Residents as Sentinels and Change Agents for Safer Care

[The following appeared on Educate the Young, a blog started by Dr. David Mayer of MedStar Health to promote discussions of patient safety and transparency in health care.] 

By David Meyer, MD

April 18, 2013

This coming Saturday, April 26th, the Committee of Interns and Residents (CIR) will be hosting its next QIIQ Conference titled, “How to be a Lead Agent of Change: From Bedside to Transformative Care“, in NYC. Rosemary Gibson, Carole Hemmelgarn, Shelly Dierking and I have the honor of joining leaders from CIR to help facilitate the all-day interactive session. While many faculty will be attending, the major focus of this educational meeting will be on the residents, both from CIR Hospitals as well as other GME programs, and aligns with the “Educating the Young” mission.

Residents can be change agents for safer, higher quality care. There are now numerous examples across the country of this fact–residents leading important quality and safety initiatives that have reduced risk and raised the quality of care provided–and they have done this work despite internal challenges and long work weeks. Those that have followed our ETY blog for the past two years will remember my post on the work of David Leach, the former CEO for the ACGME (see The Canary in the Coal Mine…).  In one of his publications, Dr. Leach shared the most important role of graduate resident physicians was to act as the “moral agent” for their patients. Residents must be the gatekeepers for safe, high quality care–a sentinel on watch for the many unsafe conditions they might encounter while trying to provide optimal patient care, prepared to alert faculty and leadership to these unsafe conditions, and then work with their institutions to find solutions to remove risk from the patient experience. The analogy Dr. Leach used was the canary in the coal mine, taking on the role of guardian and protecting others from harm before it was too late. I loved this “moral agent” concept. It is so simple, yet so important in the quest for safer, higher quality, patient care. In academic medical centers, resident physicians spend more time in the hospital, have more direct contact with patients, and see many more unsafe conditions during days, evenings and weekends than most other caregivers, except possibly nurses. And they do it many times with little, if any, direct supervision. Resident physicians can be those sentinels and serve as excellent change agents for safer care.

We need more conferences like CIR’s QIIQ focused on our next generation of caregivers.  Please help spread the word about the conference. Below is some additional background information with the links to register. The third link is the conference brochure which has additional details.  We appreciate the support and as always, thank you!!

Background Info:
The one-day conference on How to be a Lead Agent of Change will be held Saturday, April 26th in New York City. Given the importance of the patient experience and the desire for more patient-centered care, the Committee of Interns and Residents conference is meant to empower medical residents to develop and execute high-value care projects in their hospitals and health systems, and better equip them with the competencies they need to work in a rapidly changing delivery system.

To register for this conference, please click here. There will also be a webcast, and people can sign up for that here. The agenda and conference brochure can be found here (this includes logistics on location and timing, as well as goals for the day and additional contact information). Please feel free to share this information, as well as the links to register, with your organization and networks.

*CIR has also been tweeting about the conference with the #QIIQ hashtag. Here is a sample tweet you are more than welcome to share with your followers: What’s your #QIIQ? Join @cirseiu & @EinsteinMed in NYC on 4/26 for the next #QIIQ conference. Register now! bit.ly/qiiq426

Resident Physicians Serve as Educators in Bronx Community Outreach Program

Excerpt reprinted from Wing of Zock.

By Sarah Sonies

May 15, 2014

Among New York State counties, the Bronx has some of the poorest health outcomes. National data show that the Bronx lags behind in areas such as childhood obesity, pediatric asthma, and overall pediatric health.

The commonality of these conditions and high rates of hospital readmissions led resident physicians of the Service Employees International Union (SEIU) Committee of Interns and Residents (CIR) to create the Healthy Bronx Initiative in order to address the underlying causes of pediatric obesity and pediatric asthma, two of the major public health concerns in the Bronx.

Part of the HBI featured a partnership between the CIR partnered and community members from the Mary Mitchell Center for the Family Health Challenge, which celebrated its third consecutive year this January.

Structured as an eight-week program for children ages 7-11, the challenge provides a curriculum focused on health behavior changes. Physician residents teach weekly interactive sessions on nutrition, exercise, and environmental health topics in after-school programs at the Mary Mitchell Center. The lessons include takeaways that the students and their families could incorporate into their daily routine each week.

“We were presented with an opportunity to work directly with community members to develop lifelong habits,” said Camille Rodriguez, a first-year pediatric resident at Jacobi Medical Center in the Bronx and a Family Health Challenge teacher. “In order to keep kids motivated and engaged, the lessons were simple. Like encouraging kids to select low-fat milk instead of whole milk, or do 30 minutes of daily exercise.”

Please click here to read the full article.

Are You QI Cool?

[The following appeared on the blog Educate the Young, a blog started by Dr. David Mayer of MedStar Health to promote discussions of patient safety and transparency in health care.] 

By Michael Kantrowitz, DO (Guest Author and Chief Resident, Maimonides Medical Center)

April 18, 2013

It seems that there are a growing number of residents out there who are.

This past weekend, the Committee of Interns and Residents (CIR) hosted an event called “What’s Your QI IQ? Resident Physicians as Quality Improvement Leaders” in New York City. The program was developed as a partnership between the CIR Policy and Education Initiative and the Healthcare Transformation Project of Cornell University.

The day kicked off with introductions by Dr. Svjetlana Lozo, an ob/gyn resident from Maimonides Medical Center in Brooklyn and Dr. Rick Gustave, an emergency medicine resident at Lincoln Hospital in the Bronx. They described the push towards improved quality, safety, and transparency in medical practice and the central role that residents are beginning to play in leading that charge. Next up was Dr. James Pelegano who is an assistant professor and director of the master’s program in healthcare quality and safety at the Jefferson School of Population Health. Dr. Pelegano discussed his own experience in quality improvement in practice as a neonatologist. He then led us in a root cause analysis exercise using the recent death of Rory Staunton, a pediatric patient who succumbed to sepsis as case example.

Breaking into small groups, we were asked to take on various roles of the multidisciplinary team members who were involved to try to identify the contributing factors that led to the delayed recognition of Rory’s ultimately fatal illness. Many residents had never participated in a root cause analysis before, which sparked much discussion over the clinical and communication issues that could be improved. Dr. Pelegano challenged us to think like a hospital’s administration and find a process improvement that could be implemented within two days. He also discussed tools such as flow charts, Ishikawa diagrams, and PDSA cycles which we could add to our arsenal.

We then heard from three residents at CIR represented hospitals who discussed projects they have worked on at their institutions.

• Dr. Constance Liu, an ob/gyn resident at Boston Medical Center, discussed efforts to improve resident education and adverse event reporting. Residents at her hospital have received a grant for this work.
• Dr. Sepideh Sedgh, a pulmonary/critical care fellow, described the work that residents at Maimonides Medical Center have done as part of a joint quality partnership between CIR and the administration. Residents, including myself, took on the task of significantly improving the medication reconciliation process to make patient discharges safer
• Finally Dr. Say Salomon an internal medicine resident from Woodhull Medical Center explained how their House Staff Safety Council has been enhancing patient care. One project he talked about was a resident-led program to reduce heart failure readmissions through better patient education.

The day ended with an interactive discussion run by Jennifer Weiss, a public health consultant with SAE & Associates. She led a workshop on developing and writing quality improvement and patient safety grant proposals using our own ideas for projects. I plan on using these skills as I look to find funding for future projects of my own.

It’s safe to say that we all left with a boost to our QI IQ and I’m looking forward to more events like this, which will train and challenge our generation of physicians to improve quality and safety.

5-Step Patient Centered Beginning of Medical Interview

The Art of Medicine: A Physician-Patient Communication Conference Safe, quality patient care is dependent upon the relationship between health care providers and their patients. Good communication is essential, yet resident physicians typically receive little training. This pocket card details the 5-steps described by Dr. Auguste Fortin. 

>>Download

WHITE PAPER: Implementing the 2009 Institute of Medicine Recommendations on Resident Physician Work Hours, Supervision and Safety

Twenty-six of the nation’s leaders in medicine, health care, patient safety and research released a white paper today with recommendations for improving patient safety and residency training and well-being. The report, published by the journal Nature and Science of Sleep, called for sweeping changes in the design, supervision and financing of U.S. hospital residency care programs to protect patients from serious, preventable medical errors, and end dangerously long work hours for physicians in training. The authors suggest that all medical residents should work no more than 16 hours without sleep, and that Medicare physician training funds to hospitals should be tied to work-hour compliance. 

The report is a product of a conference held last June at Harvard Medical School, sponsored by the CIR Policy and Education Initiative, which was convened to develop a road map for implementation of the Institute of Medicine’s 2009 recommendations for residency reform, documented in the IOM’s pivotal report Resident Duty Hours: Enhancing Sleep Supervision and Safety.

Co-moderated by patient safety leader Lucian Leape, MD and sleep scientist Christopher Landrigan, MD, MPH, the two-day invitation-only roundtable conference and resulting white paper encouraged medical educators and hospitals to embark on fundamental system re-design. “The safety of our patients and our trainees requires nothing less,” write the authors.

» Read and download the report.

» Read the press release.

 White Paper Report in the Press

• Los Angeles Times (Op-Ed)
• Reuters
• Healthwatch
• Newsworks (WHYY/NPR)
• HealthLeaders Media