It was fine: Sleep-deprived hospital doctors

Going into premature labor eight weeks early, my wife was admitted to a Harvard teaching hospital, where doctors delayed her childbirth for a week. They gave her beta dimethasone, a drug to speed the maturation of the lungs of our unborn baby. Two days later came one of the happiest days of my life, when we learned that a lab test revealed the drug had worked: my son’s lungs would be fine, and he wouldn’t need a ventilator.

Residents had affixed a band and device around my wife’s belly to measure and graph the fetal heartbeat and the contractions of her uterus. Noticing the graph showed regular peaks, I asked a young resident what that meant. She reassured me that it was fine, and I didn’t pursue it.

Then when hearing in the evening that my wife was experiencing abdominal pain, the sleep-deprived residents confidently attributed them to gas pains! Finally the next morning, a pelvic exam revealed her cervix was nearly fully dilated, ready for delivery. Exhaustion had ruined their judgment, so my wife had had to suffer labor pains for 12 hours without any pain medication.

The doctors at the Harvard teaching hospital had missed the fact that my wife was in labor! They’d ignored their device, ignored my question about the rhythmic spikes in uterine contractions, and misdiagnosed my wife’s pain.

The newest safety rules limit hospital residents to working no more than 16 hours at a time. You read right. See the OpEd column in the June 24 issue of the Los Angeles Times by Dr. Lucian Leape and Helen Haskell.

Advice: If your young doctor in the hospital looks sleepy, ask your patient advocate what to do.

Read more about staying safe in the hospital from my book, Getting Your Best Health Care: Real-World Stories for Patient Empowerment.

In a new way: The American Society of Professionals in Patient Safety

Diane Pinakiewicz and her team at the National Patient Safety Foundation recently announced the launch of the American Society of Professionals in Patient Safety.

In an interview, Diane told the story and described the vision behind it. This is excerpted from our interview:

In 2007, we took stock, and said, We've been working in this area for ten years, and now, patient safety is a legitimate discipline. So how do we legitimize and organize it and help move it forward? We developed the Leape Institute, as a think tank for the field.

There were many passionate people, but no membership organization for them to connect to. NPSF had a membership programs for hospitals, but not one for individuals with patient safety as its uniting principle.

And the field lacked a certification program like the ones there are for Risk Management, Quality Improvement, and so forth.

We want people to understand that this is everyone's responsibility.

Our vision of success for the ASPPS ten years from now would have two parts. First, everyone in the healthcare system who delivers services to patients would have learned, and could exhibit, competencies for safe care. Second, that patients and their families would be educated and involved in a new way in the tenets of patient safety, and they'd know why their involvement is so important.

Read another story about http://www.patientsafetyblog.com/2011/01/recent-progress-by-patient-activists.html">visionary patient safety experts. Thanks to Diane Pinakiewicz for the interview.