Outcomes Methods RRC-Internal Medicine Educational Innovations Project: Clinical Quality Improvement and Patient Safety- Deliverables to Healthcare from Graduate Medical Education Banner Good Samaritan Medical Center Internal Medicine Residency Program, Phoenix, Arizona Alan I Leibowitz MD, KeriLyn Morgan MD, Cheryl W O’Malley MD Individual residents on the research rotation work with quality management services in the hospital to track resident specific data on compliance with core measures. Medication Error Reduction Ward teams review the orders written by their peers and the team with the lowest number of unsafe abbreviations or other errors gets a monthly “Prize for Performance (P4P). Achieve national quality standards Continuous quality improvement targeting care processes and individual performance Skills that can be exported to their future practices Safer patient care Resident experience in the system of “Pay for Performance” Overall Project Outcomes: Graduates participate in quality initiatives and patient safety projects as part of their daily practice. This improves patient care now and in the future. The objectives of this project will be to allow our program to integrate the BGSMC culture of quality improvement and patient safety (both major components of patient-centered care) into the curriculum of our program. Through innovative design we plan to make this culture an integral part of residency education and future practice for our graduates. Through education and evaluation of residents and measurement of their clinical outcomes, the strengths of GME can be exported to the entire hospital. The “Prize for Performance” Innovation Chronic Care Model (CCM) Currently all residents participate in diabetes group visits, the element of Self Management Support. Beginning with a pilot group, all residents will be members of multidisciplinary teams to improve chronic illness care via all components of the CCM. Resident “Chief Safety Officer” Temple University “DISCLOSE” forms Monthly Patient Safety Case Conference Increase knowledge of patient safety issues and root cause analysis Residents are integral in identifying systems problems and creating solutions. Distinguishing DISCLOSE forms from institutional incident reports Prioritizing the anticipated large number of possible safety projects that will result from this innovation Barriers Decreased availability of the residents to focus on other activities. Increased teaching responsibilities for faculty intensivists. ICU Process Improvement Resident Safety Council Promote an environment that allows easy reporting of near- misses/adverse events without fear of punitive action; study and implement changes to improve the safety of the system Spring 2006 Extra time for residents to review charts Less comprehensive data collection tools Resources to collect individual resident performance Numerous core measures to choose from Timeline Closer interaction between residents and attendings Increase number of procedures completed Effective leadership during in code arrest/rapid response Graduates with improved skills in managing critical care patients Improve compliance with specific ICU protocols (e.g central line bundle) July 2006 Increase number of patients meeting or exceeding national standards Improve self directed learning Productive interactions between informed patients and providers with resources and expertise. Enhance resident experience in Systems Based Practice. Faculty inexperience with the CCM Time/scheduling for all involved Administrative buy-in to facilitate acquisition of resources Program National Clinical Performance Indicators Inpatient: e.g. immunizations, CHF discharge orders, smoking cessation. Ambulatory: e.g. diabetes, and preventive care. Resident Education in Critical Care Residents work one on one with in house faculty intensivists learning core ICU topics designed for the general internist. Increased focus on procedure skills, palliative care, and crisis management. Specific curriculum for interns will be utilized. Raise the awareness of professionalism in residents Direct accounts of resident actions provide oppportunities to improve professional behaviors Potential for bias to occur with personality conflicts Open access could lead to misrepresentation of events Professionalism 360 degree evaluation with online “Program Issues of Concern” and ABIM Praise/Concern cards Enhancing Professionalism in the Physician- Patient Relationship Chronic Care Model Data collected from peer chart review is a part of the resident evaluation. A prize (P4P) will be given for compliance Competing priorities in residents’ lives Need to provide continual training on the use of the data collection software for many providers