1. A Layered Interdisciplinary Educational Initiative to Support a Quality Improvement Intervention
Nicholas D Hartman, M.D., M.P.H.1, Kim L. Askew, M.D.1, David E. Manthey, M.D.1, Cynthia A. Burns, M.D.2, Pamela W. Duncan, Ph.D.3, Simon A. Mahler M.D., M.S.1
1Department of Emergency Medicine, 2Department of Medicine, 3Department of Neurology Wake Forest School of Medicine, Winston-Salem, NC
Background
The HEART Pathway is a clinical decision aid intended to improve care delivery for patients with chest pain.
Validated in recent clinical trials, the Heart Pathway uses relevant and routinely gathered clinical variables as well as basic cardiac laboratory testing to risk stratify patients presenting to the Emergency Department with acute chest pain.
Expected benefits from frequent utilization of the Heart Pathway:
Decreased hospital admissions
Shorter length of stay
Cost savings
No increase in missed adverse cardiac events
In order for these benefits to be realized, the tool must be used correctly. Therefore educational initiatives must be undertaken in a variety of specialties and settings.
Phase 1 – Self Directed Modules
Goal: Introduce the Heart Pathway and the rationale behind it using a computerized module with Articulate-based software.
These self-directed modules will be tailored to each learner group, including:
Nurses
Medical students
Attending physicians
Advanced practice clinicians
Residents (EM, IM, etc)
Fellows
Measurements of Effectiveness
Using the electronic health record as well as partnerships with insurance carriers, we will track care patterns and outcomes for patients after implementation, and will be able to compare these variables to pre-intervention norms.
Based on Kirkpatrick’s Hierarchy:
Level 3: Knowledge Acquisition
Before and after tests of knowledge
Level 4: Change in Professional Behavior
Rates of HEART pathway use and adherence
Level 5: Change in Organizational Practice
Rates of admission for chest pain patients
Level 6: Benefits in Patient Care
Adverse cardiac events
Length of stay
Cost
Conclusion
Our layered learning and rigorous testing framework will provide a model for education platforms designed to support multidisciplinary QI implementations.
Consistent with the “flipped classroom” model, in which facts and concepts are introduced prior to a group learning experience.
Testing for knowledge of key principles will be done before and after the modules in order to measure module effectiveness.
HEART Pathway decision support algorithm
Phase 2 – Interdisciplinary Collaborative Learning
Goal: Promote application of the HEART Pathway to real situations at our institution using live formats
Will include collaborative, interdisciplinary, team-based learning sessions.
Scenarios based conferences will be held to elucidate a practical approach.
Faculty discussants, who are conversant in the science behind the tool, will assist during these sessions
Testing will be completed after these sessions
Repeated at 6 and 12 months to test retention of these concepts.