Wednesday, February 24, 2010

Doctor Dalai To The OR - STAT!!!

 

As a non-interventional radiologist, I rarely get to the OR.  (I do sometimes wander by the ER to discuss some weird finding.  This has morphed into the positive Dalai sign; the docs know something bad is afoot if I've made the effort to travel over to their neck of the woods.)

Yesterday, the rad tech working surgery came running down the hall.  "How do I get in touch with your IT guys?" he yelled.  It seems that one of the surgeons needed to look at images on my group's PACS (not the hospital system) and couldn't get the client running on the hospital computer in the OR.  I bravely volunteered to go to the OR myself, and after throwing on some scrubs (and hoping the nasty surgeons wouldn't raid the unlocked locker containing my valuables) I sauntered into the OR like a real surgeon.  There, on the table, was the patient with his internal anatomy revealed, and a very frustrated surgeon nearby.   I went immediately to the computer in question, and indeed, our AMICAS client wouldn't load, because the bloody computer was locked down, and it wouldn't accept the necessary JAVA run-time code.  I quickly called our HELP desk and explained the problem, noting that Dr. X had a patient filleted open on the table, thus requiring assistance NOW.  The fellow on the other end apologized, noting that he couldn't do anything, but would contact the DESKTOP help area immediately.  In the meantime, I decided to try our program on the computer that was used for patient monitoring and data collection (yes, somewhat risky, but...) and lo and behold, I was able to bring up our client!  The surgeon was happy, and I left the OR still not having heard from DESKTOP.

The moral of the story:  PACS involves patient care.  If a department, be it Radiology or IT, is given the mandate to control and maintain PACS, it has to realize that this is a mission-critical, literally life-and-death proposition.  Sometimes, we just don't have five or ten minutes to wait.  Yes, I understand that this was an aberrant situation, and I suppose we should be forever grateful that we are allowed to view our "foreign" system from within the hospital at all.  Still, this is the way it is, and we need help, not hindrance in these situations.  Remember, we're all here to promote patient care.  That's the bottom line.

ADDENDUM

I've received two interesting comments on this post.  Anonymous (1) said:


"technically arent you messing with the warrenty on the monitoring system by runing external software on a "closed system"?


Sure you might be lucky and everything works nicely with the java runtime and everything, but you might have affected the system in a manner where other patients life are put at risk?


I am certain this isnt adviceable behavior and that it can indanger patients and/or deaths."
and Anonymous (2) said...


"Moral of the story:


Before anything else, preparation is the key to success AGB


In the days of film key images would have been displayed on the light box BEFORE the start of the operation.


If the PACS workstation stopped working without warning, good on you Dr Dalai, I would have been tempted to get a lap-top or pinch a workstation from next door though."
I think Anonymous (2) is right on.  Definately, scalpel should not have touched skin before the images were on-screen.  YOU tell that to the surgeon. 

As for Anonymous (1). . . He/she embodies the IT mentality that drives me up the wall.  Yes, I was taking a risk, although I believe it was minor. The computer I ultimately got running was actually the data-collection station (drugs, toys used, etc.), and not a true patient monitor.  It fortunately already had the proper Java in place.  No damage done there.

The patient who is cut open on the table HAS to be one's primary concern in this instance. PERIOD. It seems there are some IT types who would have told the surgeon, "too bad, chump" and walked away because we might have done something to their precious computers. If you are going to deal in health care issues, friends, you need to realize that someone might die if the computer doesn't do what it's supposed to do.  Yes, one can hide behind the mantra that altering the computer might harm the next patient.  In situations like this, you have to realize that NOT altering the computer had an immediate risk of harm to the patient that was there bleeding (a little) on the table right then.  Somehow, IT has to be made to understand the criticality of PACS and patient care. 

I'm trying to educate them, slowly but surely. 

11 comments:

Anonymous said...

technically arent you messing with the warrenty on the monitoring system by runing external software on a "closed system"?

Sure you might be lucky and everything works nicely with the java runtime and everything, but you might have affected the system in a manner where other patients life are put at risk?


I am certain this isnt adviceable behavior and that it can indanger patients and/or deaths.

Dalai said...

Welcome to the US by the way.

Sadly, I have to say this comment is clearly from an IT perspective. Yes, I was taking a risk, although I believe it was minor. The patient who is cut open on the table HAS to be one's primary concern in this instance. PERIOD. It seems there are some IT types who would have told the surgeon, "too bad, chump" and walked away because we might have done something to their precious computers. If you are going to deal in health care issues, friend, you need to realize that someone might die if the computer doesn't do what it's supposed to do.

Anonymous said...

Moral of the story:
Before anything else, preparation is the key to success AGB
In the days of film key images would have been displayed on the light box BEFORE the start of the operation.
If the PACS workstation stopped working without warning, good on you Dr Dalai, I would have been tempted to get a lap-top or pinch a workstation from next door though.

Anonymous said...

Post you hack with the IT system have you then taken any steps to ensure system is functional correct and does suffer from any garabage that might have been introduced by your tweaks?

I am simply wondering, whats the general rule when working with these systems, are there any legal aspects?

How can I (as a potential future patient) be certain that no (all due respects) hacks of yours has put my life or other patients in danger if the system later on malfunctions due to any hacks?

Anonymous said...

Future patients might have a legal right to be made aware that non-educated personal has hacked with the system. Mistreatment due to hacks arent covered by any kind of insureance.

Hardware vendors for sure has a right, I am quite possitive you have to contact the suppliers of the monitoring system.

Not saying what you did was the right thing, it was correct and great! But theres some damage fixing post the hack that has to be made.

Dalai said...

My Danish friend, you just aren't hearing me. Disregard everything else...It was CRITICAL to get the images immediately to the surgeon while in the operating room. Your classic IT-esque fears of what might possibly happen would cause harm to the patient on the operating table now.

My main point is that if IT is to have control over life-and-death situations, it had better be ready to respond IMMEDIATELY. Since they didn't, I did. Sorry if that scares you.

Anonymous said...

Having a laptop which works on your hospital network with working copies of your multitude of viewing clients might be a better solution for such occasions. Wheel into the OR with your magic laptop = instant hero?

ORQA said...

Dalai,
Without question you did the right thing, you should be commended not criticized, period. Disregard the IT comments here, it's IT's job to restore the workstation to "blessed" configuration.
There is no excuse for the surgeon not having the images displayed prior to cutting, that's an explicit step on the WHO surgery checklist which is now mandatory in several states and countries and almost certainly coming soon to your hospital as mandatory for all cases.
However, you do have a risk going forward because you're now aware of a significant hazard that nearly caused harm and could cause harm in the future if not corrected. Don't just tell IT and dismiss it.
I STRONGLY recommend you submit a report, anonymously if you must, to the patient safety and risk management departments.
You could definitely be punished/liable knowing about this hazard and not reporting it through your reporting system, especially if your hospital/state has mandatory reporting policy/law.

ORQA said...

quote:
technically arent you messing with the warrenty on the monitoring system by runing external software on a "closed system"?
/quote

Do you think the patient cared about the equipment warranty?

Anonymous said...

"Having a laptop which works on your hospital network with working copies of your multitude of viewing clients might be a better solution for such occasions."

Did you take intp acct. that this all hapened in OR?In my country it is strictly forbidden to bring in non verfied and probably contaminated equipm. into OR.

Although I personnaly working for a PACS vendor that does not want to see any manipulations at these medical devices I would assume
1. The given Workstation didn't work before the manipulation (to be regarded as defective)
and
2. This was an emergency case incl. lethal risk for the patient.

Yes, its too less info to finally judge but
This should be enough to justify any actions taken to save life.
A system out of order is not worth risking any patients health. Each individual or organisation that would not agree here (imho) does not bring up the necessaty awareness to be situated in healthcare business.

Kris said...

Working in PAC's I can tell you that the Help Desk EASILY adds an additional 5 to 25 minutes of lag in return call. Don;t get me wrong most hospitals REQUIRE that the help desk is the single point of contact for problems. However, the automated systems don't always work correctly (emails are not always sent) and sometimes it is operator error. The HD staff can easily assign the ticket to the wrong group which can add a significant delay. On top of that, the staff could easily be 10 min away even while on campus. My office is situated in a remote data center but still on campus; it takes me at least 10 minutes to make it to the OR or Radiology.

Please realize I do understand the bigger picture is the "patient". Hell, I've been a patient before!!! But sometimes things just don't work like they should!

I have to agree, and have been on the recipricating end of such situations, the surgeon should have reviewed the images prior to gutting the patient!