Clinical Quality Improvement and Patient Safety- Deliverables to Healthcare from Graduate Medical Education

1. Clinical Quality Improvement and Patient Safety-Deliverables to Healthcare from Graduate Medical Education

3. Our Program 55 Categorical Medicine 24 Med-Peds Fully integrated with the Phoenix VA Good Sam is a 673 beds, 120 critical care beds 7 accredited fellowships Good Sam is a major teaching campus for the University of Arizona and 40% the students spend time in Phoenix. With all of 55 Categorical Medicine 24 Med-Peds Fully integrated with the Phoenix VA Good Sam is a 673 beds, 120 critical care beds 7 accredited fellowships Good Sam is a major teaching campus for the University of Arizona and 40% the students spend time in Phoenix. With all of

4. “tightly couple the process of doing work with the process of learning to do it better as it’s being done”

5. Areas for Innovation Prize for Performance ICU Process Improvement Resident Safety Council Professionalism Chronic Care Model 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.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.

6. “Prize for Performance” (P4P) Medication Error Reduction National Clinical Performance Measures Ambulatory Diabetes Preventive care Inpatient Immunizations CHF Smoking cessation

7. Medication Error Reduction Inpatient peer chart review Weekly for 3 weeks Ward team with fewest errors receive prize

8. National Clinical Performance Measures Ambulatory and Inpatient Measures Individual and program performance feedback to direct educational and systems interventions P4P as incentive Individual performance feedback through peer chart rIndividual performance feedback through peer chart r

9. P4P Outcomes Achieve national quality standards Continuous quality improvement targeting care processes and individual performance Skills that can be exported to future practices Safer patient care Resident experience in the system of “Pay for Performance” Addresses all competencies

10. ICU Process Improvement One on one with in house faculty intensivists at Good Sam Focus on core topics for general internists Specific curriculum for interns including Simulation Center Didactics Intubation skills We are going to completely reorganize the ICU rotation at Good Sam so that residents will work one on one with the in house critical care faculty during their 2nd and 3rd years. While on the ICU rotation they will attend relevant meetings discussing the effectiveness of the rapid response team and other ICU specific patient safety/quality improvement projects. And while they have primary patient care responsibilties, the residents will have the intensivists to immediately model clinical reasoning skills and provide feedback, education and quality patient care. The interns who were formerly part of the good sam ICU rotation will be moved to the VA where they will participate in all aspects of daily patient care but have protected time to have structured didactics directed at their level, and practice procedural skills in the simulation center which will be available within the next year, direct supervision and some new opportunities in the operating room to practice intubation skills. We are going to completely reorganize the ICU rotation at Good Sam so that residents will work one on one with the in house critical care faculty during their 2nd and 3rd years. While on the ICU rotation they will attend relevant meetings discussing the effectiveness of the rapid response team and other ICU specific patient safety/quality improvement projects. And while they have primary patient care responsibilties, the residents will have the intensivists to immediately model clinical reasoning skills and provide feedback, education and quality patient care. The interns who were formerly part of the good sam ICU rotation will be moved to the VA where they will participate in all aspects of daily patient care but have protected time to have structured didactics directed at their level, and practice procedural skills in the simulation center which will be available within the next year, direct supervision and some new opportunities in the operating room to practice intubation skills.

11. ICU Process Improvement: Outcomes Close interaction between residents/intensivists Increased number of supervised procedures Increased skill in codes/crisis management Core skills in managing critical care patients Improved compliance with ICU specific patient safety measures Role models Ventilator associated pneumonia, central line bundle, DVT prophylaxisRole models Ventilator associated pneumonia, central line bundle, DVT prophylaxis

12. Resident Safety Council Projects Resident “Chief Safety Officer” Chair the Resident Safety Council Serves on hospital patient safety council “DISCLOSE”* forms to identify near misses Patient Safety Case Conference We will create a resident Safety Council which will oversee resident patient safety projects. The resident chief safety officer will chair this council and be a resident rep on the hospital’s council. The council will review reports received through the implemention of Temple University’s “DISCLOSE” Incident Reports and recommend further action or RCA. Select incidents that have teaching value will subsequently be reviewed at a monthly Patient Safety Case Conferences. We will create a resident Safety Council which will oversee resident patient safety projects. The resident chief safety officer will chair this council and be a resident rep on the hospital’s council. The council will review reports received through the implemention of Temple University’s “DISCLOSE” Incident Reports and recommend further action or RCA. Select incidents that have teaching value will subsequently be reviewed at a monthly Patient Safety Case Conferences.

13. Professionalism Expand 360 evaluation Online “Program Issues of Concern” Form ABIM Praise/Concern cards on the wards for feedback from nurses, peers, patients, attendings Faculty, staff and residents Faculty, staff and residents

14. Chronic Care Model 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 The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care. These elements are the community, the health system, self-management support, delivery system design, decision support and clinical information systems 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 The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care. These elements are the community, the health system, self-management support, delivery system design, decision support and clinical information systems

15. Chronic Care Model Outcomes Increase the number of patients meeting national standards Improve self directed learning Enhance resident experience in Systems Based Practice Increase number of patients meeting or exceeding national standards Improve self directed learning of patients and residents Productive interactions between informed patients and providers with resources and expertise. Enhance resident experience in Systems Based Practice.Increase number of patients meeting or exceeding national standards Improve self directed learning of patients and residents Productive interactions between informed patients and providers with resources and expertise. Enhance resident experience in Systems Based Practice.

16. “Scrambled Eggs Super”

17. Unsafe Abbreviations Preliminary Findings Discuss the timing with JCAHO visit and the hospital priority. Other interventions like reminders in all charts, now pens. Recognition from Administration of IM Residency Initiative in solving the problem. Proving to the residents that they are part of the problem.Discuss the timing with JCAHO visit and the hospital priority. Other interventions like reminders in all charts, now pens. Recognition from Administration of IM Residency Initiative in solving the problem. Proving to the residents that they are part of the problem.