Education and debate

A primer on leading the improvement of systems

^a Institute for Healthcare Improvement, Boston, MA 02215, USA

The nurse called me urgently into the room. The child, she said, was in acute respiratory distress.

I had never met either Jimmy (the 6 year old boy) or his mother (an inner city single teenage parent) before. His asthma attack was severe, his peak expiratory flow rate only 35% of normal. Twenty years ago my next steps would have been to begin bronchodilator treatment, call an ambulance, and send the boy to hospital. That also would have been the story 10 years ago, or five, or two.

But today, when I entered the room, the mother handed me her up to date list of treatments, including nebuliser treatment with ß2 agonists, that she had administered with equipment that had been installed in her home. It continued with her graph of Jimmy's slowly improving peak flow levels, which she had measured and . . . [Full text of this article]

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