Ihi presentation sukalich


Published on

  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • Project at Riverside Methodist Hospital in Columbus Ohio. Large community hospital with training programs for internal medicine, ob/gyn, surgery and family practice residents. Availability of CME&I.
  • Mistakes happen: The 2000 institute of medicine report “To err is human” brought issue of patient safety to the forefront and led to initiatives such as the Institute for Healthcare Improvement’s “Five Millions Lives” campaign. These ongoing efforts are making an impact, yet there still are, and may always be, medical errors.
  • National Quality Forum 2006 evidence-based safe practice guide: Following serious unanticipated outcomes, including those that are clearly caused by systems failures, the patient, and as appropriate, the family should receive timely, transparent, and clear communication concerning what is known about the event.
  • This aims of this project relate to several of the Picker Patient-centered care principles.
  • Plan to analyze data and distribute. Anticipate continuing simulation each year for new interns.
  • Ihi presentation sukalich

    1. 1. Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation Sara Sukalich, MD Riverside Methodist Hospital, Columbus OH Ohio Health Foundation
    2. 2. Unfortunately… <ul><li>Mistakes happen </li></ul><ul><li>Patients and families want to know </li></ul><ul><ul><li>What happened? </li></ul></ul><ul><ul><li>Why did it happen? </li></ul></ul><ul><ul><li>Will it happen again? </li></ul></ul><ul><li>Providers need to thoughtfully and honestly answer these questions </li></ul>
    3. 3. Medical Error Disclosure <ul><li>Disclosure is bringing to light an unintended outcome </li></ul><ul><ul><li>Reinforces honesty and trust </li></ul></ul><ul><li>Barriers </li></ul><ul><ul><li>The culture of medicine—help not harm </li></ul></ul><ul><ul><li>Not taught in school </li></ul></ul><ul><ul><li>Anxiety about facing mistake </li></ul></ul><ul><ul><li>Difficulty apologizing </li></ul></ul><ul><ul><li>Fear of litigation </li></ul></ul>
    4. 4. Disclosure of a Medical Error is an Always Event <ul><li>Following a medical error, physicians will always: </li></ul><ul><li>Provide an explanation to the patient and family regarding what happened </li></ul><ul><li>Discuss potential implications or consequences of error </li></ul><ul><li>Commit to investigate what went wrong </li></ul><ul><li>Give feedback regarding the findings of the investigation </li></ul><ul><li>Offer an apology or expression of regret </li></ul>
    5. 5. Patient-Centered Care Principles <ul><li>Respect for patients’ values, preferences and expressed needs </li></ul><ul><li>Information, communication, and education </li></ul><ul><li>Emotional support and alleviation of fear and anxiety </li></ul><ul><li>Involvement of family and friends </li></ul>
    6. 6. Project Overview <ul><li>55 interns (four specialties) </li></ul><ul><li>Simulation using standardized patient </li></ul><ul><li>Multiple assessments </li></ul><ul><ul><li>Self </li></ul></ul><ul><ul><li>Attending </li></ul></ul><ul><ul><li>Standardized patient </li></ul></ul><ul><li>Review of video after simulation </li></ul><ul><li>Self-study module </li></ul>
    7. 7. Scenario <ul><li>66yo man after cardiovascular surgery </li></ul><ul><li>Nurse notices change of mental status after narcotic overdose </li></ul><ul><li>Resident quickly realizes mistake and reversal medicine administered </li></ul><ul><li>Patient transferred to ICU for observation </li></ul><ul><li>Learner’s task is disclosure of error to family member </li></ul>
    8. 8. Goals <ul><li>Decrease provider anxiety about disclosure </li></ul><ul><li>Emphasize importance of </li></ul><ul><ul><li>Clear, prompt communication </li></ul></ul><ul><ul><li>Offering an apology </li></ul></ul><ul><ul><li>Not placing blame </li></ul></ul><ul><ul><li>Placing focus on patient’s immediate care </li></ul></ul><ul><ul><li>Offering resources </li></ul></ul><ul><ul><li>Assuring investigation </li></ul></ul>
    9. 9. Project Progress <ul><li>All interns have undergone 1 st simulation </li></ul><ul><li>All interns have completed interim self-study </li></ul><ul><ul><li>On-line module about disclosure </li></ul></ul><ul><ul><li>Policy review </li></ul></ul><ul><ul><li>Learning styles inventory </li></ul></ul><ul><li>2 nd simulations underway </li></ul>
    10. 10. Preliminary Findings <ul><li>Initial self assessment identified areas of weakness </li></ul><ul><ul><li>Knowing who to notify </li></ul></ul><ul><ul><li>Whether to speculate about error or assign guilt </li></ul></ul><ul><li>10 of 55 interns did not achieve passing composite score </li></ul><ul><li>Project well-received by residents, attendings, standardized patients, and staff of simulation center </li></ul>
    11. 11. Conclusions <ul><li>Medical error disclosure should always occur </li></ul><ul><li>Disclosure is stressful </li></ul><ul><li>Simulation can teach correct approach to disclose </li></ul><ul><li>Simulation practice can help providers gain confidence </li></ul><ul><li>Teaching early in training important </li></ul>