ACGME’s CLER Site Visit What a Program Director Needs to Know Program Directors Conference

1. ACGME’s CLER Site Visit What a Program Director Needs to Know Program Directors Conference March 14, 2014

3. Clinical Learning Environment Review (CLER) Created as part of Next Accreditation System Evaluates Institution’s Clinical Learning Environment Visits every 18 month Visits occur with minimal announcement -2 weeks Focus on DIO, CEO, CMO, CIO, CNO, CSO, Dean, CHEC What is CLER?

4. Assess 6 areas Patient Safety Quality Improvement Transitions in Care Supervision Duty Hours, Fatigue Management and Mitigation Professionalism What is CLER?

5. The Institutional ACGME Site Visit An Accreditation Visit (yet) What CLER is Not !!!

6. The site visitor meet as groups with Medical Center Leadership All Program Directors Key Faculty from all programs Peer selected residents from all programs The site visitors meet on walk rounds with Nurses Residents What is CLER’s structure

7. Methodologies used in CLER Visits • Group Meeting • Audience response system • Tracer Method- Walk rounds • View transitions of care • Talk to Nurses- Credentialing, Supervision • Triangulation • Ask Similar information from multiple sources

8. PATIENT SAFETY

9. What PDs, Key Faculty, Trainees need to know • Patient Safety • What are the institution’s safety initiatives • How do you report a patient safety issue • How many of you have reported a patient safety issue • Do you feel the institution is focused on patient safety • Resident involvement institutional Patient Safety Com.

10. QI/ HEALTH CARE DISPARITIES

11. What PDs, Key Faculty, Trainees need to know • Quality Improvement • What are institution’s major quality improvement effort • What specific QI efforts are trainees involved in • What QI committees are residents involved in • How do residents use data to improve quality of care • Health Care Disparities

12. Transitions of Care

13. Transitions of Care Is there a standard institutional approach to patient sign outs Where transitions take place (quiet, no interruptions) Is all needed information transmitted currently Transitions between different service and in and out of hospital What PDs, Key Faculty, Trainees Need to Know

14. Resident Supervision

15. Supervision Is supervision always available Quality of supervision What is the process to get attending supervision off hours What PDs, Key Faculty, Trainees Need to Know

16. Duty Hours

17. Duty hours, fatigue management and mitigation How are duty hours monitored How accurate are the entered duty hours What is the plan for fatigued residents Do residents use fatigue mitigation approaches What PDs, Key Faculty, Trainees Need to Know

18. Professionalism

19. Professionalism Are residents coerced to falsify duty hours Do residents understand and abide by publication ethics Do resident falsify medical records (Cut and Paste) What PDs, Key Faculty, Trainees Need to Know