Ambulance- Maybe, You Are Wrong

Hey guys and gal,
I’ve been a listener (podcast and YouTube) since you started posting Westworld videos on YouTube (3 years- i had to go back and look). I’ve never written before, but here I am.

I have worked in healthcare for almost 30 years. I was a trauma RN for a long time and I am now a Nurse Practitioner and a college professor. I agree, healthcare providers are getting smarter and smarter. We have an abundance of research based evidence to use when we care for patients and all health care professionals are required to keep their knowledge based current in order to provide the most safe and comprehensive care.

However, I could totally see a situation similar to the ambulance scene happening out in the field or in a facility. Because there is so much information about health and healthcare available, many healthcare professional rely on clinical decision tress to guide treatment. In a 2004 article regarding a primary care physician “estimated it would take 30 years to summarize all the current controlled trials” (Alper, et al, 2004). Clearly, this is impossible, so clinical decision support systems (CDS) were created.

CDSs utilize the immense amount of clinical literature, evidenced based research, and current guidelines to create clinical decision trees that can help a practitioner make good decisions about patient care. The use of clinical decision trees (clinical decision support) is fairly widespread (imbeded into electronic health records), but most do allow for clinicians to use their best judgement (Bresnick, 2017). However, I can see a situation where an insurance company would require the use of a CDS or deny payment. (That is sort of what happens when you call your insurance company for an authorization for a procedure or to see a specialist).

Scene: You’ve got 2 trained EMT’s picking up a patient from the field. The protocal states that before any actions are taken, the monitoring system is to be applied to the patient. The monitoring system will then report the patient diagnosis and actions to be taken. The EMT’s know that if they deviate from the protocol, the claim on this patient pick up will be denied (no payment) and they will be fired or reprimanded for taking action. They know what to do, they have the skills required, but they feel their hands are tied. So they try the system again- just like the show.

Today I heard about an RN in Chicago who quit her ICU job because the hospital’s protocol stated that she could not wear her own N95 mask to care for her COVID19 patient. The hosptial ran out of supplies (big surprise) and since the CDC hasn’t updated their protocols to keep up with the rest of the world, she was told she could not protect herself and her family by wearing her own personal N95 mask…This nurse knows what she needs to do. She read the current world research, but due to ‘protocol’, she was unable to do what she knows she should be doing.

So, yes, I could totally see the EMTs not acting based on a CDS and protocol. It happens now.

Great show!
Your faithful listener,
Ann the NP

Alper, B. S., Hand, J. A., Elliott, S. G., Kinkade, S., Hauan, M. J., Onion, D. K., & Sklar, B. M. (2004). How much effort is needed to keep up with the literature relevant for primary care?. Journal of the Medical Library Association : JMLA, 92(4), 429-437. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC521514/

Bresnick, J. (2017). Understanding the Basics of Clinical Decision Support Systems. Retrieved from https://healthitanalytics.com/features/understanding-the-basics-of-clinical-decision-support-systems

Subscribe Now

• Android: https://shatpod.com/tv/westworld-android
• Apple/iTunes: https://shatpod.com/tv/westworld-itunes

Help Support the Podcast

• Contact Us: https://www.shatpod.com/contact
• Commission Movie: https://www.shatpod.com/support
• Support with Paypal: https://www.shatpod.com/paypal
• Support With Venmo: https://www.shatpod.com/venmo
• Shop Merchandise: https://www.shatpod.com/shop
• Shop Amazon With Our Affiliate Link – https://www.amazon.com/?tag=shatmovies-20
• Theme Song – “The Ecstasy Of Gold” (Hip Hop Instrumental Version)  by Dj 2 Bad
• Outro Music – By Simon Eric Haywood