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?
Make Your Trauma PI BIG EASY! 5/2/2018
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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
Make Your Trauma PI BIG EASY! 5/2/2018
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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!
Make Your Trauma PI BIG EASY! 5/2/2018
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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?
Make Your Trauma PI BIG EASY! 5/2/2018
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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”
Make Your Trauma PI BIG EASY! 5/2/2018
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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?
Make Your Trauma PI BIG EASY! 5/2/2018
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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?
Make Your Trauma PI BIG EASY! 5/2/2018
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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)!
Make Your Trauma PI BIG EASY! 5/2/2018
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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?
Make Your Trauma PI BIG EASY! 5/2/2018
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When do you haveDuty to Inform the
PATIENT???
Make Your Trauma PI BIG EASY! 5/2/2018
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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?
Make Your Trauma PI BIG EASY! 5/2/2018
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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)
Make Your Trauma PI BIG EASY! 5/2/2018
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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
Make Your Trauma PI BIG EASY! 5/2/2018
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Questions?
Or Best Practice Examples from the Audience?