WHY the World Needs Improv
It was a Tuesday at 0315 in the morning in an upscale community hospital in middle America. Within the NICU, an RN was assigned to care for a 25 weeks gestation infant who weighed < 500 grams or approximately one pound, one ounce. Besides the intravenous solution lines running through his infinitesimal umbilical arteries and one vein, and the orogastric tube that ran to his stomach, the baby was connected to an oscillating ventilator that delivered > 300 soft, quick breaths per minute to his still-developing lungs. The nurse dutifully sat at the bedside, monitoring vital signs and every move.
Suddenly, an alarm sounded. It was the pulse oximeter, connected to a tiny infrared light wrapped around his hand which measured the amount of saturated oxygen delivered to the capillary bed. She looked up at the telemetry monitor and paused it for two minutes while she evaluated the change.
The baby’s chest was retracting and his color wasn’t looking good, so she called the Respiratory Therapist (RT) to assist. They suctioned the baby’s mouth and ET tube and found a large amount of cloudy, white returns.
While the RN changed the baby’s equally tiny, wet diaper, the RT collected a small amount of blood for an arterial blood gas test from one of the umbilical lines. Both agreed the child’s breaths still appeared labored, even after suctioning. The blood gas test, completed in less than five minutes, confirmed the status change.
The RT called for a STAT chest X-ray and the RN phoned the in-house pediatrician, who was on-call for the neonatologist.
When the physician arrived, the X-ray was completed and the films displayed at the central station, across from the patient area. Results? Just as they thought: a pneumothorax.
Up to this point, the process worked well; they congratulated themselves that only 18 minutes had passed.
The RN hurried to prepare the area for the chest tube placement, a sterile, bedside procedure. She assisted the MD with his gown and pulled the instrument tray to the left side of the bed.
It looked like the situation was well in hand.
Then, to her surprise, the physician asked the RN to move the instruments to the opposite side of the bed. She complied, and asked, “Do you need anything else?”
“Nope,” he quipped. “Got it.”
The nurse went back to the central station and looked again at the X-ray. She thought the lung collapsed on the left side, not the right side. However, she reminded herself, she was sometimes confused when interpreting X-rays. She wished the RT was nearby to confer with him, but he was charting next to the bedside in case the physician needed assistance. So, she decided against it and went back to her charting.
That was the first mistake…