong desire to alleviate that suffering.

“When patients see that we truly care for them holistically as a person, not merely their specific disease or symptoms, they will be satisfied with our care. When they see our eager desire to increase their quality of life, they will better adhere to our prescribed medical treatments and recommendations. Here at BSI, we want to call current and future physicians to apply and cultivate compassion to promote trust within doctor-patient relationships and improve patient outcomes across healthcare. “

Stanley Saju, Campbell University School of Osteopathic Medicine ’22

Aviation Safety in Healthcare

Jun 28, 2018

Jeremie Bourget at his white coat ceremony

“I want you to imagine a circumstance in which you require a high-risk operation. The day prior to the operation, you come across information pertaining to the surgeon assigned to your case. In scenario 1, it is revealed to you that the surgeon in charge has had over 20 years of experience, and that during their years of practice they have accumulated many mistakes. Many of the mistakes they excuse as simply horrible turn of events, and they reassure you it won’t happen again. What exactly is their reassurance? Well, you’re likely not going to be classified as a “horrible turn of events”. Are you feeling confident leading into the surgery?

“Now imagine scenario 2, which includes the same high-risk operation performed by a surgeon with a similar profile. A shocking difference is that the surgeon in scenario 2 has embraced the errors throughout their career. They inform you that any error that ever occurred during their 20-year practice was included into a checklist system. They reassure that the checklist system guaranteed that the same mistake could never be repeated. They have great confidence in their abilities as a surgeon, but they understand that human errors occur. They reassure you that their life-long checklist minimizes surgical variability and significantly reduces the potential for human error. Are you feeling a little more confident?

“The only fictional part concerning the aforementioned scenarios, is that the surgeon described as embracing his errors would realistically have a more successful profile than a surgeon that attributes his error to horrible luck. The concept of embracing your mistakes and having a system in place that prevents them from being repeated is the highest standard of care. Embracing your mistakes is difficult, especially due to the prevalent operating room culture.

“If a surgeon embraces his mistakes and therefore learns from his mistakes, why is there a need for a checklist system? The surgical checklist system accounts for the concept of human factors. In aviation, where the stakes are also high and lives are at risk, researchers have found that accidents most often occur not due to mechanical errors but rather human errors. For this reason, aviation has focused on the study of human factors and how they might eliminate them. Human factors can be described in terms of fatigue, stress, poor communication and personal life problems. All of these can be attributed to errors in performance.

“High stress and poor communication can be some of the more frightening human factors present in the operating room. Can you recall the last time you were in a rush and panic began to dominate your thoughts? Studies have shown that when you feel rushed, you begin to take cognitive shortcuts. You begin to subconsciously omit steps in order to complete the task at hand. You also begin to severely underestimate elapsed time. The omission of steps and the miscalculation of time can pose a serious threat to a patient in the instance of an operating room crisis. Checklists systems have been shown to eliminate these cognitive shortcuts, omission of steps, miscalculation of time and further eliminate other human factors.

“The culture in healthcare is changing. I hope that sometime soon, the dismissal of healthcare errors will be a thing of the past. Maybe hospitals networks will begin to share their errors amongst each other with the goal of preventing their reoccurrence. Last week I had the opportunity to observe a thoracic spinal fusion performed by a surgeon that is a major advocate for healthcare safety reform. He was a surgeon that resembled the description in scenario two. He had embraced his errors throughout his career. Every minute error that had occurred during his career was carefully resolved and incorporated into his over 400 surgical checklist system. His performance in the operating was conducted with precision, following each step on the checklist. Observing the surgery, you might have felt like you were in an airplane cockpit. I considered his checklist as a career long attempt to perfect his surgical performance. The greatest beneficiary of this checklist are his patients. An elevated standard of care has been established, and I’m confident it will soon become the norm.”

Jeremie Bourget, Campbell University School of Osteopathic Medicine, ’22

Compassion

Jun 28, 2018

An Bui with her first OR shadowing with Dr. Hey

” Here at Better Samaritan Institute, we want to call current and future medical professionals and students who have the same desires and stories as I do and improve patient outcomes globally. ”

“A prayer for comfort. A hand to hold. In medicine, it is not always the didactic academics and clinical lab results that can lead to healing; often, it can be the ability to comfort a patient. I remember when I was in Vietnam for a medical mission trip, there were often many patients who needed help but we lacked the supplies and surgeons. I saw the most bluest boy to a patient with severe scoliosis that she was unable to walk. As frustrated I was then, I realized that it was not the medicine or clinical knowledge that heal this patients, it was hope and compassion. Compassion gave the people in Vietnam hope to come back and let us treat them, continuously improving their conditions.

“As a Better Samaritan Intern, the theme of compassion and strive for better patient safety is integrated within the course and training. Every time I learn more about reducing medical errors and improving patient-doctor relationships, I am reminded of my time in Vietnam and my strive to serve. Here at Better Samaritan Institute, we want to call current and future medical professionals and students who have the same desires and stories as I do and improve patient outcomes globally. “

An Bui, Campbell University School of Osteopathic Medicine ’22

Aviation Safety

May 30, 2018

Flight safety has improved drastically over time. By studying human factors and flight data, leaders in aviation safety make incremental improvements to safety procedures each time something goes wrong, so that the same error does not happen again.

“What is it that links pilots and physicians? The commonality that both are responsible for the lives of others each day, however the differences between safety improvement is each of the fields is striking. Aviation safety is built on the basis of checklists; pilots wholeheartedly believe in and rely on them to ensure that they have completed the tasks necessary to maintain the safest environment during that flight.

“But what if something goes wrong? There is a checklist for that as well. Pilots and Co-pilots have multitudes of checklists categorized into specific problems they may face during a flight that have been established based on prior errors in the field of aviation. Additionally, the speed at which flight complications are investigated, remedied, and turned into a learning tool for the rest of the aviation community is what all of healthcare should strive for. Within a matter of days or weeks, the system makes changes to its guidelines based on the recordings collected from a black box recorder on that flight and the rest of the community is educated on in a timely manner.

“We cannot say the same about healthcare. Healthcare historically has been slow to fully investigate the source of errors. This may be attributed to the longstanding stigmatization that making errors in healthcare is equated with being an inadequate physician. Having another life in your hands is already a high-pressure situation, and when pilots face trouble, they distribute responsibility and authority to prevent their focus from narrowing. The world of healthcare has yet to embrace this model, but establishing a system, like checklists, that allow for all team members to have a voice during an operation, etc. it can prevent loss of good judgement and lead to better outcomes for patients.

“You wouldn’t want to get on a flight knowing the pilots might miss a crucial step because they didn’t complete their checklists, so why are we accepting anything less in healthcare where there are also lives at stake every single day? It is time for the healthcare system to take a page from the book of aviation and step into the future of patient safety.”

Kristen Mylcraine, Campbell University School of Osteopathic Medicine, ’22

Checklists

May 28, 2018

The goal of checklists is to standardize work so that no crucial steps are missed. This not only improves patient safety, but also builds a better team environment. Checklists can save patients, doctors, and nurses from severe harm.

“Would you feel safe having an operation in the hospital where you work? This is an important question that has been raised by medical professionals across America. This question is not intended to start the blame game or point fingers. Rather, it is intended to raise awareness to the need for change in the operating room dynamics all over the world. To provide the best care possible for patients, we must ask this question. Everyone is fallible, and no matter how many years of experience a surgeon, anesthesiologist, nurse, etc. may have, there is always room for improvement. At the Better Samaritan Institute, we want to catalyze a cultural change in operating rooms that recognizes this so the welfare of the patient is always at the forefront.

“That is the core tenet of the Better Samaritan Institute, and it is central to the culture change needed in surgery. In one word, the entirety of the Better Samaritan Institute comes down to humility. Countless stories have been recorded where medical harm occurred upon a patient because trained professionals did not address a superior, who they knew to be wrong in one way or another, because they were afraid of the consequences. With the advancement in knowledge and technology, surgery is now more complex than ever. Now more than ever, we need every member of the surgical team to cooperate as a team. That is why it is important that every member of the team feel they can call a time-out with impunity.

“One way to do this is by using a checklist. Surgical checklists improve safety, strengthen the team atmosphere, provide peace of mind, and can serve as a foundation to quickly and accurately assess and correct a crisis in the operating room. Crisis is the surgeon’s worst nightmare, but with a checklist, crisis is much less likely to arise. In conjunction with 3Greens, an electronic checklist developed by Dr. Lloyd Hey, and Duke Raleigh Hospital, the Better Samaritan Institute aims to Target Zero. Improvements to the healthcare system must be made until there is zero avoidable harm done to any patient or provider.”

Steven Barker, Campbell University School of Osteopathic Medicine, ’22

Aman Singh, University of Rochester, ’22

Royce Le, University of North Carolina at Chapel Hill, ’20