an introduction to quality and safety methodology for medical students
TRANSCRIPT
Jodi F. Abbott, MD12.15.15
Essentials of Public Health: Intro to Quality and Safety Methodology
Learning Objectives• Define health care value• Understand where the money comes from for
health care and where it is spent• Discuss which elements of health care costs are
impacted by physicians • Give examples that you have seen when the
process of health care delivery appears to work against the education of the patient about their care or their health.
2
Requirements QI Elements of Course• Turn in IHI Open School
Certificates 101 & 102 Jan 5 2015• Complete Family Member Adverse
Healthcare experience surveyPost to Blackboard Site by January 5
• Complete ICM Site QI project interviewPost to Blackboard Site (Spring)
3
Expectations QI Elements of Course• Do the reading/video watching• Come to class and hear medical students
and resident talk about their QI project• Participate in the in class group work to
learn the process of QI• Learn how to be a member of a QI team
4
ESCAPE FIRE: WHAT DID WE LEARN? 5
ESCAPE FIRE: WHAT DID WE LEARN? 6
WHERE DO WE WANT TO GO? 7
Six Aims of Healthcare • Safe Medical Care • Effective Care • Patient-Centered• Timely• Efficient• Equitable
Crossing the Quality Chasm: A New Health System for the 21st Century 2002
My experience with Quality Improvement is: A. I have had a paid position in
quality or safety workB. I have experience doing the
work of quality and safety C. I have taken classes on
PSQID. I watched the movie
Escape FireE. I am in this room right now
Response Counter
Watching this movie I feel the most connection to:A. Current (traditional)
healthcare providersB. The patients whose stories are
toldC. The providers swimming
upstream (innovators in health care delivery)
D. I am thinking about my family and their healthcare
E. I’m wondering why I am going into debt to join this profession
Today we will talk about how you can personally impact safe and effective care from your first
clinical experience
11
What is Safe Care? • Freedom from:
Accidental Injury Unintended Outcomes
• Reliable care= Failure Free Performance Over Time
12
13Healthcare Associated Infections
• What is the incidence of C Difficile infection at BMC (per month)?
15 infections per month
• What is the incidence of MRSA infection at BMC (per month)?
9 infections per month
BUT WHAT CAN A 1st YEAR DO?
14
15Hand Hygiene
Effective Care
• Consistent Evidence Based practices
16
% Patients Receiving Interventions to Prevent Recurrent Preterm Delivery
18
EFFECTIVE CARE FOR 1st YEARS• Be committed to being a lifelong learner• Work to identify whether “best practices” exist • Become involved in IHI Open School• Participate in Quality Improvement Initiatives &
Projects
19
Patient Centered Care • Care based on continuous healing relationships• Customization based on patient needs and values• The patient as the source of control • Shared knowledge and free flow of information• Transparency• Anticipation of needs
20
CENTERING PREGNANCY 21
CENTERING PREGNANCY 22
PATIENT CENTERED CAREFOR 1st YEARS: ADVOCACYLearn about your patients life:
who does he/she live withwho are his/her supportsdoes he/she have a church/mosque/temple
Make sure your patient is engaged in their caredoes he/she understand the plando he/she think they can follow itwrite down (in his/her language) diagnosis
Ask about material resourcesfood or housing insecurity
24
Timely• Timely care is related both to effectiveness and
cost• Delay time from Emergency Room to hospital
admission is both dangerous and costly• Delay in getting prescriptions at hospital discharge
and for outpatients increases hospital admissions and readmissions
• Many quality improvement initiatives are needed and are being done to diminish delays
25
Median Total 31hr
Efficient Care
Decrease care delays for 1st years• Ask patients at their visits:
1) do you need any refills today?2) if you need medications what pharmacy
would you like us to use? 3) who will pick up the medications for you?4) do you have money for a copay?
• Participate in a Quality Improvement Initiative
27
EFFICICIENT MEDICAL CARE FOR 1st YEARS• Any duplication of care increases cost• Always watch the time • Make sure you are an accurate documenter
– Review patients meds and allergies– Make sure your preceptor has access to the information
that you have gathered
28
Equitable Medical Care 29
What are the Four Elements in Blum’s Paradigms of Health (Shi & Singh)
A. Heredity, Health Care, Environment, Behavior
B. Heredity, Culture, Behavior, Impairment
C. Health, Healthcare, Environment, Behavior
D. Heredity, Social, Culture, Education
EQUITABLE CARE FOR 1st YEAR MED STUDENTS• Become an active member of the BMC and
Boston Medical Communities• Consider joining a group/ service learning• Summer programs next year
– Global Heatlh– Primary Care – Participate in Research or QI projects
35
Organizational Supports for Change• Redesign care processes to effectively serve the
needs of the chronically ill• Making effective use of information technology• Manage growing knowledge base & training all
healthcare workforce• Coordination of care across patient conditions• Continually advance the effectiveness of teams• Incorporating care process and outcome
measures into their daily work
• Crossing the Quality Chasm: A New Health System for the 21st Century 2002
36
37
PM rounds
BMC Mortality Data
38BMC Mortality Data
Goal--To reduce observed mortalities by 10% and focus on unexpected deaths.
Process- • Weekly review of all deaths• Detailed review of unexpected• Action items to reduce probability of recurrence.
39BMC Mortality Reduction Project
ACTION PLAN
• Reduced barriers to ICU • PM rounds• Attending triggers for notification• Vitals in SCM (Inpatient Electronic Health Record)• Sepsis mortality project
DESIGNING AN IMPROVEMENT PROJECT: WHERE DO WE WANT TO GO?
40
SETTING OUR AIMS• What are we trying to accomplish? • How will we know a change is an improvement?
• What?• For Whom ?• By How Much?• By When?
41
You can personally impact safe and effective care from your first
clinical experience
42