Transcript Document

RRC-Internal Medicine Educational Innovations Project:
Clinical Quality Improvement and Patient SafetyDeliverables to Healthcare from Graduate Medical Education
Banner Good Samaritan Medical Center Internal Medicine Residency Program, Phoenix, Arizona
Alan I Leibowitz MD, KeriLyn Morgan MD, Cheryl W O’Malley MD
The objectives of this project will be to allow our program to integrate the BGSMC culture of quality improvement and patient safety (both major components of patient-centered care) into the
curriculum of our program. Through innovative design we plan to make this culture an integral part of residency education and future practice for our graduates. Through education and evaluation
of residents and measurement of their clinical outcomes, the strengths of GME can be exported to the entire hospital.
Timeline
Spring 2006
2001-2007
2006-2007
The “Prize for Performance” Innovation
Program
Medication Error
Reduction
National Clinical Performance Indicators
Ambulatory: e.g.
diabetes, and
preventive care.
Methods
Outcomes
Ward teams review
the orders written by
their peers and the
team with the lowest
number of unsafe
abbreviations or
other errors gets a
monthly “Prize for
Performance (P4P).
Data collected
from peer chart
review is a part of
the resident
evaluation.
A prize (P4P) will
be given for
compliance.
Inpatient: e.g.
immunizations, CHF
discharge orders, smoking
cessation.
Individual residents on
the research rotation
work with quality
management services
in the hospital to track
resident specific data
on compliance with
core measures.
Resident Education in
Critical Care
Residents work one on one
with in house faculty
intensivists learning core ICU
topics designed for the
general internist.
Increased focus on procedure
skills, palliative care, and
crisis management.
Specific curriculum for interns
will be utilized.
•Increase number of
procedures completed
• Continuous quality improvement targeting care processes and
individual performance
• Skills that can be exported to their future practices
• Safer patient care
• Resident experience in the system of “Pay for Performance”
Barriers
ICU Process
Improvement
•Closer interaction between
residents and attendings
• Achieve national quality standards
Extra time for residents
to review charts
July 2006
Competing priorities
in residents’ lives
Need to provide
Less comprehensive data continual training on
collection tools
the use of the data
collection software
for many providers
Resources to collect
individual resident
performance
•Effective leadership during
in code arrest/rapid response
•Graduates with improved
skills in managing critical
care patients
•Improve compliance with
specific ICU protocols (e.g
central line bundle)
Decreased availability of
the residents to focus on
other activities.
Numerous core measures to Increased teaching
choose from
responsibilities for faculty
intensivists.
2006-2007
Resident Safety
Council
• Resident “Chief
Safety Officer”
• Temple University
“DISCLOSE” forms
• Monthly Patient
Safety Case
Conference
2005-2007
Professionalism
Enhancing
Professionalism in
the PhysicianPatient
Relationship
360 degree
evaluation with
online “Program
Issues of Concern”
and ABIM
Praise/Concern
cards
Promote an environment
that allows easy
reporting of nearmisses/adverse events
without fear of punitive
action; study and
implement changes to
•
Raise
the
improve the safety of the
awareness of
system
professionalism in
residents
• Increase knowledge of
• Direct accounts of
patient safety issues
resident actions
and root cause analysis
provide
• Residents are integral in
oppportunities to
identifying systems
improve
problems and creating
professional
solutions.
behaviors
Distinguishing
DISCLOSE forms from
institutional incident
reports
Prioritizing the
anticipated large
number of possible
safety projects that will
result from this
innovation
Potential for bias to
occur with
personality conflicts
Open access could
lead to
misrepresentation of
events
2005-2008
Chronic
Care
Model
Chronic Care Model
(CCM)
Currently all residents
participate in diabetes group
visits, the element of Self
Management Support.
Beginning with a pilot group,
all residents will be members
of multidisciplinary teams to
improve chronic illness care
via all components of the CCM.
•Increase number of patients
meeting or exceeding national
standards
•Improve self directed
learning
•Productive interactions
between informed patients
and providers with resources
and expertise.
•Enhance resident experience
in Systems Based Practice.
Faculty inexperience with the
CCM
Time/scheduling for all
involved
Administrative buy-in to
facilitate acquisition of
resources
Overall Project Outcomes: Graduates participate in quality initiatives and patient safety projects as part of their daily
practice. This improves patient care now and in the future.