Please change Diet orders. Mediterranean diet

Each day I admit cardiac patients who end up with a "heart healthy diet".
It may change now!.

The definition of heart healthy diet is evolving as we speak. For a diet to be heart healthy I may have to order some nuts, fish, virgin oil with some red wine.

I hope I won't get into trouble.

A new study published in New England Journal of Medicine defies our conventional beliefs regarding low fat diet to be heart healthy. This new study suggest that Mediterranean diet is more "heart healthy" almost by 30% as compared to a regular diet.

In this humongous study out of Spain, where 7447 individuals were enlisted were shown to improve their heart attack risk by 30%.


Participants were asked to eat white meat like fish, lentils, almonds, walnut and virgin oil. Results are so phenomenal that some of the primary researchers even changed their own diet.

By the way today I bought some nuts on my way back!

PS: About the picture, very visual menu somewhere in Europe.

Buddhist temple, Kyoto, Japan

Buddhist temple, Kyoto, Japan, a photo by At_a_tangent on Flickr.

Keeping an eye on me.

Keeping an eye on me., a photo by At_a_tangent on Flickr.

Bird One

_DSC0419, a photo by At_a_tangent on Flickr.

Yahoo Dome, Kyoto. HDR version

Yahoo Dome, Kyoto. HDR version, a photo by At a tangent on Flickr.

Huddle, Multidisciplinary Rounds.

Finally I was able to successfully roll out Huddle or multidisciplinary rounds at all three hospitals.

So far I have heard great things the way we are conducting these rounds. 

We have a huddle for 20 minutes every day, less than a minute per patient at a specific location in each hospital.

Out team members include everyone who are stakeholders in patient care.

1- Dedicated case manager. (I would appreciate if you can assign a dedicated case manager for all our patients)

2- House nursing supervisor.

3- Floor supervisors (optional).

4- Physical therapy and occupational therapy.

5- Dietary.

6. Core measure/ quality measure person for real time corrective measures for CHF, Pneumonia, AMI etc.

7- Hospital DRG coder. (Again this would take care of any def. in documentation).

8- Mr. Computer, so we can take care of orders during rounds.

9. Pharmacist (if they can).

Our team has so far improved,

1- Potential early discharges and transfers. 

2- Plan of care for the day.

3- Identify needs for patients.

4. Improve work flow and delegation of tasks.

5. Improve core measure compliance and power plans. 

6. Improve documentation. 

7- Contain cost per case.

And the best part is.... it is a lot of fun.

Hiroshima, A Hard Stop.

A hard stop is something you can absolutely not do after a certain point.  I believe as far as nuclear arsenal is concerned we should have had a hard stop on August 6^th, 1945.

We were in Koyoto for few days; we were debriefed regarding our Kaizen project in Fukoaka.  Dr Rippe, Dr Nunez and I decided to make a quite round trip to Hiroshima. We took a bullet train and ended up in Hiroshima.

I wanted to visit this site since I wrote a blog here almost two years ago regarding a patient of mine who was in Hiroshima.

As soon we entered the Hiroshima Peace Park, it felt like the bomb was still hovering over you rather then something which has happened almost 70 years ago. 

Sometimes you can almost feel the sounds of tortured spirits screaming and begging you to stop their anguish, your mind starts to play tricks on you, you can smell bodies burning and seeing charred skin. As you continue to walk you finally come across ground zero, the prefectural Hall that now lies in ruins.

My friend Ramone was in so much anguish, he could not even finish the museum.

In the end you wonder what has changed since then? Our course remain unaltered. Auschwitz, Bosnia, Rawanda and 9/11….

About the picture:  The picture shows a shadow left behind by radiation heat rays. The shadow is of a person who was sitting 250 meters from the hypocenter, waiting for the bank to open. It never did!

Toyota Production System. Part 3.

Kaizen project at Showa Industry.

Our 2 teams spent 5 grueling days at the Showa Tekko plant in Fukuoka. This particular plant produces all kind of equipment, from air conditions to vacuum boilers. Some of their cooling equipment is as large as a small building.

Our project was to Kaizen (Improve) their production line. They produce a certain model of air conditioner. Our task was to reduce overtime of their workers without any change in their production capacity.

We utilized Toyota Production principles as I have mentioned before. We divided our team into 2 sub teams. 

We observed three different operators.  First operator was involved in the assembly,  second was  the inspector and third operator was involved with packaging.

Our goal was to reduce the total TakTime. We started with standard flow chart and measured their timings. Caroline White was our team leader and she did a remarkable job leading our team.

We came up with some great ideas. Dr. Nunez and Ruth Hemphill suggested a U shaped module for the inspector work station which reduced his walking time significantly, my team suggested to eliminate waste (Muda) from packaging and add value to the operator’s time by assisting other colleagues.

Our patients are not cars, but on the other hand we do have a line, a line in the ER. Different patients presenting with different problems like a production line, where you may have a Camry and the next could be a Highlander.

Our goal is to have a standard work for these problems so that all operations run free of defects/medical errors and our quality remains top notch/improved survival.