by Sanaz Cordes, MD
Nurse: “Doctor, an invisible man is in our waiting room.”
Doctor: “Tell him I can’t see him now.”
Pediatric clinicians endure their share of cringe-worthy doctor jokes. After returning home from the theater (where I sat, spellbound, watching my childhood superheroine deflect bullets with her bracelets), I thought about the invisible man in the waiting room, and the nurse that “saw” him. My laptop beckoned me with articles I had been reading, earlier, about trend lines. Soon, I began to wonder if the seemingly unrelated worlds of superheroes and patient trend lines have more in common than one would think:
1) Trend lines can be invisible, underestimated villains that lurk inside the labyrinth of disparate data sources.
2) Doctors can’t always see these hidden antagonists.
3) Nurses have vision superpowers.
4) A powerful hero/heroine is needed to thwart these stealthy adversaries, once and for all.
So, back to trend lines…Most people think about stock market trading when they hear the term “trend line.” As a sales manager, I think about shifts in customer behavior – like an increase in the duration of one stage of the sales cycle over a given period of time. In general, a trend line indicates the general course or tendency of time-series data. In medical school, we learned about “normal-but-trending” labs, defined as the shift of a patient’s lab value within the accepted reference range. Since reference ranges are based on normal, healthy populations, they have high specificity for health but lower sensitivity for disease.
For example: A trauma patient’s hemoglobin (Hgb) trend line reveals a Hgb of 14 on the day of admission that has since crept down 1 g/dl per day – slowly approaching the cutoff for the reference range.
As medical students, we obsessively scrutinized every speck of patient data in preparation for team rounds. We could trend lines, as a result. But a busy hospitalist doesn’t have the luxury of lengthy chart reviews. These physicians care for dozens of patients and spend their days (and nights) clicking feverishly through the EMR just to keep up with the patient data that is flagged as “abnormal.” Trend lines are often invisible.
Cue the theme from the aforementioned superhero movie and picture this scenario: While a doctor pours over copious EMR data, a noticeably tall nurse with unusually shiny wristlets approaches and says: “before you go, did you notice that our E. coli patient’s creatinine went from 0.1 on admission to 0.3 yesterday to 0.6 this morning?”
In my experience, this superpower is not limited to nurses who relocated from a geographically unspecified island nation. Most nurses demonstrate a superhuman ability to see the invisible stuff. These men and women see the trend lines. Armed with this new information, the doctor now notices that this patient has decreased urine output, a rising BUN, and worsening abdominal pain… all potential signs of hemolytic uremic syndrome.
Dr. Kim Maryniak, author and nurse educator explains: “[As nurses,] a key point of assessing patients is to look at the whole picture, which includes not just the ‘snap shot’ of the current situation, but any trends that indicate a change in patient condition.” Nurses follow their patients’ labs, imaging, vitals, and personal updates throughout the day. They possess an extraordinary ability to piece this information together and uncover seemingly invisible trends.
Physicians see data. Upon seeing data flagged as “abnormal,” they have a few minutes (sometimes seconds, depending on acuity) to sort through more data, factor in patient-specific considerations such as sex, underlying disease, and medical history to rapidly formulate a new assessment and plan. And unless they click a few dozen times in the EMR to (hopefully) land on the correct screen with graphical displays of individual data points, they don’t stand a chance of seeing invisible trend lines.
So, in this era of digital health innovation, it’s time for a new superhero. Nurses have far too much on their plate to exhaust their powers hunting for trend lines. But, nurses and doctors have a new champion that can reliably detect every trend line for every patient… technology to the rescue! Supercharged software now exists that can pull in data points from disparate sources, interpret them through a patient-specific lens, process them within the framework of clinical protocols and display trend lines - within seconds. And the display is a visually optimized presentation that lives outside the confines of the EMR’s hostile user interface – enabling the care team to read the patient’s personalized, real-time story at a glance.
Physicians can now rapidly react to otherwise “invisible” threats that can jeopardize their patients’ improvement. In a world where every hour of treatment delay can cause things like an 8% increase in mortality for septic patients, exponentially faster intervention speed elevates the physician to inarguable superhero status.
What greater superpower exists than the ability to predict and prevent an adverse patient outcome – before it happens? What DC or Marvel protagonist can rival a doctor who protects patients from invisible threats and adjusts treatments at superhuman speed? Although it may not be the formula for a Warner Bros blockbuster, it’s a superhero story that most of us in healthcare will undoubtedly want to see.