1
|
Murphy JE, Khawaja H, Messina D, Monteiro JFG, Jeremiah J, McGarry K. Implementation, Reach, and Effectiveness of the Direct Observation of Residents in Clinic Program. Educ Health (Abingdon) 2023; 36:104-110. [PMID: 38133125 DOI: 10.4103/efh.efh_90_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Direct observation is important, yet medical residents are rarely observed. We implemented and evaluated a direct observation program in resident clinics to increase the frequency of observation and feedback and improve perceptions about direct observation. METHODS We assigned faculty as observers in our resident clinics between June 2019 and February 2020. We surveyed residents and faculty before and after the program. Faculty completed a form for each observation performed. We analyzed surveys to examine changes in barriers, frequency and type of observations and feedback, and attitudes toward observation. The analytical sample included 38 and 37 pre- and postresident surveys, respectively, and 20 and 25 pre- and postfaculty surveys, respectively. RESULTS Resident survey response rates were 32.3% (40/124) pre- and 30.7% (39/127) postintervention. Most residents (76% [pre], 86% [post], P = 0.258) reported being observed in at least one of the four areas: history, examination, counseling, or wrap-up. We received observation tracking forms on 68% of eligible residents. Observed history taking increased from 30% to 79% after the program (P = 0.0010). Survey response rates for faculty were 64.7% (22/34) pre- and 67.5% (25/37) postintervention. Fewer faculty reported time (80% [pre], 52% [post], P = 0.051) and competing demands (65% [pre], 52% [post], P = 0.380) as barriers postintervention. Fewer faculty postintervention viewed observation as a valuable teaching tool (100% [pre], 79% [post], P = 0.0534). All faculty who did not view observation as valuable were the least experienced. DISCUSSION Assigning faculty as observers can increase observation, especially in history taking, though data suggest an increase in negative perceptions of observation by faculty.
Collapse
Affiliation(s)
- Jessica E Murphy
- Department of Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | | | | | | | | | | |
Collapse
|
2
|
Lacasse M, Renaud JS, Côté L, Lafleur A, Codsi MP, Dove M, Pélissier-Simard L, Pitre L, Rheault C. [Feedback Guide for direct observation of family medicine residents in Canada: a francophone tool]. Can Med Educ J 2022; 13:29-54. [PMID: 35321416 PMCID: PMC8909829 DOI: 10.36834/cmej.72587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is no CanMEDS-FM-based milestone tool to guide feedback during direct observation (DO). We have developed a guide to support documentation of feedback for direct observation (DO) in Canadian family medicine (FM) programs. METHODS The Guide was designed in three phases with the collaboration of five Canadian FM programs with at least a French-speaking teaching site: 1) literature review and needs assessment; 2) development of the DO Feedback Guide; 3) testing the Guide in a video simulation context with qualitative content analysis. RESULTS Phase 1 demonstrated the need for a narrative guide aimed at 1) specifying mutual expectations according to the resident's level of training and the clinical context, 2) providing the supervisor with tools and structure in his observations 3) to facilitate documentation of feedback. Phase 2 made it possible to develop the Guide, in paper and electronic formats, meeting the needs identified. In phase 3, 15 supervisors used the guide for three levels of residence. The Guide was adjusted following this testing to recall the phases of the clinical encounter that were often forgotten during feedback (before consultation, diagnosis and follow-up), and to suggest types of formulation to be favored (stimulating questions, questions of clarification, reflections). CONCLUSION Based on evidence and a collaborative approach, this Guide will equip French-speaking Canadian supervisors and residents performing DO in family medicine.
Collapse
Affiliation(s)
| | | | - Luc Côté
- Université Laval, Québec, Canada
| | | | | | | | | | | | | |
Collapse
|
3
|
Jorro-Barón F, Suarez-Anzorena I, Burgos-Pratx R, De Maio N, Penazzi M, Rodriguez AP, Rodriguez G, Velardez D, Gibbons L, Ábalos S, Lardone S, Gallagher R, Olivieri J, Rodriguez R, Vassallo JC, Landry LM, García-Elorrio E. Handoff improvement and adverse event reduction programme implementation in paediatric intensive care units in Argentina: a stepped-wedge trial. BMJ Qual Saf 2021; 30:782-791. [PMID: 33893213 DOI: 10.1136/bmjqs-2020-012370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/28/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes' effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs). METHODS Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation. RESULTS We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5-97.4) vs intervention 60.4 (33.2-109.9), p=0.99, risk ratio: 1.0 (0.74-1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6-41.8) vs intervention 34.7 min (26.5-42.1); difference 1.43 min (95% CI -2.63 to 5.49, p=0.49)). The providers' perception of improved communication did not change. CONCLUSIONS After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs' frequency or the perception of enhanced communication. TRIAL REGISTRATION NUMBER NCT03924570.
Collapse
Affiliation(s)
- Facundo Jorro-Barón
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina .,PICU, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Inés Suarez-Anzorena
- Quality of Care, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Rodrigo Burgos-Pratx
- PICU, Hospital Materno Infantil 'Héctor Quintana', San Salvador de Jujuy, Jujuy, Argentina
| | - Noelia De Maio
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Matías Penazzi
- PICU, Hospital de Niños de San Justo, San Justo, Provincia de Buenos Aires, Argentina
| | | | - Gisela Rodriguez
- PICU, El Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Daniel Velardez
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Luz Gibbons
- Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Silvina Ábalos
- PICU, Hospital Materno Infantil 'Héctor Quintana', San Salvador de Jujuy, Jujuy, Argentina
| | - Silvina Lardone
- PICU, Hospital de Niños de San Justo, San Justo, Provincia de Buenos Aires, Argentina
| | - Rosario Gallagher
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Joaquín Olivieri
- PICU, El Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Rocío Rodriguez
- Statistics, Data Management and Information Systems, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Juan Carlos Vassallo
- Teaching and Research, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Luis Martín Landry
- PICU, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | | |
Collapse
|
4
|
Blazin LJ, Sitthi-Amorn J, Hoffman JM, Burlison JD. Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. Pediatr Qual Saf 2020; 5:e323. [PMID: 32766496 PMCID: PMC7382547 DOI: 10.1097/pq9.0000000000000323] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Communication failures are common root causes of serious medical errors. Standardized, structured handoffs improve communication and patient safety. I-PASS is a handoff program that decreases medical errors and preventable patient harm. The I-PASS mnemonic is defined as illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver. I-PASS was validated for physician handoffs, yet has the potential for broader application. The objectives of this quality improvement initiative were to adapt and implement I-PASS to handoff contexts throughout a pediatric hospital, including those with little or no known evidence of using I-PASS. METHODS We adapted and implemented I-PASS for inpatient nursing bedside report, physician handoff, and imaging/procedures handoff. Throughout the initiative, end-user stakeholders participated as team members and informed the adaptation of the I-PASS mnemonic, handoff processes, written handoff documents, and performance evaluation methods. Peers observed handoffs, scored performance, and provided formative feedback. Adherence to I-PASS was the primary outcome. We also evaluated changes in handoff-related error frequency and clinician attitudes about the effects of I-PASS on personal and overall handoff performance. RESULTS All 5 elements of the I-PASS mnemonic were used in 87% of inpatient nursing, 76% of physician, and 89% of imaging/procedures handoffs. Inpatient nurses reported reductions in handoff-related errors following I-PASS implementation. Clinicians across most handoff settings reported that using I-PASS improved both general and personal handoff performance. CONCLUSIONS I-PASS is adaptable to many handoff settings, which expands its potential to improve patient safety. Clinicians reported reductions in errors and improvements in handoff performance. We identified broad institutional support, customized written handoff documents, and peer observations with feedback as crucial factors in sustaining I-PASS usage.
Collapse
Affiliation(s)
- Lindsay J Blazin
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jitsuda Sitthi-Amorn
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
- Hospitalist Program, St. Jude Children's Research Hospital, Memphis, TN
| | - James M Hoffman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis TN
| | - Jonathan D Burlison
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|