Immersive Training of Interns in Incident Management

1. Immersive Training of Interns in Incident Management Michael Agrez - DPET, John Hunter Hospital/John Hunter Children�s Hospital Kim Hill � Clinical Governance Barbara Rodham � Clinical Governance Naomi Lee � Medical Workforce Jeanette Chadban � JMO Network Management Unit Jessica Moore � JMO Manager, John Hunter Hospital/Royal Newcastle Centre Meredith Caelli - Clinical Governance

2. Immersive training of interns in Incident Management Aim To assess exposure of interns to the learning capabilities listed in the Australian Curriculum Framework for Junior Doctors (ACFJD) through participation in incident management as a team member on a Root Cause Analysis.

4. Root Cause Analysis Root Cause Analysis (RCA) is a review process to �drill down� into adverse events to identify root causes. The goal is to discover barriers or systems that can be put into place that would have prevented this incident from happening and may prevent similar incidents. Since 1 August 2005, legislation in NSW has required that all serious clinical incidents be investigated using RCA methodology. Suggest we add info re it being a �no blame� approach, people make mistakes because they are put in a situation where mistakes will happen etcSuggest we add info re it being a �no blame� approach, people make mistakes because they are put in a situation where mistakes will happen etc

5. Root Cause Analysis � Process and Team Structure During an RCA causal statements are generated through event mapping and investigation of links between context, events, actions and patient outcomes. Team: Patient Safety Officer (PSO) +/- second PSO Clinical Governance Associate Director Patient Safety Manager Health Care Professionals not directly involved in the patient�s care (medical, nursing, allied health, paramedics, other health care services as relevant) Intern +/- second Intern (the Study)

7. ACFJD Three Learning Areas Clinical Management Communication Professionalism Categories (Categories incorporated into the RCA Questionnaire) Patient Interaction, Managing Information, Working in Teams, Doctor & Society and Professional Behaviour Learning Topics

8. Study Design - 2011 Study Design Orientation program included RCA training Conflicts of interest addressed RCA team allocation Term Supervisors notified Electronic questionnaire referenced to the ACFJD Certificate of Participation

9. ACFJD-listed Categories incorporated into the post-RCA questionnaire Patient Interaction Managing Information Working in Teams Doctors & Society Professional Behaviour

10. Serious Clinical Incidents Reviewed Through RCA Investigations on the wrong patient Unexpected death Neonatal death Retained instrument or material Clinical management issues Misdiagnoses Procedural injuries

11. Participants 79 interns received RCA training during Orientation in the HNE Local Health District 57 interns had participated on a RCA team by 1st October 2011 60% interns completed the on-line questionnaires by 1st October 2011

12. Results � Interim analyses from 34 respondents by 1st October 2011 Time commitment: 252 hours dedicated to RCA teams 158 hours rostered overtime 94 hours unrostered overtime 82% respondents required = 2 hours unrostered overtime Team interaction: meetings face-to-face and tele/videoconference Contribution: group discussion research verbal and written reports interviews (patients / family / staff)

17. Professional Behaviour 79% reported a much better/better understanding of the importance of reflecting on personal experiences, actions and decision making 62% reported a much better/better understanding of the ethical complexity of practice and need to follow professional and ethical codes

18. Participant support 97% recommended or strongly recommended participation on an RCA team 100% agreed or strongly agreed they had adequate team support 74% reported no barrier to team participation commonest barriers were workload and after-hours rostering

19. Benefits of Participation � comments �provided a big picture of the huge benefits that small changes can make� �emphasised the value of approaching patient care at a holistic level� �emphasised the importance of good communication and documentation� �made me realise that errors are multi-causal and that an RCA is not about individual targeting� Participation leads to increased confidence to practise and is valued by interns

20. Conclusions and Future Directions Intern participation on RCA teams offered opportunities to experience many ACFJD-recommended learning capabilities The RCA process has been integrated as a learning program for interns within HNE Health Neutral responses may highlight further training needs Impact on patient care planned