Thursday, July 12, 2012

A Technologist Reflects on the Rory Staunton Case In New York

Re: "An Infection, Unnoticed, Turns Unstoppable"
Brief summation: boy gets infection via a superficial seeming injury. Multiple medical professionals fail to catch it as it escalates, eventually killing the boy. 
Reading this piece in the NYTimes is painful. As a parent, these stories rattle your paranoia. Parenthood seems to be that thing which shakes us from a "it can't happen to me" attitude. Yet my parental paranoia wasn't the only issue raised. I left wondering what could've been done differently, or, more specifically, how could technology help to prevent such tragedy.

Some key data were missed in the process, in particular several key elevated levels ("His bands were 53% (normal high is 15%); absolute neutrophils were 13.5 (normal high is 8.5); absolute bands were 7.8 (normal high, 4.2). On the other hand, a blood value associated with viral infection was low. His lymphocytes were 3% (normal low, 28%).") were, for whatever reason, not acted upon  by the hospital staff. There are several possible reasons, but all seem to stem from human error. What I envisioned is the doctor, while being distracted by the myriad distractions in an ER setting, simply missed this information.

One thing technology can do well is remove the "human" part on these sorts of errors. It's easy to conceive of a medical data system that would compare the results with "acceptable limits", or some sort of gradient. Then a simple script would flash/harangue, staff until acted upon.

Would such a thing have saved this boy? Hard to say. I don't know if such a system existed and was operational at the time. But I like to think of solutions when faced with crisises. And like to think that there are technological solutions for a great many global ills. Perhaps that's naiveté, or hubris. Yet, it's there. If it's a survival mechanism meant to mitigate the sadness or fear, it's not very effective. It is something, no?

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