CLER Program

1. CLER Program

2. Next Accreditation System (NAS) Annual Data Collected and Reviewed • Annual ADS Update - Streamlined • Program Attrition • Program Characteristics – Structure and Resources • Scholarly Activity • Board Pass Rate – Rolling Rates • Clinical Experience (Case Logs) • Resident Survey • Faculty Survey – Core Faculty • Semi-Annual Resident Evaluation and Feedback • Milestones • Clinical Competency Committees • CLER site visits

3. CLER:Clinical Learning Environment Review • Emphasizes the responsibility of the SI for the quality and safety of the environment for learning and patient care • Also emphasizes addressing health care disparities • Intent to improve quality and safety goals after graduation

4. CLER Site Visit: Areas of Focus • Key institutional policies affecting residents: • Transitions of care (patient handoffs) • Supervision • Duty hours, fatigue management & mitigation • Professionalism • Integration of residents into projects: • Patient Safety • Quality Improvement (Including health care disparities)

5. CLER Site Visit: Goals • Support national efforts addressing patient safety, quality improvement, and reduction in health care disparities. • Increase resident knowledge of and participation in safety activities and quality improvement. • Monitor Sponsoring Institution maintenance of a clinical learning environment that promotes the six goals.

6. Implementation • Initially, not for accreditation decisions • Set expectations for the 6 focus areas and provide institutions with formative feedback • CLER Evaluation Committee charged to set expectations for the 6 focus areas • First cycle (18 months): information shared with ACGME/RCs will be de-identified and/or reported in aggregate. • Second cycle: CLER Evaluation Committee will share relevant information from the CLER site visits with the IRC and RCs

7. CLER Site Visit: Agenda • Senior leadership initial and exit meetings: CEOs, DIO/GMEC Chair, Resident Member of GMEC • Quality & Safety Leadership: Chief Safety Officer and Chief Quality Officer • Residents/Fellows • Core Faculty • Program Director • Walk-arounds

8. CLER Site Visit Materials • Organizational charts • Supervision policy • Duty hour policy • Care transitions policy • Patient safety protocol/strategy (approved by Board) • Quality strategy (approved by Board) • Quality & Safety Committee membership rosters (identifying resident members) • DIO’s most recent annual report to SI governance

9. Example/”beta” test visit UW • Patient Safety: relatively little resident reporting in PSN and viewed as a “black hole”; many didn’t know Patients are First goals • Quality Improvement: Data from hospitals not readily available for QI projects; need to brand Housestaff Quality and Safety Council (HQSC); no strategy on health care disparities • Transitions in Care: CORES is a best practice but could be more effectively used; observed a handoff without supervision • Supervision: Policy template is a best practice; need to make policies and approved procedures available to nurses/care team • Duty Hours/Fatigue: No significant duty hour concerns; insufficient fatigue training for faculty; need to improve fatigue monitoring • Professionalism: Very strong education; residents know how to report concerns (too many avenues to report?)

10. What to Do Now? • Include residents in real, meaningful experiences • Root cause analysis • Protocol development • LEAN/RPIW teams • Patient safety reporting • Obtain clinical effectiveness data • Work with SI leadership, including safety and quality officers • One should be on GMEC

11. What to Do Now? • Implement meaningful policies for supervision and duty hours • Develop transitions of care protocols • Provide fatigue management/mitigation training • Develop monitored standards for professionalism • Include residents in SI initiatives in patient safety, quality improvement, and addressing health care disparities