Clinical Quality and Patient Safety Training Using an OutcomesBased Approach

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Clinical Quality and Patient Safety Training
Using an Outcomes-Based Approach

• Eric J. Scher, MD, FACP
• Vice Chair and Program Director
• Department of Internal Medicine
• Henry Ford Health System
• APDIM EIP Launch Session
• April 4, 2006

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GOALS

• To integrate quality improvement theory and
  practice into existing ambulatory curriculum
• To underscore the concept of patient safety and
  make it a central theme in the inpatient training
  environment
• To develop resident portfolios and study the
  predictive validity of these and other
  educational outcomes measures in all six
  competencies utilizing clinical outcome data
  imbedded in our post-graduate survey tool

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TIME LINE

• Practice Improvement Modules
• piloted in 2005/2006 academic year
• formally integrate into curriculum in July, 2006
• Collaborative Practice Model
• piloted in 2005/2006 academic year
• formally integrate into curriculum in July, 2006
• Continuum of Care (hand-off)
• pilot in January, 2007
• Simulator Training
• piloted in 2005/2006 academic year
• Resident Portfolio Development/Outcome Measure
  Analysis
• July, 2008

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How Will These Innovations Affect Care As
Perceived By Patients?

• Outpatient Setting
• More proactive approach in secondary preventive
  measures
• More emphasis on patient education
• Fewer complications and debilitation
• Greater shared decision-making

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How Will These Innovations Affect Care As
Perceived By Patients?

• Inpatient Setting
• More emphasis on safety through collaborative
  rounds
• Improved coordination of care between providers
• Less discomfort (i.e. fewer IV lines, catheters)
• Better continuity of care during off-hours
  (hand-offs)
• Fewer unanticipated ICU transfers
• Shorter length of stay

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METHODS-Quality Improvement Curriculum

• Utilizes the ABIM Practice Improvement Modules
  (PIM)
• Chart Audits
• Patient Surveys
• Practice Survey
• Administrative Databases
• PIM Intervention Tools

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METHODS-Patient Safety Curriculum

• Utilizes a Collaborative Practice Model
• Daily Multidisciplinary Rounds
• Safety Checklists
• Administrative Databases
• Patient and Care Provider Surveys
• Continuum of Care (Hand-Offs)
• OSCE Stations Simulating Effective Hand-Offs
• Patient and Care Provider Surveys
• Simulator Instruction on Invasive Procedures

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METHODS-Predictive Validity

• Statistical Correlation and Factor Analysis
  Utilizing
• Existing Educational Outcome Measures
• Future Portfolio Artifacts
• Postgraduate Resident Surveys
• Employer Surveys
• ABIM Board Scores

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Innovation Products AnticipatedEducation
Outcome Measures

• PIM Project
• PDSA and FEMA worksheets
• Documentation of Residents QI Project
• Reflective Exercises
• System-Based Practice Portfolio
• OSCE for Hand-Offs
• Knowledge
• PIM pre- and post-test
• Communication and Interpersonal Skills
• Patient Satisfaction Surveys

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Innovation Products Anticipated Clinical
Outcome Measures

• PIM data
• Achieve standard outcomes for chronic disease
  and preventive services
• Simulator Training
• Central line complications
• Rate of Blood Stream Infection
• Collaborative practice measures
• Attain IHI inpatient quality improvement
  initiatives
• Achieve several of the inpatient NQF measures
• Patient satisfaction survey scores

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How These Innovations Will Affect Learning As
Perceived By Residents?

• Portfolios
• More learner-centered
• More relevant to clinical practice
• Allows self-reflection on learners needs
• Allows more participation in developing
  learning/remediation plans
• Greater ownership of evaluation process
• Better understanding of concepts in
  practice-based learning/ improvement and
  systems-based practice

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ANTICIPATED BARRIERS

• The outpatient PIM curriculum will require
  substantial faculty and resident buy-in with
  regards to time, effort and a willingness to
  participate in continuous quality improvement
• The safety initiatives will require faculty time
  for teaching and evaluation. We also anticipate
  some resistance from faculty members in
  participating in our collaborative practice model
  given the additional time commitment
• The hand-off curriculum will require alignment of
  resident and nursing sign-out times between shift
  changes which may prove to be onerous from a
  scheduling prospective