15 bonta make your trauma pi big easy...to the mprc? make your trauma pi big easy! 5/2/2018 10 when...

Make Your Trauma PI BIG EASY! 5/2/2018

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Make Your Trauma PI BIG EASY!

Marco J. Bonta, MD, MBA, FACS

Trauma Medical Director, Riverside Methodist Hospital, OhioHealth

Columbus, Ohio

What really is Trauma PI?And Why is it IMPORTANT?


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Regulatory Aspects vs.Outcome/Pt Safety Aspects

Do we care every three years or every single day?

Inadequate Trauma PI is Most Common Reason to Fail!

Surveyors need to see evidence of excellence

in Trauma PI


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Four Quadrants of Trauma PI

1. Identification of System Issues

2. Identification of Peer Review Issues

3. Loop Closure for System Issues

4. Loop Closure for Peer Review Issues

Should You Show Your Best Clinical Care?

Negative, Ghostrider.

Show your best PI activity instead!


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Unexpected Survivorship

Certainly include some of these!

And be sure to include favorable T-QIP results!

But surveyors want to see PI!

What’s changing with Trauma Site Surveys?

Moving away from pure preparedness?

Toward comparative outcomes analysis?


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IDENTIFICATIONADJUDICATION

LOOP CLOSURE DOCUMENTATION

Let’s discuss these separately!

Identification!

FIVE WAYS!

1. Audit Filters – How are these selected?

2. Death Reviews – We really doubt there

is only one problem

3. Anecdotal Reports – Probably over-

represented.

4. Random Chart Reviews – Every MR#

ending in 3?

5. CONCURRENT IDENTIFICATION –

Appeal to a higher level of learning! The

“PI ROUNDER”


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ADJUDICATION!

Primary (TPM), Secondary (TMD),

Tertiary (Committee), Quaternary

(External Review)

Who can close what issues?

How much of TMD time is PROTECTED?

Does the TPM have SCHEDULED time

with TMD?

Can the registry keep up with the 80/60

rule?


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LOOP CLOSURE

What the heck is this, anyway?

YOUR Trauma PI CommitteesCan they act autonomously?

Or do they serve as a screening body for a higher

committee?


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Where do the Trauma Content Experts Sit?

If your Trauma Peer Review

Committee (WITH your content

experts) refers cases to a higher

committee (WITHOUT your trauma

content experts), you may well fail!

Physician Peer Review can be Inherently Exonerative

You must transcend this problem!

Here’s an idea…Let’s not tell anyone what we do (EXPLAIN)!


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A IDEAL CARE WITH NO QUALITY CONCERNSaka EXEMPLARY CARE

________________________________________________________________

B OUR REAL PI PLAYGROUNDDisclose Selectively

________________________________________________________________ This represents the STANDARD OF CARE

C SUBSTANDARD CAREDisclose Usually

DISCLOSURE OF FINDINGS

To the Medical Staff Office?

To the VPMA?

To the MPRC?


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When do you haveDuty to Inform the

PATIENT???


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”Future Similar Patients Are Less Likely to Have This Problem Because ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________”

Practice Management Guidelines

Where do these live?

Who can see them at night?


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We use EVERNOTE

I have nothing to do with Evernote

How aboutA PI DASHBOARD?

From Heather Poker, TPM, St. Mary’s Hospital,

Madison, Wisconsin (with permission)


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www.trauma‐news.com

I have no business interest with them.

Great site with PI emphasis

It really can be BIG EASY…

…if you’re prepared


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Questions?

Or Best Practice Examples from the Audience?

15 bonta make your trauma pi big easy...to the mprc? make your trauma pi big easy! 5/2/2018 10 when...

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