PSQI Objectives

1. Patient Safety System: The graduating house officer must define and apply system thinking (complex sets of interactions, relationships and linkages that make up today’s healthcare environment) to their day-to-day clinical practice.

Key topic area examples: Safety culture, high reliability, just culture, human error/at risk behavior/reckless behavior, stop the line, systems failures, personal role in system functioning, Swiss cheese analogy, basics of system evaluation (e.g. Donabedian Quality of Care framework), TeamSTEPPS, Agency for Healthcare Research and Quality (AHRQ) Culture of Safety Survey, diagnostic error.

Program Level Assessment: AHRQ Culture of Safety Survey, Internal assessment

Individual Assessment: Internal assessment

Resources: The Washington Manual of Patient Safety and Quality Improvement (available from Becker through Ovid ), IHI Open School

Teaching/Curriculum: IHI Open School; DOM safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)

 2. Patient Safety Goals: The graduate must state their institutional (hospital/departmental/divisional) and relevant national patient safety goals, priorities and strategies and how they interface with daily practice in their field.

Key topic area examples: National Patient Safety Foundation (NPSF) Goals, AHRQ PSI-90 quality indicator, Washington University/BJH/SLCH goals and priorities.

Program Level Assessment: Institutional Survey

Individual Assessment: Milestones

Resources: Departmental Patient Safety Officer and Coordinator, IHI/NSPF website, Pocket Guides (BJH GME), Patient Safety Resource Grid (available from the GME office)

Teaching/Curriculum: DOM Safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)

 3. Interprofessional activities: The graduate will lead and/or serve on interprofessional health care teams in a manner that maximizes safety and quality and appropriately support the role of other healthcare professionals on the team.

Key topic area examples: Stages of team development (forming, storming, norming, performing), characteristics of successful teams (common purpose, measurable goals, leadership, communication, respect), stop the line, TeamSTEPPS, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

Program Level Assessment: Participation in TeamSTEPPS, HCAHPS/PRC data

Individual Assessment: 360 evals, TeamSTEPPS participation (if applicable),

Resources: TeamSTEPPS, Partnering to heal

Teaching/Curriculum: Pending

 4. Error reporting and event analysis

a. Reporting: The graduate will identify patient safety events or unsafe circumstances that must be reported. The graduate will take the professional responsibility to ensure that these events have been reported into the appropriate system.

Key topic area examples: Adverse events, errors, global/hospital/department/division specific triggers, near miss, sentinel event

Program Level Assessment: Triggers, # reports by department, % reports submitted by trainees

Individual Assessment: Annual/Semiannual PD/APD meeting (have you put a report in), FPP Patient Safety Case Quiz (In development)

Resources: Departmental Patient Safety Officers and Coordinators, FPP Patient Safety Case Quiz (In Development), Patient Safety Resource Grid (available from the GME office), IHI Open School

Teaching/Curriculum: DOM safety and Quality Seminar (email t.ciesielski@wustl.edu for more information); IHI Open School

 b. Analyzing: The graduate will analyze patient safety events, participate meaningfully in the event review process (including participate in the process of root cause analysis) and disseminate lessons learned to colleagues.

Key topic area examples: debrief, root cause analysis/cause mapping, Patient Safety Alerts (PSAs), fishbone diagram, fatigue and supervision as contributing factors.

Program Level Assessment: % housestaff invited to debrief/RCA who attended (monthly), fatigue and supervision assessment in M&M/case review

Individual Assessment: Led M&M/QI conference

Resources: IHI Open School;

Teaching/Curriculum: IHI Open School; DOM Safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)

 5. Person-Centered Communication: The graduate will apply effective communication strategies to engage patients and care-givers in active participation with their care, promote safety and quality and describe (demonstrate) how to utilize common Centers for Medicare and Medicaid Services (CMS) assessments of person-centered communication.

Key topic area examples: Health literacy, cultural competency/humility, structured effective communication tools with patients (e.g. Acknowledge/Introduce/Duration/Explanation/Thank: AIDET), CMS HCAHPS/Clinician and Group (CG)-CAHPS/Outpatient and Ambulatory Surgery (OAS) CAHPS, Value-based purchasing.

Program Level Assessment: Participation in TeamSTEPPS, HCAHPS/PRC data

Individual Assessment: 360 evals, Participation in TeamSTEPPS

Resources: TeamSTEPPS, IHI Open School

Teaching/Curriculum: IHI Open School

 6. Disclosure of Adverse Events: The graduate will recognize events that require disclosure to patient and families. Through simulation or participation under direct attending/faculty supervision, the graduate will utilize the correct process and use person-centered communication in the disclosure of events to patients and families.

Key topic area examples: Frameworks for effective communication with patients (e.g. AIDET), who should disclose adverse events, apology, second victim.

Program Level Assessment: Institutional Survey (adding clinical vignette questions on if an event needs disclosure)

Individual Assessment: Pending

Resources: The Washington Manual of Patient Safety and Quality Improvement (available from Becker through Ovid), BJH Patient Safety Video on medical error

Teaching/Curriculum: Pending

 7. Transitions of Care: The graduate will participate in safe, consistent transitions of patient care (change of shift, service, location-including discharge) utilizing a standard format and effective communication skills between providers, patients and care-givers.

Key topic area examples: IPASS, SBAR, Read-back, Contingency planning, service-line readmissions, social determinants of health, health literacy.

Program Level Assessment: Participation in Handoff seminar, questions answered on seminar prep document, readmission data, ED return rate data, Transitions of Care policy

Individual Assessment: Encourage specific evaluation and assessment of handoff, read back of critical information.

Resources: FPP Transitions of Care Summit

Teaching/Curriculum: Pending

Quality Improvment

8. Quality Data: The graduate will obtain and analyze specialty-specific data on quality metrics and benchmarks related to their patient populations.

Key topic area examples: Basic quality metrics (observed/expected mortality, readmissions), best in class scorecards, Quality and Accountability (Q&A, Vizient) Scorecard, department specific dashboards, patient satisfaction, CMS HCAHPS/CG-CAHPS/OAS CAHPS, Medicare Access and CHIP Reauthorization Act (MACRA)/Merit-based Incentive Payment System (MIPS), cost, publicly reported metrics, national surgery quality improvement program (NSQIP), healthcare disparities, social determinants of health, community health needs assessment, implicit bias.

Program Level Assessment: LOS, Mortality, Readmissions, procedural complications, program designee attendance at BJH safety and quality council, program designee attendance at Housestaff safety and quality council.

Individual Assessment: QIKAT

Resources: DellMed Value-Based Care; IHI Open School

Teaching/Curriculum: DellMed Value-Based Care; IHI Open School; DOM safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)

9. QI Project: The graduate will apply fundamental aspects of quality improvement to the care of their patients and will participate in quality improvement activities in their program or their clinical learning environment.

Key topic area examples: Lean, Six sigma, IHI Model for Improvement, Plan-Do-Study-Act cycle, system of profound knowledge, run chart, control chart, implementation science.

Program Level Assessment: % Trainees participating in a QI project (asked on Institutional program survey)

Individual Assessment: Participation in a QI project, QIKAT

Resources: DellMed Value-Based Care; IHI Open School; The Washington Manual of Patient Safety and Quality Improvement (available from Becker through Ovid)

Teaching/Curriculum: DellMed Value-Based Care; IHI Open School; DOM safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)

Clinical Applications

10. Preventable harm: The graduate will recognize risk and apply risk mitigation strategies in their clinical learning environment at all times to prevent patient safety events.

Key topic area examples: Human error/at risk behavior/reckless behavior, universal protocol, wrong site/patient/procedure events, retained foreign objects, positive patient identification, specimen identification, HIPAA/patient confidentiality, hospital acquired infections, falls with serious injury, pressure ulcers, VTE prophylaxis, and medication errors.

Program Level Assessment: Hand-washing compliance (service line/floor), universal protocol compliance (Service line/floor), hospital/health system preventable harms data.

Individual Assessment: Pending

Resources: Just culture training, Partnering to heal; The Washington Manual of Patient Safety and Quality Improvement (available from Becker through Ovid)

Teaching/Curriculum: DOM Safety and Quality Seminar (email t.ciesielski@wustl.edu for more information)