hospitalists as safety intervention tuesday, december 5, 2006 12:00 – 1:00 p.m. eastern time
TRANSCRIPT
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Hospitalists as Safety Intervention
Tuesday, December 5, 200612:00 – 1:00 p.m. Eastern Time
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Moderator: Christopher Landrigan, MD, MPH, FAAPPediatric Hospitalist / Research & Fellowship DirectorChildren’s Hospital Boston, Inpatient Pediatrics
ServiceBoston, Massachusetts
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This activity was funded through an educational grant from the
Physicians’ Foundation for Health Systems Excellence.
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Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Grid
The AAP CME program aims to develop, maintain, and increase the competency, skills, and professional performance of pediatric healthcare professionals by providing high quality, relevant, accessible and cost-effective educational experiences. The AAP CME program provides activities to meet the participants’ identified education needs and to support their lifelong learning towards a goal of improving care for children and families (AAP CME Program Mission Statement, August 2004).
The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.
All AAP CME activities will strictly adhere to the 2004 Updated Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.
The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.
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DISCLOSURESActivity Title: Safer Health Care for Kids - Webinar Hospitalists as Safety Intervention Activity Date: December 5, 2006
DISCLOSURE OF FINANCIAL RELATIONSHIPS All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name Name of Commercial Interest(s)*
(*Entity producing
health care goods
or services)
Nature of Relevant Financial
Relationship(s) (If yes, please list: Research Grant,
Speaker’s Bureau, Stock/Bonds
excluding mutual funds, Consultant,
Other - identify)
CME Content Will Include
Discussion/ Reference to Commercial
Products/Services
Disclosure of Off-Label (Unapproved)/Investigational Uses of Products
AAP CME faculty are required to disclose to the AAP and to learners when they plan to discuss or
demonstrate pharmaceuticals and/or medical devices that are not approved
Jack M. Percelay, MD, MPH, FAAP
No No No No
Erin R. Stucky, MD, FAAP
No No No No
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DISCLOSURESSAFER HEALTH CARE FOR KIDS - PROJECT ADVISORY COMMITTEE AND STAFF DISCLOSURE OF FINANCIAL RELATIONSHIPS All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name Name of Commercial Interest(s)*
(*Entity producing health care goods
or services)
Nature of Relevant Financial Relationship(s)
(If yes, please list: Research Grant, Speaker’s
Bureau, Stock/Bonds excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include Discussion/
Reference to Commercial Products/Services
Disclosure of Off-Label (Unapproved)/Investigational Uses
of Products AAP CME faculty are required to
disclose to the AAP and to learners when they plan to discuss or
demonstrate pharmaceuticals and/or medical devices that are not approved
Karen Frush, MD, FAAP (PAC Member)
No No No No
Uma Kotagal, MD, MBBS, MSc, FAAP (PAC Member)
No No No No
Christopher Landrigan, MD, MPH, FAAP (PAC Member)
No No No No
Marlene R. Miller, MD, MSc, FAAP (PAC Chair)
No No No No
Paul Sharek, MD, MPH. FAAP (PAC Member)
No No No No
Erin Stucky, MD, FAAP (PAC Member)
No No Not sure No
Nancy Nelson (AAP Staff) No No No No
Melissa Singleton, MEd (Project Manager – AAP Consultant)
No No No No
Junelle Speller (AAP Staff) No No No No
Linda Walsh, MAB (AAP Staff)
No No No No
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DISCLOSURESAAP COMMITTEE ON CONTINUING MEDICAL EDUCATION (COCME) DISCLOSURE OF FINANCIAL RELATIONSHIPS All individuals in a position to influence and/or control the content of AAP CME activities are required to disclose to the AAP and subsequently to learners that the individual either has no relevant financial relationships or any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in CME activities.
Name Name of Commercial Interest(s)*
(*Entity producing health care goods
or services)
Nature of Relevant Financial Relationship(s)
(If yes, please list: Research Grant, Speaker’s
Bureau, Stock/Bonds excluding mutual funds,
Consultant, Other - identify)
CME Content Will Include Discussion/
Reference to Commercial Products/Services
Disclosure of Off-Label (Unapproved)/Investigational Uses
of Products AAP CME faculty are required to
disclose to the AAP and to learners when they plan to discuss or
demonstrate pharmaceuticals and/or medical devices that are not approved
Ellen Buerk, MD, FAAP
No No No No
Meg Fisher, MD, FAAP
No No No No
Robert A. Wiebe, MD, FAAP
No No Not sure No
Jack Dolcourt, MD, FAAP
No No No No
Thomas W. Pendergrass, MD, FAAP
No No No No
Beverly P. Wood, MD, FAAP No No No No
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CME CREDIT
The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AAP designates this educational activity for a
maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
This activity is acceptable for up to 1.0 AAP credit.
This credit can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Fellows of the American Academy of Pediatrics.
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OTHER CREDIT
This webinar is approved by the National Association of Pediatric Nurse Practitioners (NAPNAP) for 1.2 NAPNAP contact hours of which 0.0 contain pharmacology (Rx) content. The AAP is designated as Agency #17. Upon completion of the program, each participant desiring NAPNAP contact hours should send a completed certificate of attendance, along with the required recording fee ($10 for NAPNAP members, $15 for nonmembers), to the NAPNAP National Office at 20 Brace Road, Suite 200, Cherry Hill, NJ 08034-2633.
The American Academy of Physician Assistants
accepts AMA PRA Category 1 Credit(s)TM from organizations accredited by the ACCME .
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Jack M. Percelay, MD, MPH, FAAPPediatric HospitalistHunterdon Medical CenterFlemington, New Jersey
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Erin R. Stucky, MD, FAAPPediatric HospitalistChildren’s Specialists of San DiegoRady Children’s HospitalSan Diego, California
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Hospitalists as Safety Intervention
Jack Percelay MD, MPH, FAAPErin Stucky MD, FAAP
AAP Safer Health Care for Kids Webinar
December 5, 2006
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Disclosures
• Dr Erin Stucky does in fact have a time twizzler just like Hermione Granger and that is how she is able to accomplish so much in so little time
• Dr Jack Percelay is significantly taller than Erin Stucky
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What we will cover today
Participants shall be able to:• a. List key resources and personnel to
establish a pediatric patient safety program in a community hospital.
• b. Name key hospital committees and (medical staff) department relationships through which the hospitalist can effect patient safety changes.
• c. Identify specific patient safety targets for pediatric hospitalists in community and children's hospitals.
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Wachter NEJM OriginalDefinition of Hospitalist
• “Hospitalists are physicians who spend more than 25% of their time based in a hospital setting, where they serve as Physicians-of-record after accepting “hand-offs” of hospitalized patients from primary care physicians, returning those patients to the care of the primary care physicians at the time of hospital discharge.”
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Society of Hospital Medicine
Current Definition of Hospitalist• “Physicians whose primary professional focus
is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to hospital care.”
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Key Features of Definition
• Hospital is exclusive work environment
• Commitment to systems improvement• Communication, communication,
communication • Implicit risk of the handoff• Multiple roles besides purely clinical
care
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SHM ProjectionsNumber of Hospitalists
AAP Section on Hospital Medicine – October 1998 75 members– October, 2006 670 members
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AAP Guiding Principles for Pediatric Hospitalist
Programs 1 Voluntary referrals.
2 Designed for Local Needs3 BC/BE pediatric equivalent training4 Include appropriate follow-up5 Timely and complete communication6 Data collection
Pediatrics, April 2005
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Community HospitalistsMany of these points will also apply to the
Children’s Hospitalist
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Multiple Hospitalist RolesMultiple Opportunities
• Pediatric ward – teaching residents• Nursery • NICU and PICU• Emergency Department• Hospital services – radiology,
sedation • Clinical partners – nursing,
respiratory therapy, pharmacy
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Ingredients for a Successful Hospitalist/Hospitalist
Program • Clinical acumen and communication
skills • Broad systems interest• Lead by example• Shared quality and outcome goals,
not just revenue• Job description, compensation,
career advancement linked to performance improvement
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Hospital RelationshipsInstitutional Leadership
• In community hospital, hospitalist is often the physician leader for pediatrics
• Department chair may be office based
• Unlikely to have pediatric ER• Neonatology often present, rarely
involved with ward
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Hospital RelationshipsKey Contacts for Pediatric
Advocacy • VP of Medical Affairs• Patient Safety Officer• Department of Pediatrics Chair• Pharmacy, Radiology and Laboratory• Nurse Manager, VP of Nursing• Risk Manager• JCAHO• PI/QI
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Hospital RelationshipsKey Physician Contacts
• Department Chair• Office based PCPs, • Sub-specialists, adult and pediatric• Surgeons--general, pediatric &
subspecialty • Anesthesiologists• Radiologists• ER• Pathologist/Clinical Lab Director• Outside tertiary care referral subspecialists
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Hospital RelationshipsKey Committee Involvement • Patient Safety• Pharmacy and Therapeutics• Performance Improvement/QI• JCAHO• Credentials• Forms/Medical Records• Education• Multi-disciplinary Pediatric Committee
– Create one if it doesn’t already exist
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Initial Safety Efforts Leading by Example
• Culture of safety• Teamwork• Do the little things right--if you
don’t, no one will•ALWAYS wash hands,• always write mg/kg
• Monitor and evaluate your own performance– Ask for feedback, debrief
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Other Safety Projects for the Community
Hospitalist • Clinical Practice Guidelines• Transitions of Care and Hand-offs• Medication safety and weight based
dosing• Infection control• Rapid Response Team • Other knock-offs of successful projects
already implemented in children’s hospitals
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Tips for Success Vigilance on Advocacy
Issues• Put pediatrics on the dashboard
– Infrastructure is geared towards adult population
• Get buy-in from pediatricians• Get buy-in from adults
– Use example “if it were your child (use name)”
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Tips for Success Beware of Potential
Pitfalls• Change is never easy• Be cautious about how high to set the
bar– Depends on local culture and
politics– First task is to get buy-in for your
hospitalist program– Identify and respect potential
obstacles
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Suggestions
• Start small, improve your practice first• Create alliances with non-physicians• Create physician alliances
– Specialty and surgical co-management*• Let others advocate for your expanded role• Change systems to change behaviors/
outcomes
*Pediatrics March 2003, pp. 707-709
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Opportunities for the Community Pediatric
Hospitalist• Potential to directly impact care • Potential for a significant leadership
role in your hospital– May extend to adult safety areas
• Regional and national pediatric hospitalist and/or pediatric patient safety activities
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Children’s Hospitalists
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Perceptions – real or not?
• Less individual responsibility to lead?• Focus on the greater good for all
children• Infrastructure in place • Sophisticated endeavors: RRT, safety
rounds• Administrators chart the safety course?
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Key Resources and Personnel: the Hospital• All noted with Community Hospitalists
apply• Liaisons with units intimate
– Respecting expertise– Transfers of care; RRT; medication
reconciliation
• Partnership with PCPs– CSHCN, access for outpatient f/u studies
• Key hospital administrators may be Hospitalists
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Key Resources and personnel – The look
withinWhat qualities should you expect when
hiring a Children’s Hospitalist?• Role on the pediatric ward
– Culture; IHI efforts; teach safety at bedside
• Role in the Hospital – Chair committees; seek projects;
formal safety education
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Key Resources and personnel – The look
withinRole with the Hospital • Local leader /representative
– Discuss best practices, NACHRI, NICHQ interpretation
• JCAHO implementation• The “go to” division for safety
challenges • The “go to” division for patient safety
research
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Hospital Committees and Department
Relationships• All noted with Community Hospitalists apply• QI and Medical Staff Executive Committee
memberships a must• Department of Surgery and Trauma
Committees• Key M&M Committees: Critical care,
Transport, Emergency Department, Pediatrics
• Chair of the University Department of Pediatrics
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Specific Safety Targets • Surgical and specialty co-management• Medication reconciliation• RRT• IHI bundles; 100L lives campaign• Trauma and Emergency Preparedness• Transport systems• Sedation• Teaching oversight, curriculum
development• Fatigue and stress education
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Tips for success
• All noted with Community Hospitalists apply
• Awareness of site-specific issues• Learn your system and stakeholders• Insert safety as part of your division’s
mission• Legitimize hospitalists’ efforts in
patient safety by leading systems improvement efforts
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Hospital Medicine Web Resources
– AAP Section on Hospital Medicine and LISTSERV•[email protected]
– Ambulatory Pediatric Association Special Interest Group in Hospital Medicine•www.Ambpeds.org
– Society of Hospital Medicine•www.hospitalmedicine.org
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Patient Safety Resources – AAP Practice Management – Safety.
http://practice.aap.org/topicBrowse.aspx?nodeID=1000.1013.1020
– AAP Things that work. http://www.aap.org/visit/thingsthatworkcall.htm
– Child Health Corporation of America CHCA http://www.chca.com/company_profile/pi/index.html
– Agency for Healthcare Research and Quality AHRQ www.ahrq.org.
– National Insitute for Child Health Quality. http://www.nichq.org/nichq 100 Lives campaign.
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Patient Safety Resources – Institute for HealthCare Improvement
http://www.ihi.org/ihi Leadership Guide to Patient Safety – Free download.
– Principles of Patient Safety in Pediatrics Pediatrics Vol. 107 No. 6 June 2001, pp. 1473-1475 American Academy of Pediatrics National Initiative for Children's Health Care Quality Project Advisory Committee
– AAP Safer Heath Care for Kids Webinars– AAP Safety email list