APPD/APA PHM Leadership SIG Confronting Racism Virtual Cafe: Systemic Racism Needs a Systematic Approach: Using QI as a framework - Shared screen with speaker view
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How aggressively was his pain treated in the ED?
Why is he drowsy? Pain is a powerful stimulant. I worry about stroke in a sickle cell patient
Was he treated as an opioid-naïve patient or someone who may have some tolerance to opioids and therefore need higher doses? People often judge what's a "high" dose without factoring in the patient's experience.
We have a clinical pathway across care areas for pain in SCD
Biggest threat we are encountering with regard to pain treatment in SCD are the application of DRGs to our pediatric population. This limits the number of days for which the hospital will be reimbursed, and we fear may result in inadequate treatment before discharge from te hospital. Although this applies to all, it affects the SCD population more than others.
The potential positive aspect of DRG based reimbursement could also be more attention to home and outpatient management improvements in order to minimize admissions and readmissions. I do agree that It is a bit of a double edged sword though.
The challenge is to upgrade our ambulatory/home game.
Very true. Ideally both outpatient and inpatient entities (if not under same organizational umbrella) would see a benefit in working together to improve the care of various patient populations.
pathway for pain for narcotic non naïve and that is shared with the patient
I would add that the challenge is to advocate for the reimbursement for care coordination activities. When children/families of color (more likely to be on Medicaid, less likely to feel comfortable to advocate/coordinate care for themselves or with LEP) need this outpatient/inpatient coordination and it isn’t reimbursed well or at all, this itself poses a form of structural racism and inequities in outcome.
Properly implemented pathways to which all must adhere, might be a help in assuring equitable interventions, especially if there are consequences for those who do not follow the pathway.
Certainly, it doesn’t mean that we as practitioners won’t engage in this coordination as it is the right thing for the patient/family, but as a complex care pediatrician caring for low income families, it is difficult for me to demonstrate to my institution what the value of my clinic is.
I had a similar case recently but the issue was not the trainees who recognized the concern but the nurses who felt uncomfortable with dosing of the PCA despite cross check with the pain team and pharmacy.
Does this clinical pathway address each individual's own opiod tolerance/individualized needs?
BMC has a great model for Health Equity Rounds where they review a case with their Dept directly related to discrimination and/or bias that has lead to a poor outcome for a patient / family https://www-ncbi-nlm-nih-gov.revproxy.brown.edu/pmc/articles/PMC7050660/
It should do so, and it should be evidence and outcome data based, reviewed regularly.
We can go back and correct or in some way compensate for the wrongs for events like occurred in Tulsa.
Great presentation. I have to drop off but thank you for raising this important issue in a QI framework
This was an excellent presentation. Thank you so much for sharing. I have to move to another meeting but really enjoyed listening in.
Do you train residents and faculty in addressing escalation? CPI?
When you only have a hammer (i.e. one tool) everything looks like a nail
Thank you Dr. Jackson - great presentation.
Thank you this was terrific!