Objectives

  1. List five safety practices of The Christ Hospital Health Network.

  2. Describe the methods in which a health system can monitor and respond to medical errors and/or adverse events.

  3. Explore methods for predicting and preventing errors or poor outcomes.

  4. Apply rapid process improvement methodology to address an area of improvement.

  5. Practice inter-professional teamwork skills of clear communication, accountability, goal/ vision alignment, & clear delineation of roles and responsibilities.

  6. Participate in safety and improvement initiatives through the Safety Operation Center.

Logistics

Available only as a 2 week block

Location: Safety Operations Center (SOC), MOB 303 (knock to enter)

Time: Monday through Friday, 7 or 8:00 – 17:00

On Call Responsibilities: None

Faculty Lead: Dr. Rich, MaryAnn Nutt and Gina Witko

Expectations

  1. Serve as physician liaison to SOC team, monitoring and assessing hospital patient populations remotely using analytics to triage patients at risk for deterioration or other harm

  2. Serve as physician member of STAT team, dispatched to intervene on patients identified as needing intervention by SOC, initiating emergent treatment if needed

  3. Responsible for communicating with attending physicians in real time when interventions are indicated

  4. Participate in daily Safety Operations Call, representing SOC and the IM Residency, reporting out for those two groups

  5. Assist Infection Prevention team by serving as physician auditor of safety processes utilized by IM Residents (e.g. central line insertion practices)

  6. Participate in Safety and Quality committees and meetings (see attached list)

  7. Participate in all Root Cause Analyses that occur during the month

  8. Utilize the Press Ganey PSO software to review all Midas Safety Events and categorize them according to the HRO Taxonomy

Teaching Methods:

1. Formal reading list of selected literature on a. High Reliability Organizations b. Hospital Acquired Conditions c. PSI 90 program d. Sepsis program e. IHI Quality Improvement Methodology

2. Training in use of a. MIDAS b. STATIT c. PG HRO Taxonomy software d. PG HCAHPS Patient Experience software e. EPIC Monitor f. EPIC Safety Tiles

3. Participate in Relevant Committees and Meetings: a. Daily Hospital Safety Call Daily 9:00-9:15 b. Weekly Medical Staff Midas Review Wednesdays 9:15-10:00 c. Comp Med QAPI Last Wednesday 6:45-8:00 d. Comp Med Peer Review 2nd Tuesday 7:00-8:00 e. PPEC 2nd Wednesday 7:00-8:00 f. Safety Committee 1st Thursday 7:00-8:00 g. IP Sepsis Committee 3rd Thursday 2:00-3:00 h. ED Sepsis Committee 2nd Monday 12:00-1:00 i. Infection Control Steering Committee 2nd Tuesday 1:00-2:00 j. NQAPI 2nd Friday 6:45-8:00

Suggested Schedule:

Day 1: spend the day getting to know about the predictive analytic endeavors including time with the remote ICU RN and One Call.

Day 2: Learn about tele project and identify role to help improve tele use for certain conditions. Meet w/ MaryAnn to learn about the watcher list and the stat team to discuss their proactive rounding process.

Every day: Join Safety Calls from 8:15-9:15a (ED huddle, all inpt units, then network wide) and again at 1:45p.

Fridays: RCA panels

1st Thurs: safety steering committee

Wednesdays: Join Drs. Kennedy & Manders in complaints/grievances/incident report reviews with Gina Witko; Hospital weekly safety and rapid QI - opportunity for resident to get involved on a project.