SES B38 Integrating the Health Care Matrix into your Transitional Year Quality and Safety Curriculum AHME Institute May 15, 2015
Objectives At the conclusion of this session, the learner should be able to: 1. Review the Transitional Year requirements and milestones concerning QI 2. Understand the benefits of involving first-year trainees in a QI curriculum 3. Provide faculty development in using a root cause analysis tool, the Health Care Matrix 4. Demonstrate analyzing a real case using the Health Care Matrix in an interactive format 2
Outline of Session Introduction 10 minutes Matrix training 15 minutes TY Case review in small groups 20 minutes Wrap-up 5 minutes 3
Introduction Next Accreditation System (NAS) Milestones CLER ACGME-accredited residency programs MUST integrate residents into patient safety and quality improvement (QI) initiatives
QI as TY ACGME Requirement IV.A.5.d) Residents are expected to develop skills and habits to be able to meet the following goals: IV.A.5.d).(4) systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement; (Outcome) IV.B.2. Residents should participate in scholarly activity. (Core) IV.B.2.a) Participation should include each resident s presentation of a case report or a presentation to colleagues on a subject of interest, and/or development of a research or quality improvement project. (Detail)
TY QI Milestone PBL 3 Implements a QI Project Participates in individual or team-based organized quality improvement activities
Involving Residents in PSQI Early involvement of residents in QI Help to recognize and implement QI initiatives
Approach to PSQI in TY program Limitations of a one year program Individual projects Group projects Program based Hospital/Institution CLER
TY QI Curriculum Components Online educational modules (IHI.org) Pre Post test survey Plan Do Check Act LIVE training session Sample case/matrix exercise Asking the right questions PICO Evidence based medical literature searching with Research Librarian Complete Matrix and present Power point with questions and literature search to TY s Recommend patient, physician and system interventions Complete QI reflection form
Root Cause Analysis: Mentored Process Residents select clinical cases where things did not go as they should Develop case and simple write up Use HCM to analyze Discuss initial HCM Come up with PICO questions to research (#1 2) Research and pull articles Hone case and HCM for last time and make Power point Present/discuss at TY education meeting Risk Master/PSQI Champion
Faculty Development in PSQI
Health Care Matrix 6 ACGME Core Competencies
Health Care Matrix 6 IOM Aims for Patient Care Improvement Safe Timely Effective Efficient Equitable Patient Centered
Health Care Matrix Allows us to: Assess an episode of care as an interaction between the quality outcomes and the skills, knowledge, and attitudes necessary to effect those outcomes.
Objectives - Educate residents to analyze systems using root cause analysis Incorporate the HCM tool in this process
Hypotheses - Enhance resident knowledge, skills and attitudes regarding QI Outcome: Results from a pre-post test Potentially : QI intervention that may become a system change Other potential downstream outcomes Resident reflections/satisfaction with education Culture of Safety Survey ACGME Resident/Faculty Survey Accreditation (CLER)
Results: In September of 2012, a TY resident QI project resulted in the targeted implementation of a bedside labeling apparatus in all intensive care units to avoid the mislabeling of patient blood specimens. In all years a TY resident s project was selected to as a basis for department-wide interdisciplinary Medicine Mortality and Morbidity conference.
Other Outcomes
Patient Safety Culture Survey 19
Patient Safety Education Grand rounds Morbidity and Mortality presentations Educational conferences Computer Module/ Online training Patient care conferences 20
Matrix How to Using Sample Case
Sample Case for Matrix
Sample Matrix
In Summary Residency programs must teach trainees the basics of QI and involve them in QI projects. As a result of this project, the TY residents actively advocate for quality care in optimal systems by proposing QI solutions from the perspective of patients, providers, and systems. This multi faceted approach to QI training in the first year of residency focusing on the PDCA cycle and using the healthcare matrix to investigate and propose patient, provider and system solutions is generalizable to all residency training programs.
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