Patient safety and quality care

Abstract

This whole journey began with a very busy day in my procedure clinic; at this point in time, Duke Dermatology was in the midst of a very active growth period. Several new dermatologists, including myself, had joined the faculty over the previous 2 years, and our nursing support structure was in the process of growing in parallel to keep pace. As a result, clinics not infrequently were relatively understaffed with nursing team members. On this particular day, two patients had been added to my schedule with fairly short notice; I had a new resident working with me; and we had no dedicated nursing support. I saw two patients that day for spot check of concerning lesions; I’ll call them Mr. Ear and Mr. Chest. Mr. Ear had a raised keratotic papule on his left ear; Mr. Chest had a stuckon–appearing thin plaque on his right upper chest that was partially avulsed. Mr. Ear was concerned that his spot might be a small squamous cell skin cancer; I agreed. Mr. Chest was worried that his spot might be a melanoma; I greatly favored a traumatized seborrheic keratosis. The resident and I were in and out of examination rooms several times to gather procedural supplies, generate