Transcript Hospitalists as Safety Intervention Tuesday, December 5, 2006 12:00 – 1:00 p.m.

Hospitalists as Safety Intervention
Tuesday, December 5, 2006
12:00 – 1:00 p.m. Eastern Time
Moderator:
Christopher Landrigan, MD, MPH, FAAP
Pediatric Hospitalist / Research & Fellowship Director
Children’s Hospital Boston, Inpatient Pediatrics Service
Boston, Massachusetts
This activity was funded through an
educational grant from the
Physicians’ Foundation for Health
Systems Excellence.
Disclosure of Financial Relationships and
Resolution of Conflicts of Interest for AAP CME Activities Grid
The AAP CME program aims to develop, maintain, and increase the competency, skills, and
professional performance of pediatric healthcare professionals by providing high quality,
relevant, accessible and cost-effective educational experiences. The AAP CME program
provides activities to meet the participants’ identified education needs and to support their
lifelong learning towards a goal of improving care for children and families (AAP CME
Program Mission Statement, August 2004).
The AAP recognizes that there are a variety of financial relationships between individuals and
commercial interests that require review to identify possible conflicts of interest in a CME
activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts
of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and
scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of
interest prior to the confirmation of service of those in a position to influence and/or control
CME content. The AAP has taken steps to resolve any potential conflicts of interest.
All AAP CME activities will strictly adhere to the 2004 Updated Accreditation Council for
Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to
Ensure the Independence of CME Activities. In accordance with these Standards, the
following decisions will be made free of the control of a commercial interest: identification
of CME needs, determination of educational objectives, selection and presentation of
content, selection of all persons and organizations that will be in a position to control the
content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and
mechanisms to resolve them prior to the CME activity are implemented in ways that are
consistent with the public good. The AAP is committed to providing learners with
commercially unbiased CME activities.
DISCLOSURES
Activity Title:
Safer Health Care for Kids - Webinar
Hospitalists as Safety Intervention
December 5, 2006
Activity Date:
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP
CME activities are required to disclose to the AAP and subsequently to
learners that the individual either has no relevant financial relationships or
any financial relationships with the manufacturer(s) of any commercial
product(s) and/or provider of commercial services discussed in CME
activities.
Name
Name of
Commercial
Interest(s)*
(*Entity
producing
health care
goods
or services)
Nature of
Relevant
Financial
Relationship(s)
(If yes, please list:
Research Grant,
Speaker’s Bureau,
Stock/Bonds
excluding mutual
funds, Consultant,
Other - identify)
CME Content Will
Include
Discussion/
Reference to
Commercial
Products/Services
Disclosure of Off-Label
(Unapproved)/Investigational Uses of Products
AAP CME faculty are required to disclose to the AAP
and to learners when they plan to discuss or
demonstrate pharmaceuticals and/or medical devices
that are not approved
Jack M. Percelay,
MD, MPH, FAAP
No
No
No
No
Erin R. Stucky, MD,
FAAP
No
No
No
No
DISCLOSURES
SAFER HEALTH CARE FOR KIDS - PROJECT ADVISORY COMMITTEE AND STAFF
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME ac tivities are required to disclose to the AAP and
subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name
Name of
Commercial
Interest(s)*
(*Entity producing
health care goods
or services)
Nature of Relevant
Financial Relationship(s)
(If yes, please list:
Research Grant, Speaker’s
Bureau, Stock/Bonds
excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include
Discussion/
Reference to Commercial
Products/Services
Disclosure of Off-Label
(Unapproved)/Investigational Uses
of Products
AAP CME faculty are required to
disclose to the AAP and to learners
when they plan to discuss or
demonstrate pharmaceuticals and/or
medical devices that are not approved
Karen Frush, MD, FAAP
(PAC Member)
No
No
No
No
Uma Kotagal, MD, MBBS,
MSc, FAAP (PAC Member)
No
No
No
No
Christopher Landrigan, MD,
MPH, FAAP (PAC Member)
No
No
No
No
Marlene R. Miller, MD, MSc,
FAAP (PAC Chair)
No
No
No
No
Paul Sharek, MD, MPH.
FAAP (PAC Member)
No
No
No
No
Erin Stucky, MD, FAAP (PAC
Member)
No
No
Not sure
No
Nancy Nelson (AAP Staff)
No
No
No
No
Melissa Singleton, MEd
(Project Manager – AAP
Consultant)
No
No
No
No
Junelle Speller (AAP Staff)
No
No
No
No
Linda Walsh, MAB (AAP
Staff)
No
No
No
No
DISCLOSURES
AAP COMMITTEE ON CONTINUING MEDICAL EDUCATION (COCME)
DISCLOSURE OF FINANCIAL RELATIONSHIPS
All individuals in a position to influence and/or control the content of AAP CME ac tivities are required to disclose to the AAP and
subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the
manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name
Name of
Commercial
Interest(s)*
(*Entity producing
health care goods
or services)
Nature of Relevant
Financial Relationship(s)
(If yes, please list:
Research Grant, Speaker’s
Bureau, Stock/Bonds
excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include
Discussion/
Reference to Commercial
Products/Services
Disclosure of Off-Label
(Unapproved)/Investigational Uses
of Products
AAP CME faculty are required to
disclose to the AAP and to learners
when they plan to discuss or
demonstrate pharmaceuticals and/or
medical devices that are not approved
Ellen Buerk, MD, FAAP
No
No
No
No
Meg Fisher, MD, FAAP
No
No
No
No
Robert A. Wiebe, MD, FAAP
No
No
Not sure
No
Jack Dolcourt, MD, FAAP
No
No
No
No
Thomas W. Pendergrass, MD,
FAAP
No
No
No
No
Beverly P. Wood, MD, FAAP
No
No
No
No
CME CREDIT
The American Academy of Pediatrics (AAP) is
accredited by the Accreditation Council for
Continuing Medical Education to provide continuing
medical education for physicians.
The AAP designates this educational activity for a
maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate
with the extent of their participation in the activity.
This activity is acceptable for up to 1.0 AAP credit.
This credit can be applied toward the AAP CME/CPD
Award available to Fellows and Candidate Fellows of
the American Academy of Pediatrics.
OTHER CREDIT
This webinar is approved by the National Association of
Pediatric Nurse Practitioners (NAPNAP) for 1.2
NAPNAP contact hours of which 0.0 contain
pharmacology (Rx) content. The AAP is designated
as Agency #17. Upon completion of the program,
each participant desiring NAPNAP contact hours
should send a completed certificate of attendance,
along with the required recording fee ($10 for
NAPNAP members, $15 for nonmembers), to the
NAPNAP National Office at 20 Brace Road, Suite 200,
Cherry Hill, NJ 08034-2633.
The American Academy of Physician Assistants accepts
AMA PRA Category 1 Credit(s)TM from organizations
accredited by the ACCME .
Jack M. Percelay, MD, MPH, FAAP
Pediatric Hospitalist
Hunterdon Medical Center
Flemington, New Jersey
Erin R. Stucky, MD, FAAP
Pediatric Hospitalist
Children’s Specialists of San Diego
Rady Children’s Hospital
San Diego, California
Hospitalists as Safety
Intervention
Jack Percelay MD, MPH, FAAP
Erin Stucky MD, FAAP
AAP Safer Health Care for Kids Webinar
December 5, 2006
Disclosures
• Dr Erin Stucky does in fact have a time twizzler
just like Hermione Granger and that is how she
is able to accomplish so much in so little time
• Dr Jack Percelay is significantly taller than Erin
Stucky
What we will cover today
Participants shall be able to:
• a. List key resources and personnel to establish a
pediatric patient safety program in a community
hospital.
• b. Name key hospital committees and (medical staff)
department relationships through which the
hospitalist can effect patient safety changes.
• c. Identify specific patient safety targets for pediatric
hospitalists in community and children's hospitals.
Wachter NEJM Original
Definition of Hospitalist
•
“Hospitalists are physicians who spend more
than 25% of their time based in a hospital
setting, where they serve as Physicians-ofrecord after accepting “hand-offs” of
hospitalized patients from primary care
physicians, returning those patients to the care
of the primary care physicians at the time of
hospital discharge.”
Society of Hospital Medicine
Current Definition of Hospitalist
•
“Physicians whose primary professional focus
is the general medical care of hospitalized
patients. Their activities include patient care,
teaching, research, and leadership related to
hospital care.”
Key Features of Definition
• Hospital is exclusive work environment
• Commitment to systems improvement
• Communication, communication,
communication
• Implicit risk of the handoff
• Multiple roles besides purely clinical care
SHM Projections
Number of Hospitalists
AAP Section on Hospital Medicine
– October 1998 75 members
– October, 2006 670 members
AAP Guiding Principles for
Pediatric Hospitalist Programs
1 Voluntary referrals.
2 Designed for Local Needs
3 BC/BE pediatric equivalent training
4 Include appropriate follow-up
5 Timely and complete communication
6 Data collection
Pediatrics, April 2005
Community Hospitalists
Many of these points will also apply to the Children’s Hospitalist
Multiple Hospitalist Roles
Multiple Opportunities
•
•
•
•
•
•
Pediatric ward – teaching residents
Nursery
NICU and PICU
Emergency Department
Hospital services – radiology, sedation
Clinical partners – nursing, respiratory therapy,
pharmacy
Ingredients for a Successful
Hospitalist/Hospitalist Program
•
•
•
•
Clinical acumen and communication skills
Broad systems interest
Lead by example
Shared quality and outcome goals, not just
revenue
• Job description, compensation, career
advancement linked to performance
improvement
Hospital Relationships
Institutional Leadership
• In community hospital, hospitalist is often the
physician leader for pediatrics
• Department chair may be office based
• Unlikely to have pediatric ER
• Neonatology often present, rarely involved with
ward
Hospital Relationships
Key Contacts for Pediatric Advocacy
•
•
•
•
•
•
•
•
VP of Medical Affairs
Patient Safety Officer
Department of Pediatrics Chair
Pharmacy, Radiology and Laboratory
Nurse Manager, VP of Nursing
Risk Manager
JCAHO
PI/QI
Hospital Relationships
Key Physician Contacts
•
•
•
•
•
•
•
•
•
Department Chair
Office based PCPs,
Sub-specialists, adult and pediatric
Surgeons--general, pediatric & subspecialty
Anesthesiologists
Radiologists
ER
Pathologist/Clinical Lab Director
Outside tertiary care referral subspecialists
Hospital Relationships
Key Committee Involvement
•
•
•
•
•
•
•
•
Patient Safety
Pharmacy and Therapeutics
Performance Improvement/QI
JCAHO
Credentials
Forms/Medical Records
Education
Multi-disciplinary Pediatric Committee
– Create one if it doesn’t already exist
Initial Safety Efforts
Leading by Example
• Culture of safety
• Teamwork
• Do the little things right--if you don’t,
no one will
• ALWAYS wash hands,
• always write mg/kg
• Monitor and evaluate your own performance
– Ask for feedback, debrief
Other Safety Projects for the
Community Hospitalist
•
•
•
•
•
•
Clinical Practice Guidelines
Transitions of Care and Hand-offs
Medication safety and weight based dosing
Infection control
Rapid Response Team
Other knock-offs of successful projects already
implemented in children’s hospitals
Tips for Success
Vigilance on Advocacy Issues
•
Put pediatrics on the dashboard
– Infrastructure is geared towards adult
population
• Get buy-in from pediatricians
• Get buy-in from adults
– Use example “if it were your child
(use name)”
Tips for Success
Beware of Potential Pitfalls
•
•
Change is never easy
Be cautious about how high to set the bar
– Depends on local culture and politics
– First task is to get buy-in for your hospitalist
program
– Identify and respect potential obstacles
Suggestions
•
•
•
Start small, improve your practice first
Create alliances with non-physicians
Create physician alliances
– Specialty and surgical co-management*
• Let others advocate for your expanded role
• Change systems to change behaviors/ outcomes
*Pediatrics March 2003, pp. 707-709
Opportunities for the Community
Pediatric Hospitalist
• Potential to directly impact care
• Potential for a significant leadership role in your
hospital
– May extend to adult safety areas
• Regional and national pediatric hospitalist
and/or pediatric patient safety activities
Children’s Hospitalists
Perceptions – real or not?
•
•
•
•
•
Less individual responsibility to lead?
Focus on the greater good for all children
Infrastructure in place
Sophisticated endeavors: RRT, safety rounds
Administrators chart the safety course?
Key Resources and Personnel:
the Hospital
• All noted with Community Hospitalists apply
• Liaisons with units intimate
– Respecting expertise
– Transfers of care; RRT; medication reconciliation
• Partnership with PCPs
– CSHCN, access for outpatient f/u studies
• Key hospital administrators may be Hospitalists
Key Resources and personnel –
The look within
What qualities should you expect when hiring a
Children’s Hospitalist?
• Role on the pediatric ward
– Culture; IHI efforts; teach safety at bedside
• Role in the Hospital
– Chair committees; seek projects; formal safety
education
Key Resources and personnel –
The look within
Role with the Hospital
• Local leader /representative
– Discuss best practices, NACHRI, NICHQ
interpretation
• JCAHO implementation
• The “go to” division for safety challenges
• The “go to” division for patient safety research
Hospital Committees and
Department Relationships
• All noted with Community Hospitalists apply
• QI and Medical Staff Executive Committee
memberships a must
• Department of Surgery and Trauma
Committees
• Key M&M Committees: Critical care, Transport,
Emergency Department, Pediatrics
• Chair of the University Department of
Pediatrics
Specific Safety Targets
•
•
•
•
•
•
•
•
•
Surgical and specialty co-management
Medication reconciliation
RRT
IHI bundles; 100L lives campaign
Trauma and Emergency Preparedness
Transport systems
Sedation
Teaching oversight, curriculum development
Fatigue and stress education
Tips for success
•
•
•
•
•
All noted with Community Hospitalists apply
Awareness of site-specific issues
Learn your system and stakeholders
Insert safety as part of your division’s mission
Legitimize hospitalists’ efforts in patient safety
by leading systems improvement efforts
Hospital Medicine Web Resources
– AAP Section on Hospital Medicine and
LISTSERV
• [email protected]
– Ambulatory Pediatric Association Special
Interest Group in Hospital Medicine
• www.Ambpeds.org
– Society of Hospital Medicine
• www.hospitalmedicine.org
Patient Safety Resources
– AAP Practice Management – Safety.
http://practice.aap.org/topicBrowse.aspx?nodeID=1000.1
013.1020
– AAP Things that work.
http://www.aap.org/visit/thingsthatworkcall.htm
– Child Health Corporation of America CHCA
http://www.chca.com/company_profile/pi/index.html
– Agency for Healthcare Research and Quality AHRQ
www.ahrq.org.
– National Insitute for Child Health Quality.
http://www.nichq.org/nichq 100 Lives campaign.
Patient Safety Resources
– Institute for HealthCare Improvement
http://www.ihi.org/ihi Leadership Guide to
Patient Safety – Free download.
– Principles of Patient Safety in Pediatrics Pediatrics Vol.
107 No. 6 June 2001, pp. 1473-1475 American
Academy of Pediatrics National Initiative for
Children's Health Care Quality Project Advisory
Committee
– AAP Safer Heath Care for Kids Webinars
– AAP Safety email list