De-freezing frozen patient management

Area of Science:

• Medical education
• Clinical decision-making
• Patient safety

Background:

• Physicians often struggle to adapt patient management strategies, despite the recognized importance of timely adjustments.
• External medical team reviews can prompt consideration of alternative patient care pathways.
• Gaps between expected and actual patient findings highlight potential areas for management improvement.

Purpose of the Study:

• To compare the effectiveness of real-time external medical team review versus a 're-thinking-protocol' (de-Freezing) in prompting patient management changes.
• To evaluate which method better encourages medical teams to consider a 'leap' to a new patient management routine.

Main Methods:

• A study involving non-interrupting student observers in an emergency department setting.
• Four discussion modes were employed: real-time review and de-Freezing questionnaire, involving both treating and external medical teams.
• Data collected on whether a management 'leap' was considered after each discussion.

Main Results:

• The de-Freezing protocol significantly increased the consideration of management leaps by both treating (133 instances) and external teams (140 instances) compared to real-time review alone.
• External teams considered leaps more often than treating teams (76 vs. 47) during real-time review.
• The de-Freezing protocol proved more effective than external team involvement in encouraging management leaps.

Conclusions:

• The de-Freezing protocol is a cost-effective method to enhance consideration of necessary changes in patient management.
• This protocol can improve clinical decision-making by prompting teams to move beyond established routines.
• Incorporating the de-Freezing protocol into medical practice and education is recommended for all medical processes.