Patient Safety CME Curriculum Patient Safety: The Other Side of the Quality Equation

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Patient Safety CME CurriculumPatient Safety
The Other Side of the Quality Equation

• Under a Grant from
• The Agency for Healthcare Research and Quality
• Principal Investigator
• Christel Mottur-Pilson, PhD
• Director, Scientific Policy
• ACP-ASIM

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Patient Safety The Other Side of the Quality
EquationSeven Modules in Ambulatory Care

• Systems
• The influence of systems on the practice of
  medicine.
• Cognitive Capacity
• Coping mechanisms under information overload and
  time pressures
• Communication
• Communication barriers, lack, and unclear
  communication
• Medication Errors
• Uniform dosing, look- and sound-alikes, forcing
  functions

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Patient Safety The Other Side of the Quality
EquationSeven Modules in Ambulatory Care

• The Role of Patients
• Patients as allies in patient safety
• The Role of Electronics
• Supportive products and processes
• Idealized Office Design
• Medical practice design to support patient safety

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Logistics

• CME To receive your CME, please fill out the
  usual forms
• Evaluation form
• CME form
• Research Grant Surveys
• Pre-CME assessment of knowledge level
• Post-CME assessment of knowledge level
• Six-month follow up to CME
• Virtual Patient Safety Electronic Community

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Presentation Goals

• Understanding how communication influences care
• Examples of communication breakdowns and how to
  avoid them
• Take home points to help you apply communication
  skills in your practice
• This module was developed by Elizabeth C.
  Bernabeo, MPH and Christel Mottur-Pilson, Ph.D.
  for the American College of Physicians-American
  Society of Internal Medicine.

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Levels of Communication

• Physician ? Patient
• Physician ? Physician Staff

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Levels of Communication

• Physician ? Colleagues (referrals)
• Physician ?Clinical Support Facilities

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Why Teach Communication Skills?

• How we communicate is just as important as what
  we say
• Communication makes evidence-based medicine real
  to patients
• Communication improves outcomes for both patients
  and physicians

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Problems in Communication

• 1 of 5 adults experiences one or more
  communication problems
• Physicians overestimate the time they spent on
  explanation and planning by up to 900
• 1 of 4 patients does not always follow physician
  advice
• 1 in 7 patients is dissatisfied with the current
  health care system

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Barriers to Effective Communication

• Time Management
• Differing Agendas between Doctor and Patient
• The Art of Asking Questions
• Working to Achieve Behavioral Change

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Solutions to Barriers (1)

• Remember the SEGUE Framework (adapted by
  Northwestern University)
• Set the Stage
• Elicit Information
• Give Information
• Understand the Patients Perspective
• End the Encounter

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Solutions to Barriers (2)

• No need to work faster, just differently
• Effective communication does not prolong time
  with patients
• Investing time now will save time later

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Solutions to Barriers (3)

• Tell the patient what he/she wants to know before
  explaining what you think he/she is suffering
  from.

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Solutions to Barriers (4)

• Keep patients talking about their symptoms
• Understanding a patients emotions is crucial

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Solutions to Barriers (5)

• The mnemonic NURS will help you remember the
  steps
• Name the emotion
• Understand their reactions
• Respect the difficulties
• Support the person

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Working to Achieve Patient Change The 4 Es

• Engage the individual
• Establish a working agenda
• Empathize with his/her story
• Educate the patient
• Avoid Arguing
• Establish Trust

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Difficult Situations

• The Role of the Family No Patient is an Island
• Treating the Elderly
• Working with Difficult Patients
• Being Culturally and Gender Sensitive

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Difficult Situations (2)

• When delivering bad news
• Remember SPIKES
• Sharpen your listening skills
• Pay attention to patients perceptions
• Invite the patient to discuss details
• Know the facts
• Explore emotions and deliver empathy
• Strategize next steps with patients family

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Case One

• Patient presents with complaints of shortness of
  breath
• Physician is forewarned, from his staff, that the
  patient has chronic obstructive lung disease.

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Case One Take Home Points

• What are some take home points from Case One?

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Case Two

• Patient presents with long list of symptoms
• Patient has own agenda of what is wrong, what he
  needs and wants from the physician

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Case Two Take Home Points

• What are the important take home points from Case
  Two?

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Case Three

• Patients daughter is upset about the nature and
  course of her mothers care
• The mother has experienced a return of breast
  cancer

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Case Three Take Home Points

• What are the take home points from Case Three?

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Case Four

• Patient with chronic renal failure
• Workup after complaining of abdominal pain
• You wrote CT of abdomen w/o contrast.

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Case Four Take Home Points

• What are the take home points from Case Four?

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Case FiveGastroenterologist Referral

• 64- year- old male with positive occult blood in
  stool
• Internist referral to gastroenterologist
• Evaluate for blood in stool

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Case Five Take Home Points

• What are the important take home points from case
  five?

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Case Six

• 76-year-old male with ischemic heart disease
• Rx of sublingual nitroglycerin

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Case Six Take Home Points

• What are the important take home points from case
  six?

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Case Seven

• 50-year old woman with type 2 diabetes
• Difficulty controlling blood sugars
• Rx change

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Case Seven Take Home Points

• What are the important take home points for case
  seven?

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Electronic Communication

• Increased access to information
• Facilitates communication
• Dangers
• Privacy
• Ethics
• Inaccurate information

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Outcomes of Effective Communication

• Improved diagnostic accuracy
• Greater involvement of the patient in decision
  making
• Increased likelihood of adherence to therapeutic
  regimens
• Increased patient and clinician satisfaction

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Where do we go from here?

• Educational Programs work!
• Open Communication
• Get to know your patients
• Define communication roles
• Empower the patient
• Know your mnemonics!
• NURS, SPIKES, SEGUE, the 4 Es

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Conclusions

• Communication is essential to providing patient
  centered care
• The lessons learned apply to all interactions, be
  they medical or not
• Effective communication is both clinically and
  personally satisfying

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Patient Safety Interactive Learning Community
(PSILC)

• Program Information Updates
• All Seven Modules
• Refresher Exercises
• Email Discussion Groups

• http//www.acponline.org/ptsafety

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Refresher Exercises

• http//www.acponline.org/ptsafety