Chief of Residents for Quality Improvement and Patient Safety: A Recipe for a New Role in Graduate Medical Education

Ferraro, Kelly; Zernzach, Randall C.; Maturo, Stephen; Nagy, Christopher J.; Barrett, Rebecca

doi:10.7205/milmed-d-16-00179

Cited by 11 publications

(11 citation statements)

References 3 publications

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“…One of the strengths of our program is the interprofessional group of faculty and PS experts involved in the development and delivery of the curriculum. Although other curricula have been primarily delivered by using online modules ( 14 , 20 ), by chief residents ( 13 , 18 , 20 , 26 ), by resident QI–PS councils ( 15 , 27 ), by faculty with QI–PS interests ( 13 , 18 , 22 , 28 ), or by including residents in institutional QI–PS frameworks ( 23 , 29 ), a novel feature of our curriculum is the direct integration of a local PS expert from our institution’s office of PS into the classroom. The PS analyst was intimately involved with the design of the curriculum and served as the moderator for the active-learning sessions.…”

Section: Discussionmentioning

confidence: 99%

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

et al. 2022

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Background Healthcare organizations seeking to promote a safety culture depend on engaged clinicians. Academic medical centers include a community of physicians-in-training; however, medical residents and fellows are historically less engaged in patient safety (PS) than are other clinicians. Increased attention has been focused on integrating PS into graduate medical education. Nonetheless, developing curricula that result in real-world system changes is difficult. Objective To develop an interactive PS curriculum for internal medicine (IM) residents that analyzes real-word PS problems. Methods A multidisciplinary group developed a five-session, case-based PS curriculum for IM residents in the context of a 3-year, longitudinal quality-improvement, PS, and high-value-care curriculum. The curriculum was facilitated by a PS analyst and incorporated mock root cause analysis (RCA) based on actual resident-reported PS events. Each mock RCA developed an action plan, and outcomes were tracked. Pre- and postcurriculum assessments with participating residents were conducted to evaluate the curriculum. Results Twenty-eight IM residents completed the curriculum during four iterations from 2017 to 2020. The curriculum identified multiple potential PS risks, led to tangible changes in clinical processes, and enhanced resident confidence in improving systems of care. Conclusions We describe an active-learning PS curriculum for IM residents that addressed actual resident-reported PS problems. Through RCA, action items were identified and meaningful system changes were made. Leveraging the expertise of local PS experts in the design and delivery of PS curricula may improve the translation of learner recommendations into real system changes and cultivate a positive PS culture.

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Section: Discussionmentioning

confidence: 99%

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

et al. 2022

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Section: Performing Rcamentioning

confidence: 99%

“…RCA capabilities can be enhanced by educating residents, fellows, ancillary staff, and faculty in these procedures, including hands-on exposure through experiential learning. [43][44][45][46] As front-line health care providers in academic health care with nurses and other bedside providers, trainees provide a unique perspective on system and process issues leading to adverse events; attending providers may be shielded from and unaware of many of these issues. However, trainees may be intimidated The "SucƟon PRN" order is ambiguous Figure 5.…”

Section: Rca 2 Curriculum In Graduate Medical Educationmentioning

confidence: 99%

“…5 Improving capabilities in RCA can be achieved by educating residents and the faculty in these procedures, including hands-on exposure through experiential learning. [43][44][45][46] Integrating RCA into Broader Quality and Process Improvement Programs As mentioned earlier, properly functioning event detection systems will capture many more cases than warrant complete RCA. Events not reaching the threshold to undergo RCA may be appropriate for expedited review or aggregated review, in which events are analyzed in batches to identify shared factors or solutions.…”

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confidence: 99%

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Patient Safety/Quality Improvement Primer, Part II: Prevention of Harm Through Root Cause Analysis and Action (RCA²)

Balakrishnan

Brenner²,

Gosbee

et al. 2019

Otolaryngol.--head neck surg.

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With increasing emphasis on patient safety/quality improvement, health care systems are mirroring industry in the implementation of root cause analysis (RCA) for the identification and mitigation of errors. RCA uses a team approach with emphasis on the system, as opposed to the individual, to accrue empirical data on what happened and why. While many otolaryngologists have a broad understanding of RCA, practical experience is often lacking. Part II of this patient safety/quality improvement primer investigates the manner in which RCA is utilized in the prevention of medical errors. Attention is given to identifying system errors, recording adverse events, and determining which events warrant RCA. The primer outlines steps necessary to conduct an effective RCA, with emphasis placed on actions that arise from the RCA process through the root cause analysis and action (or RCA2) rubric. In addition, the article provides strategies for the implementation of RCA into clinical practice and medical education.

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“…Current interventions to improve safety largely address the sharp end of the error. For example, at the resident level, the Accreditation Council for Graduate Medical Education requires residents, including surgical residents, to participate in interprofessional patient safety training and activities such as performing root cause analyses and reporting patient safety events, with evidence that these requirements lead to positive patient safety improvements [ 9 ]. Moreover, simulation-based training for attending surgeons appeared to decrease subsequent malpractice claims [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study

Mazur¹,

Khasawneh²,

Fenison³

et al. 2022

JMIR Res Protoc

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Background Preventable surgical errors of varying degrees of physical, emotional, and financial harm account for a significant number of adverse events. These errors are frequently tied to systemic problems within a health care system, including the absence of necessary policies/procedures, obstructive cultural hierarchy, and communication breakdown between staff. We developed an innovative, theory-based virtual reality (VR) training to promote understanding and sensemaking toward the holistic view of the culture of patient safety and high reliability. Objective We aim to assess the effect of VR training on health care workers’ (HCWs’) understanding of contributing factors to patient safety events, sensemaking of patient safety culture, and high reliability organization principles in the laboratory environment. Further, we aim to assess the effect of VR training on patient safety culture, TeamSTEPPS behavior scores, and reporting of patient safety events in the surgery department of an academic medical center in the clinical environment. Methods This mixed methods study uses a pre-VR versus post-VR training study design involving attending faculty, residents, nurses, technicians of the department of surgery, and frontline HCWs in the operation rooms at an academic medical center. HCWs’ understanding of contributing factors to patient safety events will be assessed using a scale based on the Human Factors Analysis and Classification System. We will use the data frame theory framework, supported by a semistructured interview guide to capture the sensemaking process of patient safety culture and principles of high reliability organizations. Changes in the culture of patient safety will be quantified using the Agency for Healthcare Research and Quality surveys on patient safety culture. TeamSTEPPS behavior scores based on observation will be measured using the Teamwork Evaluation of Non-Technical Skills tool. Patient safety events reported in the voluntary institutional reporting system will be compared before the training versus those after the training. We will compare the Agency for Healthcare Research and Quality patient safety culture scores and patient safety events reporting before the training versus those after the training by using descriptive statistics and a within-subject 2-tailed, 2-sample t test with the significance level set at .05. Results Ethics approval was obtained in May 2021 from the institutional review board of the University of North Carolina at Chapel Hill (22-1150). The enrollment of participants for this study will start in fall 2022 and is expected to be completed by early spring 2023. The data analysis is expected to be completed by July 2023. Conclusions Our findings will help assess the effectiveness of VR training in improving HCWs’ understanding of contributing factors of patient safety events, sensemaking of patient safety culture, and principles and behaviors of high reliability organizations. These findings will contribute to developing VR training to improve patient safety culture in other specialties.

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Chief of Residents for Quality Improvement and Patient Safety: A Recipe for a New Role in Graduate Medical Education

Cited by 11 publications

References 3 publications

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

Patient Safety/Quality Improvement Primer, Part II: Prevention of Harm Through Root Cause Analysis and Action (RCA²)

A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study

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Chief of Residents for Quality Improvement and Patient Safety: A Recipe for a New Role in Graduate Medical Education

Cited by 11 publications

References 3 publications

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

Effect of Patient Safety Curriculum for Internal Medicine Residents on a Health Care System

Patient Safety/Quality Improvement Primer, Part II: Prevention of Harm Through Root Cause Analysis and Action (RCA2)

A Novel Theory-Based Virtual Reality Training to Improve Patient Safety Culture in the Department of Surgery of a Large Academic Medical Center: Protocol for a Mixed Methods Study

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Product

Resources

About

Patient Safety/Quality Improvement Primer, Part II: Prevention of Harm Through Root Cause Analysis and Action (RCA²)