1 / 17

Scripps Mercy Hospital Continuous Circle of Care

Scripps Mercy Hospital Continuous Circle of Care. APDIM Meeting, April 6, 2006 David Shaw, M.D., Director of Medical Education Stanley Amundson, M.D., Program Director. The overall concept: Continuous Circle of Care.

tave
Download Presentation

Scripps Mercy Hospital Continuous Circle of Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scripps Mercy HospitalContinuous Circle of Care APDIM Meeting, April 6, 2006 David Shaw, M.D., Director of Medical Education Stanley Amundson, M.D., Program Director

  2. The overall concept: Continuous Circle of Care • Opportunity to improve patient care and improve resident education at every point in the patient-physician encounter • Starts with initial encounter between resident and patient: where empathy is established and patient develops confidence in the therapeutic relationship

  3. The overall concept: Continuous Circle of Care (continued) • Circle is complete when patient returns for follow-up • At this point resident learns whether he/she has been effective in motivating patient to comply with prescribed, evidence-based diagnostic procedures and therapeutic interventions

  4. The overall concept: Continuous Circle of Care (continued) • In between opportunity to improve patient care and resident education in a measurable fashion at each intervening point in circle: history, physical exam, formulation of problem list, selection of diagnostic tests, creation of differential diagnosis resolved to highest level, development of therapeutic plan, education of patient about diagnosis and therapies, integration of patient safety into processes of care, and timely and cost-effective provision of services

  5. Low-Tech Example of the Continuous Circle of Care The Cardiac CEX: Used to measurably improve physical examination and ensure accurate diagnosis, improving patient care

  6. Background • Studies continue to show that 70% of our diagnostic medical information comes from a well-performed history and physical examination. • Studies also show that current United States Residents miss 50% or more of significant cardiac physical exam findings. • The physical exam is cost effective, non-invasive and it enhances the doctor patient relationship. • A structured Cardiac CEX can evaluate and teach cardiac physical exam skills while the patient is being staffed, which is time efficient.

  7. I. CARDIAC CEXJVP Analysis Format Feel L carotid pulse & look for the R IJ vein with the patient’s neck relaxed and head rotated 30o to the L Change angle of bed to localize the “top of the oscillating column of venous blood” to the mid-neck area Determine if A wave or V wave dominant Measure height of JVP in cm of water using the angle of Louis = 5 cm as reference Credit is given for doing the appropriate maneuvers even if the wrong answer is obtained

  8. II. CARDIAC CEX JVP Analysis Accuracy • Was the JVP wave-form analyzed accurately? • Was the JVP pressure measured accurately? • Credit for this part of the CEX is given only if accurate results are obtained.

  9. Making the Cardiac CEX Efficient as a Teaching, Evaluative and Patient Care Enhancing Tool • 1. Schedule two one-hour long lectures on the cardiac exam early in the academic year. • 2. Use the evaluation form as one of the handouts and “teach to it.” This helps residents organize their cardiac exam, informs them about what they will be evaluated on, and it promotes home study. • 3. Have a limited number of specially trained core faculty do all of the Cardiac CEX’s so that evaluation and teaching are standardized.

  10. Making the Cardiac CEX Efficient as a Teaching, Evaluative, and Patient Care Enhancing Tool • 4. It is most time efficient for CEX-trained clinic attendings to supervise CEX’s on the first patient of their AM and/or PM shifts so that CEX time is also patient staffing time. It takes approximately 30 min. to complete the Cardiac CEX and staff in real time the patient’s other problems. Staffing other patients with their residents is not impeded if only the first patient of each shift is CEX’ed.

  11. High Tech Example of the Continuous Circle of Care • The Medication Translator Project: Web tool used to enhance patient safety by reconciling medications across the continuum of care, and providing patients with clear instructions translated from English to Spanish, resulting in improved patient compliance with medications, and providing new prescriptions with a single click • Being utilized by Residents discharging inpatients and in their continuity clinic. Being adopted by Attendings in their Offices

More Related