The scientist and the nurse

Tortoise_and_the_Hare_by_o_kemonoOnce upon a time, a scientist and a nurse decided to tackle sepsis, the hospital-acquired infection that often results in death for hospital patients.

The scientist reviewed the existing scientific literature on the topic, consulted with world-class experts on the problem, and concluded that what the issue needed was a $100MM grant proposal to build a genetic data base of all sepsis patients. He went to the National Institutes for Health and talked its management into endorsing his study. He recruited three leading pharmaceutical and medical equipment powerhouses to fund the proposal. The Obama administration financed the rest of the effort and the scientist became a poster child for government-funded research, next to clean energy and electronic health records. He launched a peer-reviewed, double-blind, 20 year longitudinal effort to identify the genetic markers that put patients at risk of developing sepsis. “It is time to eradicate this killer off the face of the earth”, he told the New York Times.

The nurse went to her hospital. She recruited her colleague floor nurses and took them to the lab in the hospital’s basement. They started talking with technicians and infectious disease leaders on how they could reduce the incidence of sepsis. The hospital’s infectious disease specialist explained to nurses and technicians how the risk of death increases by 8% with every hour that passes before treatment. The nurses learned to identify early signs of sepsis on a patient’s chart and draw blood earlier. They were taught to calibrate the amount of blood required by the various tests. The technicians were permitted to walk up to the floors, and nurses came to the lab. The lab manager was convinced by the technicians to buy better equipment to test for a wider set of pathogens and produce results faster. They made sure the test results did not end up in a mail basket, even on week-ends. They hounded the doctors to look at the results of the tests and act upon them promptly. They told the patient’s family when results were available, urging them to have a conversation with doctors on the test’s outcome. “We won’t solve sepsis,” she told her colleagues, “but maybe we’ll save a few lives along the way.”

The scientist received fame and glory. He appeared at scientific conferences in Cancun and Ibiza. The pharmaceutical firms flew him to colloquia and symposia where he vowed audiences with his protocols. The Sepsis Foundation featured him on their web site. The Journal of Sepsis and Sepsis Daily wrote columns about his seminal work.

Meanwhile, the nurse continued to fight for the right to hold sepsis sessions in the basement of her hospital. The hospital’s Chief Medical Officer told his doctors he had reluctantly agreed to the effort: “they seem so motivated”, he said. The Chief Nursing Officer cajoled the truth a bit and told her nurse colleagues: “the CMO is fully on-board”. The Quality people started tracking infection results from the nurses’ data and showed sepsis going down at the hospital. Together, they went to the CFO and showed evidence of the improvement. Intrigued, the CFO agreed to go talk to the CEO.

“Of course, we can improve some medical outcomes through practices of this type”, the hospital CEO conceded. “But this sort of stuff is incremental and people-dependent. But our resources are so scarce with the new healthcare regulation coming on and we’re already on projects overload.  I can’t very well generalize grass-roots initiatives of this type to the rest of our network, can I? What we need is an authoritative study with a peer=reviewed, double-blind protocol. I think there is a national study on sepsis, and we should join in and contribute our patient data to it.”

The nurses and technicians stopped meeting in the basement. The scientist continued to triumph on the lecture circuit. One day, the great genetic predictive algorithm for sepsis may emerge. Meanwhile, patients will continue to die.

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