Best Practices in Emergency Medicine

1
Best Practices in Emergency Medicine

• The Residency Review Committee (RRC)
• February 23, 2003
• PIFsManship
• Arthur Sanders, MD, Chairman
• Larry Sulton, PhD, Executive Director

2
The Program Information Form (PIF)

• Input Description Institutions and resources

3
The Program Information Form (PIF)

• Input Description Institutions and resources
• Process Description Organization and conduct of
  the program

4
The Program Information Form (PIF)

• Input Description Institutions and resources
• Process Description Organization and conduct of
  the program
• Outcome Description Methods to evaluate
  residents and the program

5
Preparing the PIF Whose Responsibility Is It
Anyway?

• Program Director
• Faculty
• Residents
• Residency Coordinator

6
Making the PIF a Team Project

• Team Leader
• Develop action plan with timeline

7
Making the PIF a Team Project

• Team Leader
• Develop action plan with timeline
• Identify key team members

8
Making the PIF a Team Project

• Team Leader
• Develop action plan with timeline
• Identify key team members
• Assign sections for draft workup

9
Making the PIF a Team Project

• Team Leader
• Develop action plan with timeline
• Identify key team members
• Assign sections for draft workup
• Review progress periodically

10
Making the PIF a Team Project

• Team Leader
• Develop action plan with timeline
• Identify key team members
• Assign sections for draft workup
• Review progress periodically
• Keep everyone on task

11
PIFsManship The Basics

• Organized
• Concise
• Consistent
• Understood

12
(No Transcript)
13
Accreditation Data System Part I (Program
Structure)

• Basic Program Information
• Resident Complement
• Scholarly Activity
• Duty Hours

14
(No Transcript)
15
Resident Complement

• EM Positions 8
• Number Trainees in Combined Program 2
• 1.0 FTE allocates 2 residents (each _at_ 0.5)

16
Accreditation Data System Part II(Program
Resources and Activities)

• Teaching Staff/Personnel
• Patient Population
• Fellowships
• Conferences
• Curriculum
• Evaluation

17
Requirements, Guidelines, and the PIFArt
Sanders, MDRRC Chair
18
(No Transcript)
19
Previous Citations or Concerns

• List each of the citations
• Describe the steps that have been taken to
  correct the problem.
• If documented in the program information form you
  prepare for this review, provide page
  references.

20
Program Changes

•  
• Describe major changes, since the last survey
  and review. (Include changes in sponsoring
  organization, participating hospitals, required
  rotations, resident complement, etc.)

21

• In the past five years, have any residents left
  the program prior to completion?
• . . . have any residents been retained longer
  than 36 months for remedial training?
• List each of the citations or concerns, if any,
  from the notification letter. Briefly describe
  actions taken to correct the problem(s).

22
Facilities and Resources

• Space, efficiency of operations, ancillary
  support
• ED Volume and acuity / variety of patients
• Clinical Supervision
• Progressive Responsibilities link to
  competencies
• Resident Duty Hours off service rotations
• Policy on personal physicians

23
Lab and Radiology Turnaround Times

• Describe the location of the lab and indicate the
  turnaround time for the following
• 0 Negative or type specific uncrossmatched blood
• ABGs
• Electrolytes
• Specifically state time to obtain results for CT
  of the head, portable lateral cervical spine
  x-ray, and portable chest x-ray.

24
Teaching Staff

• Head of Emergency Medicine
• Program Director
• Core Faculty

25
Core Faculty

• Provides clinical service and teaching

26
Core Faculty

• Provides clinical service and teaching
• Devotes majority of professional time

27
Core Faculty

• Provides clinical service and teaching
• Devotes majority of professional time
• Has sufficient protected time

28
Core Faculty

• Provides clinical service and teaching
• Devotes majority of professional time
• Has sufficient protected time
• Scholarly Activity

29
Core Faculty

• Name
• Position
• Residency Training
• Board Certification (Year)
• Faculty Years in EM
• Clinical
• Supervision
• (Hrs/Week)
• Administration (Hrs/Week)

30
Core Faculty

• Research (Hrs/Week)
• Teaching/ Didactics
• (Hrs/Week)
• Chapters
• Peer (Sub)
• Abstracts
• Case Reports
• Non-Peer (Sub)
• Natl/ Regional Presentations

31
Faculty Development

• Core Faculty
• Development vs. Evaluation/Assignments
• Example

32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
Letters of Agreement

• A statement outlining educational objectives
• A statement that the rotation summary (as
  presented in section IV.B) has been reviewed and
  agreed to by the service director
• c. A description of the resources and facilities
  in the institution that will be available to each
  resident, including but not limited to library
  and medical records

37
Letters of Agreement

• A description of the duties and responsibilities
  the resident will have on the rotation
• A description of the relationship that will exist
  between emergency medicine residents and the
  residents and faculty on the service and
• A description of the supervision emergency
  medicine residents will receive on the rotation.

38
Prehospital Care

• Paramedic base station experience
• EMS rotation
• Ride with ground ambulance units
• Participate in teaching prehospital personnel
• Participate in disaster planning and drills
• Participate in quality/performance audits

39
Educational Program

• Clinical rotation summaries / block diagram
  Link to competencies
• Conferences Who gives and attends them 70
  attendance with protected time for residents

40
Educational Program

• Tracking Procedures/Resuscitations
• Procedures and resuscitations numbers Link to
  competencies
• Patient Follow-up Protocols

41
Educational Program

• Continuous quality improvement
• Research training
• Physician wellness
• Family violence
• ACGME core competencies

42
Evaluations

• Resident evaluations
• oral and written
• procedures and resuscitations
• signed by residents
• formal remediation
• Evaluation of faculty
• ABEM test results
• Due process procedures
• Competencies