Moving beyond the lecture hall: A Multidimensional Approach ...

Moving beyond the lecture hall: A Multidimensional Approach ...

Moving Beyond the Lecture Hall: A Multidimensional Approach to Engage and Teach Quality Improvement and Patient Safety Melissa Chladek, MD Cara Lye, MD Diana Stewart, MD, MBA Erin Stucky Fisher, MD, MHM Joyee Vachani, MD, Med NO DISCLOSURES Page 2 Page 2 xxx00.#####.ppt 1/30/20 04:47:19 PM

Background Although a requirement, pediatric residents are rarely exposed to longitudinal Quality Improvement (QI) / Patient Safety (PS) training with practical applications. Addressing this need, we created the Quality Improvement and Patient Safety Curriculum (QIPSC) for Baylor College of Medicine (BCM) / Texas Childrens Hospital (TCH) pediatric residents. We received an institutional education grant from TCH to carry out this curriculum, the study was IRB approved, and part of an APA Educational Scholars Program project. Page 3 Page 3 xxx00.#####.ppt 1/30/20 04:47:19 PM

QIPSC (Quality Improvement and Patient Safety Curriculum) for Pediatric Residents PGY-1 Ignite modules and RCA Session in Pedi 101 (outpatient ambulatory rotation) Noon conference each month on QI/PS topic PGY-2 Noon conference each month on QI/PS topic PGY-3 Project work with mentors in Community Peds (outpatient

ambulatory rotation) Noon conference each month on QI/PS topic Page 4 Page 4 xxx00.#####.ppt 1/30/20 04:47:19 PM Goal/Objectives Goal: Incorporating interactive techniques into QI/PS Objectives: Apply adult learning theory to QI/PS education Identify and practice interactive teaching methods suitable for QI/PS education Recognize barriers to teaching QI/PS and develop action items to address

them Discuss methods on how to translate these techniques to other learners (non-physicians and faculty) Page 5 Page 5 xxx00.#####.ppt 1/30/20 04:47:19 PM Program Development Adult Learning Theory Program Development

Page 6 Page 6 xxx00.#####.ppt 1/30/20 04:47:19 PM Quality/ Safety Theory Program Development Kerns six step approach to developing curriculum Page 7 Page 7 xxx00.#####.ppt 1/30/20 04:47:19 PM

Program Development Kerns six step approach to developing curriculum Content reviewed by QI/Education content experts Evaluation tools developed using Kirkpatricks model and Millers pyramid (KSA) Page 8 Page 8 xxx00.#####.ppt 1/30/20 04:47:19 PM Program Development Kerns six step approach to developing curriculum Content reviewed by QI/Education content experts Evaluation tools developed using Kirkpatricks model and Millers pyramid (KSA)

PDSA cycles were run on the curriculum itself Page 9 Page 9 xxx00.#####.ppt 1/30/20 04:47:19 PM Interactive Teaching Methods and Tools Team Based Learning Process Mapping Fishbone Diagrams Page 10 Page 10 xxx00.#####.ppt 1/30/20 04:47:19 PM

Team Based Learning - Using teams to enhance engagement and the quality of learning Page 11 Page 11 xxx00.#####.ppt 1/30/20 04:47:19 PM Putting this Into Practice Divide learners into teams Lay ground rules on activity and pass out materials Provide questions Teams work together to choose best answer Learners report out to group

Page 12 Page 12 xxx00.#####.ppt 1/30/20 04:47:19 PM Putting it into Practice an example Page 13 Page 13 xxx00.#####.ppt 1/30/20 04:47:19 PM The Case You are coming on to your overnight shift and receiving sign out on a direct admission transferred from an OSH.

During sign-out you were told that the patient is a 6 year old male that arrived about 1 hour ago with a diagnosis of pneumonia. A CXR was done at the OSH but the disk was lost in transport. The read on the CXR came with the paperwork and was read as consolidation versus atelectasis. Page 14 Page 14 xxx00.#####.ppt 1/30/20 04:47:19 PM The Case continued. . . The day resident reported that the patient had the following vitals signs on initial exam: Temp 102 HR=180

RR= 30 BP= 115/80 saturating 98% on 1L NC He was given Tylenol and a fluid bolus and started on IVFs and antibiotics. Page 15 Page 15 xxx00.#####.ppt 1/30/20 04:47:19 PM The Case continued. . . The day residents assessment was that he would improve once his fever went down and told you there was nothing to do for him overnight. The night nurse gives you a call after sign out. Since you are on your way to a nearby room, you

decide to meet the nurse at bedside. Page 16 Page 16 xxx00.#####.ppt 1/30/20 04:47:19 PM https://www.youtube.com/watch?v=IlabRj028aA Page 17 Page 17 xxx00.#####.ppt 1/30/20 04:47:19 PM Overnight, the parents continued to refuse vitals. Around 0630, while you are giving sign-out, the nurse calls you. The patient is noted to have a HR

in the 200s and is breathing faster. An RRT is called and they are sent to the PICU. He seems to worsen with fluid boluses and a CXR showed an enlarged heart with extensive pulmonary edema. An ECHO is ordered and confirms a diagnosis of myocarditis. Page 18 Page 18 xxx00.#####.ppt 1/30/20 04:47:19 PM GROUP ACTIVITY #1 Page 19 Page 19

xxx00.#####.ppt 1/30/20 04:47:19 PM Tips to Making It Work- TBL Pick group sizes that facilitate discussion May need to assign roles based on group dynamics Offer incentives or prizes to winning teammake it a fun game! Summarize key teaching points Page 20 Page 20 xxx00.#####.ppt 1/30/20 04:47:19 PM Interactive Teaching Methods and Tools Team Based Learning

Process Mapping Fishbone Diagrams Page 21 Page 21 xxx00.#####.ppt 1/30/20 04:47:19 PM Process Mapping Draws a picture of the way a process actually works Develop ideas for improvement Used in interactive conferences, RCA teaching, & Simulated QI

Projects Page 22 Page 22 xxx00.#####.ppt 1/30/20 04:47:19 PM Process Maps Shows the components, relationships, and sequence in which a system functions Forces you to understand how each step occurs

Can be used to identify waste and simplify system Can be very simple or very detailed Oval = start and end of a process Rectangle = step in the process Flow line to show direction of process and connects the steps Page 23 Page 23

xxx00.#####.ppt 1/30/20 04:47:19 PM Diamond = decision point Example: Clinic Flu Vaccination MD orders vaccine Nurse sees order in EMR Is the flu vaccine stocked?

No Pharmacist sends medication via transport Yes Nurse takes vaccine to patient Nurse accepts order in EMR Nurse goes to stock room to get vaccine

Tech stocks vaccine in storage room Nurse verbally consents patient Nurse goes to stock room to get vaccine Nurse administers vaccine Page 24

Page 24 Nurse contacts pharmacy for vaccine xxx00.#####.ppt 1/30/20 04:47:19 PM GROUP ACTIVITY #2 Page 25 Page 25 xxx00.#####.ppt 1/30/20 04:47:19 PM Lets make a process map!

START: 6 yo F admitted with diagnosis of PNA END: Patient sent to PICU, diagnosed with myocarditis In your groups, work together to great a process map outlining the case events Page 26 Page 26 xxx00.#####.ppt 1/30/20 04:47:19 PM Process Map Page 27 Page 27 xxx00.#####.ppt 1/30/20 04:47:19 PM

Patient admitted with PNA Other nurse questions decision Yes Day resident signs out to night resident Patient with fever, attributed to tachycardia Day resident tells

night resident nothing to do Resident says ok for no vitals Resident meets with nurse at bedside, no exam done No No Bedside

nurse assumes its ok since resident said ok Yes In morning, patient HR 200s, tachypnea Patient continues to have vitals checked overnight RRT to PICU CXR with pulmonary edema

Nurse calls to ask night resident question Family requesting no vitals overnight Patient in PICU with myocarditis Page 28 Page 28 xxx00.#####.ppt 1/30/20 04:47:19 PM Tips to Making it work- Process Mapping

Provides a shared model for an improvement team Helps identify important leverage points in process to measure in order to improve the system Helps generate ideas for change (future QI) Tool for teaching root cause analysis can use the 5 Whys Method Page 29 Page 29 xxx00.#####.ppt 1/30/20 04:47:19 PM Interactive Teaching Methods and Tools Team Based Learning Process Mapping

Fishbone Diagrams Page 30 Page 30 xxx00.#####.ppt 1/30/20 04:47:19 PM Page 31 Page 31 xxx00.#####.ppt 1/30/20 04:47:19 PM Fishbone, Cause/Effect, or Ishikawa Diagrams Page 32 Page 32

xxx00.#####.ppt 1/30/20 04:47:19 PM Examples of Contributing Factors in Systems that Lead to Errors (6Ps) PATIENT PLANT (Language, social factors, comorbidities) (Work Environment, staffing, equipment, layout) POLICIES PROCEDURES

(Availability and use of protocols, test results, medical/legal) PEOPLE/PERSONNEL POLITICS (Training, motivation, supervision) (Regulations, goals, cultures, team dynamics) Vincent C, NEJM 2003, 348; 11 Page 33

(Resources, policies, deviations) SHM Safety and Quality Educators Academy Marchxxx00.#####.ppt 2013 Page 33 1/30/20 04:47:19 PM GROUP ACTIVITY #3 Page 34 Page 34 xxx00.#####.ppt 1/30/20 04:47:19 PM

Fishbone: Cause and Effect Diagram Patient Policies Patient only on 2L, residents used to HFNC People Premature closure Availability bias Unclear policy for vitals

No objective parameters given Plant Procedures Unclear communication about patient illness severity Politics Page 35 Page 35Reilly, Ogdie, VonFeldt, University of Pennsylvania

Myers, xxx00.#####.ppt 1/30/20 04:47:19 PM Resident skill levelidentifying sick patients Resident and nurse workload Patient deterioration not recognized DIAGNOSTIC ERROR FISHBONE DIAGRAM Anchoring, Diagnosis

Momentum, and Confirmation Biases Availability Bias Blind Obedience Bias Cognitive Factors Effect Systems Factors Team Factors

Process or Task Factors Equipment and Documentation Factors Page 36 Page 36 Diagnostic Errors Fishbone: University of Pennsylvania: Reilly, Von Feldt, Ogdie, and Myers xxx00.#####.ppt 1/30/20 04:47:19 PM Tips to Making it Work- Fishbone Focus on system issues vs. individual

Incorporate on rounds or in group settings Utilize as a preventative tool Identify system issues that may impact a patient before they occur Examples: uninsured patient, complex medical patient, etc. Page 37 Page 37 xxx00.#####.ppt 1/30/20 04:47:19 PM Barriers and Solutions Time commitment Resources On rounds ask them to identify systems issues

Culture limits discussion Speak anonymously first Key stake holder buy-in Attending modeling Concern about exposure of weaknesses Right thing to do Page 38 Page 38 xxx00.#####.ppt 1/30/20 04:47:19 PM

Putting it all together Interactive teaching methods can be a great way to engage learners with QI and PS Each tool can be adapted to fit the level of learner, learning objectives/goals, and time constraints Tools help learners focus on systems issues, potentially leading to QI projects Equipping learners with these tools gives them a framework to work through clinical scenarios and navigate the system Page 39 Page 39 xxx00.#####.ppt 1/30/20 04:47:19 PM Reflection

Page 40 Page 40 xxx00.#####.ppt 1/30/20 04:47:19 PM Thank you! Page 41 Page 41 xxx00.#####.ppt 1/30/20 04:47:19 PM

Recently Viewed Presentations

  • PORTFOLIO COMMITTEE ON BASIC EDUCATION 12 MAY 2015

    PORTFOLIO COMMITTEE ON BASIC EDUCATION 12 MAY 2015

    LEARNER WELLNESS AND SOCIAL COHESION What is Learner Wellness? Characterised by feelings of being valued in all aspects, i.e. physically, spiritually, emotionally, etc. In line with the World Health Organisation (WHO) definition, DBE accepts that there is a strong link...
  • Main Title: Content can span up to two lines using Arial Bold ...

    Main Title: Content can span up to two lines using Arial Bold ...

    * DND/CF Policy and Guidelines on Harassment Prevention and Resolution review DAOD 5012 and Guidelines Changes in the TBS Policy Directive are in most part already included in the current DAOD or Guidelines. Only an update will be required to...
  • Leon 16: Mes voisins La possession avec DE

    Leon 16: Mes voisins La possession avec DE

    Les pronoms (adjectifs) possessifs mine, yours, his/hers/its SINGULAR PLURAL (possessor) M F (je) mine (tu) yours (il) his (elle) hers Ma, ta and sa become mon, ton, and son before a vowel sound: une amie une auto mon amie mon...
  • 信 息 隐 藏 技 术 与 应 用

    信 息 隐 藏 技 术 与 应 用

    信 息 隐 藏 技 术 与 应 用 第八章 数字水印的评价理论 和测试基准 任延珍 副教授 2012.9
  • Aircraft Dispatcher Oral Test Questions, Part 1 010115

    Aircraft Dispatcher Oral Test Questions, Part 1 010115

    What is the definition of Night? 1 hour after sunset to 1 hour before sunrise. What is pilotage? Dead-reckoning? Pilot's Handbook of Aeronautical Knowledge 88. ... Example: San Francisco Warm currents of the Pacific Ocean in winter flowing on shore...
  • Resident Physics Lectures

    Resident Physics Lectures

    Larger Focal Spot = Better Heat Ratings Electron beam applies huge amount of heat to target Larger Focal Spot = Better Heat Ratings The larger the area the electron beam hits, the more intense the beam can be without melting...
  • Nail Gun Coach Ketcham Productions Nail Gun Safety

    Nail Gun Coach Ketcham Productions Nail Gun Safety

    Nail Gun Safety. Do not let workers defeat the safety switch.. The worker drops the gun onto the target. And skip along the work area… On impact, the gun fires, recoil lifts the gun. And he's on to the next...
  • Electical Circuits - California State University, Northridge

    Electical Circuits - California State University, Northridge

    PARALLEL CIRCUITS The current has a choice of routes. The components are connected side by side. If one bulb 'blows' there is still be a complete circuit to the other bulb so it stays alight. measuring current Electric current is...