patient safety & quality improvement in graduate medical education

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Patient Safety & Quality Improvement in Graduate Medical Education. Ariane Marie-Mitchell, MD, PhD, MPH Preventive Medicine & Pediatrics October 24, 2013. OUTLINE. What do all residents need to know about PSQI What resources are available to learn about PSQI - PowerPoint PPT Presentation


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Patient Safety & Quality Improvement in Graduate Medical EducationAriane Marie-Mitchell, MD, PhD, MPHPreventive Medicine & PediatricsOctober 24, 2013OUTLINEWhat do all residents need to know about PSQI

What resources are available to learn about PSQI

How can residency programs integrate training in PSQI

Training physicians to participate in Quality Improvement is a positive trend in health care.Strongly AgreeAgreeSomewhat AgreeNeutralSomewhat DisagreeDisagreeStrongly Disagree


Deaths Due to Surgical or Medical Mishaps per 100,000 Population, 2006

Source: OECD Health Data 2008, June 2008.* 2005**2004THECOMMONWEALTHFUND4Note: * Estimate. Expenditures shown in $US PPP (purchasing power parity).Source: Calculated by The Commonwealth Fund based on 2007 International Health Policy Survey; 2008 International Health Policy Survey of Sicker Adults; 2009 International Health Policy Survey of Primary Care Physicians; Commonwealth Fund Commission on a High Performance Health System National Scorecard; and Organization for Economic Cooperation and Development, OECD Health Data, 2009 (Paris: OECD, Nov. 2009).AUSCANGERNETHNZUKUSOVERALL RANKING (2010)3641527Quality Care4752136Effective Care2763514Safe Care6531427Coordinated Care4572136Patient-Centered Care2536174Access6.5531426.5Cost-Related Problem63.53.52517Timeliness of Care6721345Efficiency2653417Equity4531627Long, Healthy, Productive Lives1234567Health Expenditures/Capita, 2007$3,357$3,895$3,588$3,837*$2,454$2,992$7,290Country Rankings1.002.332.344.664.677.00

Exhibit ES-1. Overall RankingTHE COMMONWEALTH FUND5

PSQI is about how to practice medicineLLUMC Physician LoungePSQI to PSQIAdvanced Practice of PSQIModels for Integrating PSQI into GMESelected ReferencesIntroduction to PSQICore CompetenciesPractice Based Learning and Improvement (how good is my practice?)Use QI methods to analyze practice and implement changesSystems Based Practice (how good is the health care system?)Advocate for quality patient care and optimal patient care systemsWork in inter-professional teams to enhance patient safety and improve qualityParticipate in identifying system errors Use QI methods to implement system solutionsIntroduction to PSQILearning ObjectivesPatient SafetyKnow the scope of medical errors and main types Distinguish between error and harm Use voluntary reporting systems to report errors and near-misses List key methods for reducing errors Use key communication skills including SBAR (Situation, Background, Assessment, Recommendation), briefings, read-backs, and CUS (Concerned, Uncomfortable, Safety)Describe a root cause analysis Structure an effective apology Introduction to PSQILearning ObjectivesQuality ImprovementList six dimensions of quality health careDescribe how U.S. health care system compares to others Create a specific aim statement Select outcome, process and balancing measures Select appropriate measures of change Use PDSA (Plan, Do, Study, Act) cycles List key differences between QI and research Understand basics of sampling methods for QI Create and use key QI tools Understand the basics of spread and diffusion Does your program require residents to complete any IHI Open School Modules during training?YesNoConsideringDont know

1Does your program require residents to participate in an Improvement Project using QI methods?YesNoConsideringDont know

1My program has enough faculty to mentor residents on an Improvement Project using QI methods.Strongly AgreeAgreeSomewhat AgreeNeutralSomewhat DisagreeDisagreeStrongly Disagree

1Introduction to PSQIOnline LearningIHI Open School (Institute for Healthcare Improvement) Patient Safety 101-105 meet objectives or ~6 hours (2 required pre-intern)Quality Improvement- 101-104 meet objectives or ~4 hours AlternativesMayo Clinic Quality AcademyAMA Introduction to Practice of MedicineIntroduction to PSQIDidacticsSee Selected References- PSQI Education WHO Patient Safety CurriculumUniversity of Chicago Medical Center Internal Medicine Quality CurriculumIntroduction to PSQIPractice-Based Learning ProjectKey Steps#1 Identify a Faculty Mentor#2 Describe your Professional Opportunity#3 State your Aim #4 Diagram a Cause-Effect Analysis#5 Define your Measures#6 Conduct an Evidence Review#7 Collect Baseline Data#8 Test a Change (repeat tests until outcome achieved)Improvement ProjectsPractice-Based LearningData source = your patient encountersChange focuses on your practice behaviorsSystems-Based PracticeData source = your clinical microsystemChange requires team effort

Describe Cause-Effect AnalysisUse EvidenceCollect and Study DataTest ChangesPBL Project ExampleProfessional Opportunity: Underuse of influenza vaccination in my adult patients

Aim Statement: I will increase my influenza vaccinations rate to 80% in my eligible adult patients age 18-64 by December 30, 2013

Evidence Review: ACIP Vaccine Recommendations for 2013

PBL Project Example: Cause-Effect DiagramMaterialsPhysicianPatientsVaccine availabilityI know the guidelinesVaccine Record_ProcessesInfluenzaVaccination Rate Vaccination rate I remember to order_ContraindicatedNurse Schedule DeclinedInsurance coverage I effectively counsel20PBL Project Example (contd)Outcome measure = # patients age 18-64 who received influenza vaccination /total # eligible patients age 18-64 seen during time period

Process measures = Proportion missed opportunities to orderProportion orders declined

Balancing measures =Proportion patient complaints re: billing

PBL WorksheetLETS PRACTICE:Obtain a PBL Worksheet at your tableDraft items #2-5Discuss with others at your table

TIME ~ 10 minutesHow many total hours are dedicated in your current curriculum to learning PSQI?None (any PSQI is outside regular work hours)Less than 1 hour per month (


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