Doing the Right Things Right: Clinical Performance Support ...

1. PHS 2008 Scientific and Training Symposium Doing the Right Things Right:Clinical Performance Support Systems For Health and Medical Emergency Responses CAPT Arthur French MD FACEP USPHS (Ret.)

2. 2008 PHS Scientific and Training Symposium The Nexus Between Patient Safety and Corps Readiness A �delta� between required-expected performance and actual mission execution (performance gap) is likely in response Increased performance ? fewer errors : ? efficiency, ? patient morbidity & mortality Patient safety tools reduce errors ? Patient Safety = ? Mission Readiness

3. 2008 PHS Scientific and Training Symposium Performance Support and Mission Execution Training is not the solution for all performance gaps Infrequently used skills and knowledge rapidly perish (six months) Clinical care is particularly vulnerable to errors � dynamic & tightly coupled Zero tolerance for mission failure!

4. 2008 PHS Scientific and Training Symposium Emergency Support Function-8 Target Capabilities - Universal Tasks Replace damaged-destroyed medical infrastructure Patients don�t always go to the ED/DMAT Routine patients can crash DMATS may be overloaded-OOC Mis-triaged patients Acute care surge capacity for pandemics- high acuity/mortality

5. 2008 PHS Scientific and Training Symposium

6. 2008 PHS Scientific and Training Symposium

7. 2008 PHS Scientific and Training Symposium Clinical Health and Medical Emergency Response Tasks Nursing support Parenteral fluids, meds & vaccines Oxygen-airway- ventilation support Palliative care Physician-RN extenders Physician advanced life support CBRNE protocols Critical care- ventilators (post ACLS-ATLS)

8. 2008 PHS Scientific and Training Symposium Human Performance Threats in the Environment Disaster Physiological Fatigue Heat & cold Dehydration & nutrition Psychological Stress of requirements exceeding resources Sense of hopelessness

9. 2008 PHS Scientific and Training Symposium Knowledge Transfer to the Response Environment �Train like you are going to fight- Fight like you train!� Close the best practice ? action gap Must do the right things and do them right Performance support systems are �Force Multipliers� Must be accessible and familiar

10. 2008 PHS Scientific and Training Symposium Who Needs Performance Support? All CC officers deploying for clinical operations- not just clinicians! �Other duties as assigned� Likely will have duties outside normal �box� Medical Team Management Cover your shipmate�s six Deployment human performance threats are high

11. 2008 PHS Scientific and Training Symposium Performance Support Systems Use of electronic performance support systems (EPSS) can reduce errors EPSS can facilitate clinical care consistency across all responders Communicated quickly in dynamic scenario Anthrax case/prophylaxis guidelines SARS case definitions

12. 2008 PHS Scientific and Training Symposium Human Performance Technology Decision support systems Used in aviation and high-risk industries Increasing use in hospitals and EMS Can be embedded in electronic health record Paper versus electronic? Tablet PCs versus PDAs

13. 2008 PHS Scientific and Training Symposium Examples of Performance Support Systems NIH WISER DOD ALTHA-Mobile (B-MIST) AHRQ Bioterrorism Portfolio

14. 2008 PHS Scientific and Training Symposium Way Forward Plan for the worst- hope for the best Be prepared for the �Big D� Pandemic, nuclear incident, earthquake Every deployable clinical responder should be issued an EPSS PDA vs. tablet PC OFRD manage enterprise network Line item funding for system life cycle

15. 2008 PHS Scientific and Training Symposium Way Forward Partner with DOD, other Federal agencies, and private sector AHRQ COMCARE Don�t be afraid to leverage the �S� word! It can facilitate increased Corps readiness Justify increased resources Not a sign of weakness

16. 2008 PHS Scientific and Training Symposium Questions?