title: De-freezing frozen patient management.
abstract: OBJECTIVE
  To compare the effectiveness of two methods in encouraging the consideration of a leap from one patient management routine to another: (i) real-time review of the facts by an external medical team (ii) implementation of the 're-thinking-protocol' ('de-Freezing') by both treating and external medical teams.
  
  
  METHODS
  Students accompanied doctors, nurses and patients as non-interrupting observers. When an obvious gap between the expected and actual findings occurred, it was discussed four times: by two teams (treating team, external medical team) in two discussion modes (real-time review, de-Freezing-questionnaire). The students then recorded if a leap was considered for each discussion.
  
  
  METHODS
  The study was conducted in the emergency department of the Baruch Padeh Medical Centre, Poriya, Israel.
  
  
  METHODS
  All patients were included during times when both medical teams (treating, external) were present.
  
  
  METHODS
  During 14 periods of 5-7 h each, 459 patients were sampled. In 183 patients, 200 gaps were discovered.
  
  
  RESULTS
  The external team considered a leap 76 times, compared with 47 by the treating team (P < 0.001). Using the de-Freezing-protocol, the treating team considered a leap 133 times. Interestingly, even the external team benefited from the de-Freezing protocol and considered a leap 140 times (NS compared to the treating team).
  
  
  CONCLUSIONS
  While the importance of timely leaping from one patient management routine to another is emphasized in the training of physicians, medical teams too often fail to do so. The de-Freezing-protocol inexpensively encourages the consideration of a leap beyond what is evoked by the involvement of an external team. The protocol is applicable to all medical processes and should be incorporated into medical practice and education.
authors.affiliation: Department of Management, Bar Ilan University, Ramat Gan, Israel.|Department of Quality Engineering, Kinneret College, Eder 42, Haifa, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Kobo-Greenhut
authors.affiliation: Maccabi Healthcare Services, Israel.
authors.forename: Amin
authors.initials: A
authors.lastname: Shnifi
authors.affiliation: Department of Emergency department, Poria Hospital, Poria, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Tal-Or
authors.affiliation: Department of Management, Bar Ilan University, Ramat Gan, Israel.
authors.forename: Racheli
authors.initials: R
authors.lastname: Magnezi
authors.affiliation: Department of Quality Engineering, Kinneret College, Zemach, Israel.
authors.forename: Amos
authors.initials: A
authors.lastname: Notea
authors.affiliation: Department of Management, Poria Hospital, Poria, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Ruach
authors.affiliation: Department of Management, Poria Hospital, Poria, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Onn
authors.affiliation: Faculty of Industrial Engineering, Department of Industrial Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ayala
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Faculty of Industrial Engineering, Department of Industrial Engineering, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Etti
authors.initials: E
authors.lastname: Doveh
authors.affiliation: Bar-Ilan University Faculty of Medicine, Department of Medicine, Zefat, Israel.
authors.forename: Izhar
authors.initials: I
authors.lastname: Ben Shlomo
mesh_terms: D003933:Diagnosis; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration; D010820:Physicians; D011786:Quality Control
keywords: quality improvement < quality management; quality management