New Faculty Orientation Office of Clinical Affairs


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New Faculty Orientation Office of Clinical Affairs

  1. 1. New Faculty Orientation Office of Clinical Affairs
  2. 2. Role of the Office of Clinical Affairs Patient Safety Goal: Safest Health System in the U.S. Clinical Quality Associate Chiefs Medical Staff Bylaws Medical Staff Committees Insure Policy Adherence Ensure Clinical Competence Chief of Staff Risk Management Clinical Information & Decision Support Services Pharmacy Health Information Management Infection Control Associate Chiefs OCA Administration Medical Staff Services
  3. 4. Key Policies <ul><li>PRIVACY </li></ul><ul><li>Federal regulations – HIPAA – limit access to patient medical records to a “need to know” basis for the patient and physician’s protection. </li></ul><ul><li>Never give out your password to someone or allow them to use your sign-on to access patient information. </li></ul><ul><li>COMPLIANCE </li></ul><ul><li>As Medical Staff members, you are required to report violations of policy and law, including fraud, abuse, falsification and/or criminal activity. </li></ul><ul><li>Compliance concerns can be reported via the 24-hour hotline at (866) 990-0111. </li></ul><ul><li>PEER REVIEW </li></ul><ul><li>Peer Review is ongoing evaluation of medical practice and clinical care based on six core competencies – objective measures and case reports; review criteria is developed at the department level. </li></ul>
  4. 5. Speak Up To Care Enough, to Report Concerns <ul><li>Resident suspected a peer was struggling with alcohol or drug use, “smelled of alcohol” </li></ul><ul><li>Junior resident observed a senior resident sexually harassing another staff member </li></ul><ul><li>Residents observed faculty member’s behavior as disruptive – threatens others, shouts, throws things, nurses and residents afraid to approach </li></ul><ul><li>Pharmacy tech concerned about an insulin order, resident and pharmacy supervisor approved the order. Technician continued to question, moved up the chain of command. </li></ul><ul><li>Reported anonymously to the Office of Clinical Affairs </li></ul><ul><li>Resident received help, successfully completed program </li></ul><ul><li>Incident was not reported for fear of “ruining his career” </li></ul><ul><li>16 mos later a patient complained </li></ul><ul><li>Reported to Service Chief </li></ul><ul><li>Counseling/limit setting, helped the faculty member improve. </li></ul><ul><li>I.V. drip stopped serious medication error averted. </li></ul>
  5. 6. Behavior Expectations It’s not punitive. It’s maintaining the high bar. Please review the Code of Conduct on the Office of Clinical Affairs Web site: Respect & Cooperate Perform Duties Report Impairment Report Conflicts of Interest Maintain Confidentiality Act Ethically & Responsibly
  6. 7. Attending Expectations <ul><li>Members of the Medical Staff will actively supervise Clinical Program Trainees (CPT) and appropriately document this supervision in the medical school. </li></ul><ul><li>Attending Physician responsibilities: </li></ul><ul><ul><li>Personally involved in, and responsible for, directing the evaluation and management of individual patients under his/her care and supervision </li></ul></ul><ul><ul><li>Provides oversight and supervision of all care provided by trainees </li></ul></ul><ul><ul><li>Documents involvement, including all CPT history and physicals, operative reports, and discharge summaries </li></ul></ul><ul><ul><li>Ensure completion of all documentation that is created by the CPT related to patient care </li></ul></ul>For more details, see UMHHC Policy 04-06-043 Global Clinical Program Trainee (Resident) Supervision at For more details, see UMHHC Policy 04-06-043 Global Clinical Program Trainee (Resident) Supervision at
  7. 8. Expectations of House Officers <ul><li>The House Officer is obligated to report significant changes in the patient’s condition to the Attending Physician. Situations that automatically qualify as &quot;significant changes” include: </li></ul><ul><ul><li>Admission to hospital of any unstable patient </li></ul></ul><ul><ul><li>Transfer of the patient to the intensive care unit </li></ul></ul><ul><ul><li>Need for intubation or ventilatory support </li></ul></ul><ul><ul><li>Cardiac arrest or significant changes in hemodynamic status </li></ul></ul><ul><ul><li>Development of significant neurological changes </li></ul></ul><ul><ul><li>Development of major wound complications </li></ul></ul><ul><ul><li>Medication errors requiring clinical intervention </li></ul></ul><ul><ul><li>Any significant clinical problem that will require an invasive procedure or operation </li></ul></ul>CALL THE ATTENDING!
  8. 9. <ul><li>Things “fall between the cracks” when transferring patients from on unit to another. (reverse worded) </li></ul><ul><li>Important patient care information is often lost during shift changes. (reverse worded) </li></ul><ul><li>Problems often occur in the exchange of information across hospital units. (reverse worded) </li></ul><ul><li>Shift changes are problematic for patients in this hospital. (reverse worded) </li></ul>Patient Safety Culture Survey Shows #1 Concern: Hospital Handoffs and Transitions % of respondents in each department responding with “ Strongly Disagree” or “Disagree” when asked these questions.
  9. 10. Hand Off and Transitions: The key is communication! <ul><li>Hand-off Tools easily accessible in CareWeb </li></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Internal Medicine </li></ul></ul><ul><ul><li>Pediatrics </li></ul></ul><ul><ul><li>Psych </li></ul></ul><ul><li>Medication Reconciliation at key points along the care continuum </li></ul><ul><ul><li>Inpatient admission, transfer and discharge </li></ul></ul><ul><ul><li>Clinic Visits, Ambulatory Care Procedural and Surgical Suites, ED </li></ul></ul><ul><ul><li>CareWeb Problem Summary List </li></ul></ul>
  10. 11. Clinical Home Page
  11. 12. Clinical References
  12. 13. Clinical Resources
  13. 14. Connect to Other Systems
  14. 15. Hospital Floor Maps
  15. 16. CareWeb Overview <ul><li>CareWeb is a web-based clinical patient record developed at UMHS specifically for use by clinicians and clinical support staff. </li></ul><ul><li>It provides rapid access to patient data from a wide variety of clinical systems, including lab, radiology, registration, medical records, cardiology, neurology, and others. </li></ul><ul><li>Most Information in CareWeb is as &quot;real-time&quot; as possible; data drawn from source systems (done via Clinical Data Repository) is available in CareWeb within seconds of posting to the source systems. </li></ul>
  16. 17. CareLink <ul><li>UM-CareLink is a computerized provider order entry (CPOE) system that will improve the quality and safety of inpatient care in our Health System. </li></ul><ul><li>UM-CareLink features: </li></ul><ul><ul><li>Ability to electronically order tests, procedures, and medications </li></ul></ul><ul><ul><li>Maintain clinician worklists and nursing medication documentation </li></ul></ul><ul><ul><li>Can complete the required VTE Risk Assessment </li></ul></ul><ul><ul><li>Ability to sign all verbal orders as required by policy </li></ul></ul><ul><ul><li>Receive decision support information about drug interactions, patient allergies, and more </li></ul></ul>
  17. 18. Centricity TM Clinical Information View (CIV) <ul><li>Centricity TM is the electronic clinical documentation system used in the UMHHC Operating Rooms, CVC, SICU, Emergency Department and Trauma/Burn ICU. </li></ul><ul><li>CIV is Web based access to all clinical information in Centricity. </li></ul><ul><li>CIV can be accessed from CareWeb via the ED/OR/TB systems button. </li></ul>
  18. 19. Create Document Overview <ul><li>The Create Document (Create Doc) application allows users to bypass the dictation system and directly upload documents to the electronic medical record. </li></ul><ul><li>Create Document interfaces with the online Edit/Signature function (E-sig). Documents created using Create Doc can be routed to an authorized E-signer for review and electronic signature. (documents may be routed to resident physicians as well) </li></ul><ul><li>Once a document is sent, it should appear in the E-signer’s inbox within 15 minutes. Documents take 15-30 minutes to appear in the document viewer of CareWeb. </li></ul><ul><li>Templates for Create Document are approved through Health Information Management. </li></ul>
  19. 20. Connecting from Home <ul><li>Non-core Image computers (what you will need): </li></ul><ul><ul><li>A PC desktop computer or laptop* </li></ul></ul><ul><ul><li>A working high-speed Internet connection is recommended </li></ul></ul><ul><ul><li>Your Uniqname, Level-1 (Kerberos) password, and any other passwords for specialized resources, i.e. CareWeb, GroupWise </li></ul></ul><ul><ul><li>VPN software to access the Hospital Intranet (UMHS uses Checkpoint Secure Remote VPN client) </li></ul></ul><ul><ul><li>Internet Explorer 6.x or higher required (Netscape Navigator, Firefox, Opera, and Safari are not supported) </li></ul></ul><ul><ul><li>Accessing Carelink: </li></ul></ul><ul><ul><ul><li>Go to: (Install ActiveX control if prompted) </li></ul></ul></ul><ul><ul><ul><li>Log in using Level-1 (Kerberos) password and then Level-2 (Groupwise) password </li></ul></ul></ul><ul><ul><ul><li>Accept SSL Certificate security warning with “Always”. </li></ul></ul></ul><ul><ul><ul><li>Allow Pop-ups from * </li></ul></ul></ul><ul><ul><ul><li>Install Java Runtime Environment if prompted </li></ul></ul></ul><ul><ul><ul><li>Add as a trusted site </li></ul></ul></ul><ul><li>Core Image computers will already have the necessary software to connect from home; a high-speed internet connection is recommended </li></ul><ul><li>You can access your GroupWise account from any off-site location by going to (cookies must be enabled) </li></ul>* Though a Mac should be able to reach the basic web-based access page, MCIT does not support MacIntosh equipment. There has been no testing or verification of Mac usability within the UMHS computer environment.
  20. 21. Documentation & Dictation Tips <ul><li>Tips: </li></ul><ul><ul><li>Accessing the dictation system: </li></ul></ul><ul><ul><ul><li>Dial extension 188 followed by the # key .  (Inside Hospital) </li></ul></ul></ul><ul><ul><ul><li>Dial (734) 615-5000. (Outside Hospital) State date of service, name, department, service, and location of visit. </li></ul></ul></ul><ul><ul><li>Do not use instant messaging (IM) words, unapproved medical abbreviations, or slang. </li></ul></ul><ul><ul><li>Do not use a cell phone to dictate. </li></ul></ul><ul><ul><li>Complete and authenticate documentation within policy guidelines. </li></ul></ul><ul><ul><ul><li>Outpatient clinic notes should be completed as soon as possible or within 30 days Operative notes must be completed as soon as possible or within 24 hours of the procedure </li></ul></ul></ul><ul><ul><ul><li>of the patient encounter per CMS guidelines. </li></ul></ul></ul><ul><ul><ul><li>Admission H&Ps must be completed within 24 hours of the admission </li></ul></ul></ul><ul><ul><ul><li>Documentation completion is monitored by Health Information Management and Reimbursement, Compliance, and Education. Physicians that do not complete documentation within 30 days of the patient encounter are referred to OCA for potential suspension of clinical privileges. </li></ul></ul></ul><ul><ul><li>Update the Problem Summary List. This is the source for allergy information and medication reconciliation. </li></ul></ul><ul><ul><li>As the Attending of record, you are responsible for completion of all documentation related to the patient encounter as stated in the Medical Staff Bylaws. This includes documentation completed by a House Officer or other Licensed Practitioner. Failure to complete documentation within the required deadlines will result in referral to the Office of Clinical Affairs for potential suspension of clinical privileges </li></ul></ul>
  21. 22. For more Documentation and Dictation tips and aids, go to the Health Information Management web site at: . You may also contact HIM by telephone at 936-5340.
  22. 23. IT Systems Resources <ul><li>Resources for help with documentation systems: </li></ul><ul><ul><li>CareWeb Help: </li></ul></ul><ul><ul><li>Create Doc Help: Call Central Transcription Service at 936-5325 </li></ul></ul><ul><ul><li>Centricity CIV Help: Contact the CAS (Clinical Application Services) team by calling 936-9096 or by contacting the MCIT Help Desk at 936-8000 . </li></ul></ul><ul><ul><li>CareLink Training: . CareLink staff are available 24/7. For assistance, call: 936-2222 </li></ul></ul><ul><ul><li>Health Information Management web site: </li></ul></ul>
  23. 24. Pharmacy Support <ul><li>Clinical Pharmacists </li></ul><ul><li>Clinical References available from the Clinical Homepage </li></ul><ul><ul><li>Micromedix </li></ul></ul><ul><ul><li>EPocrates </li></ul></ul><ul><ul><li>Lexi-Comp </li></ul></ul><ul><li>Drug Information Services </li></ul><ul><ul><li>936-8200 </li></ul></ul><ul><li>Available 24/7 by page at 1945 </li></ul>
  24. 25. Telephone Resources <ul><li>If dialing an internal number from within the hospital, use the last five digits of the phone number, i.e. 93( 6-1111 ) </li></ul><ul><li>If dialing into the hospital from an outside line, the full prefix will be needed: </li></ul><ul><ul><li>2-1111 = 23 2-1111 </li></ul></ul><ul><ul><li>3-1111 = 76 3-1111 </li></ul></ul><ul><ul><li>4-1111 = 76 4-1111 </li></ul></ul><ul><ul><li>5-1111 = 61 5-1111 </li></ul></ul><ul><ul><li>6-1111 = 93 6-1111 </li></ul></ul><ul><ul><li>7-1111 = 64 7-1111 </li></ul></ul><ul><ul><li>8-1111 = 99 8-1111 </li></ul></ul><ul><li>Nextel phones are also used in the facility. The prefix of these phones is 216. These need to be dialed externally. </li></ul><ul><li>To get an outside line from within the hospital, dial 97 then the number. </li></ul>
  25. 26. Paging <ul><li>The Telecommunications/Paging Services Office is located at Domino's Farms, 24 Frank Lloyd Wright Lobby L Floor 3, SPC 9755. Fax: 998-2513. Phone: 647-4886. </li></ul><ul><li>Faculty and staff can arrange to pick-up new pagers at the Hospital Security office (1A201) on Tuesdays and Thursdays from 2-3 p.m., or at Paging Services’ Domino’s Farms location Monday through Friday, 8 a.m. to 4 p.m. </li></ul><ul><li>Hospital Security Services will facilitate pager repairs 24 hours a day, 7 days a week. </li></ul><ul><li>Paging online is also available at the Clinical Home Page. </li></ul>Paging Services web site:
  26. 27. PDAs and Smartphones <ul><li>PDAs and Smartphones </li></ul><ul><ul><li>MCIT Desktop Support currently offers basic installation and support for PDA devices to support Groupwise calendars, contacts, and email. </li></ul></ul><ul><li>All portable devices that store sensitive information must be secured with a password and encrypted with the strongest method that is practical. For more information, see UMHS Policy 01-04-502 Security of Portable Electronic Devices and Removable Media. </li></ul>For technical questions, please contact the MCIT Help desk at (734) 936-8000
  27. 28. Welcome to the University of Michigan! Questions Thank you The Office of Clinical Affairs is a resource for both Departments and Faculty.