Clinical Safety and Effectiveness Program University of Texas Health Science Center

Jan E. Patterson, MD, MS Associate Dean of Quality & Lifelong Learning

Educating for Quality Improvement & Patient Safety

Quality & Lifelong Learning

• Center for Patient Safety & Health Policy – Clinical Safety & Effectiveness Course – Patient safety & quality improvement

curricula for UME and GME – Interprofessional education

• Office of CME – CME as a bridge to quality

Center for Patient Safety & Health Policy

• To integrate quality and safety concepts into our everyday work

• Enhance organizational knowledge through dissemination of successful practices

• Train the next generation of health professionals to incorporate quality improvement practices in their work

• Integrate quality improvement efforts into health services/outcomes research and health policy

Aims

Educating for Quality Improvement & Patient Safety

Center for Patient Safety & Health Policy

• To train a core of individuals at UTHSCSA in quality improvement methods

• Implement quality and safety through project-based learning at levels of UTHSCSA

• Improve return on investment by improving standardization, infrastructure & support systems

• Disseminate of quality improvement methods within our system and in the region

Objectives

Educating for Quality Improvement & Patient Safety

Clinical Safety & Effectiveness Course

The purpose of the CS&E course is to establish a critical mass of clinicians able to lead improvement efforts and serve as faculty for the course to make improvement practices part of daily operations

Clinical Safety & Effectiveness Course

• Project-based training in quality improvement and patient safety principles

• Based on Dr. Brent James’ program at Intermountain Health Care, Utah

• Projects - demonstrate use of quality concepts & tools

• Eight days, eight hours/day over 5 - 6 months

Methods

Clinical Safety & Effectiveness Program

• Quality improvement theory and tools • Data management • Evidenced-based clinical practices • Team development and management skills • Patient safety theory and initiatives • Quality measures, locally and nationally • Status of national and international healthcare quality • Lean Training- Eliminating waste • Return On Investment

Course Curriculum

Educating for Quality Improvement & Patient Safety

• UT System – Innovations in Health Science Education Annual

Conference – Clinical Safety and Effectiveness Course Annual

Conference – 2009, 2010, 2011, 2012 – Share successful improvement project outcomes – Adopt applicable best practices

• Featured speakers: Brent James, Carolyn Clancy, Mark Chaisson, David Nash, Ken Shine, Maureen Bisagnano

Commitment to Interprofessional Education – System Level

CS&E Course

CS&E Course

CS&E Course

Link to Clinical Venues • CS&E alumni recruit other clinical leaders

– All venues

• Quality departments – University Health System, VA

• Pediatric hospitalist group – CHRISTUS Santa Rosa

• Chief Medical Officers – UT Medicine, University Health System

• Associate Dean Quality & Lifelong Learning

QI Project Examples • Decreasing the no-show rate in the UT Med Ophthalmology

clinic • Implementing resident procedure teams for paracentesis and

thoracentesis at UHS and VA • Decreasing overdue lab results at Westover Hills • Improving Patient Safety Assistant Utilization on 9th floor • Decreasing the blood culture contamination rate on the 8th

floor of University Hospital • Reducing radiation therapy treatment delays at CTRC. • Decreasing the time between transfusion order and

transfusion for surgical patients • Reducing overuse of medical therapy for bronchiolitis in

pediatric patients

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Blood Culture Contamination

11/19/09 Educating for Quality Improvement & Patient Safety

• Nancy Ray RN, MA. Chief Nursing Officer/Associate Administrator. CS&E Participant

• Greg Bowling MD. Hospitalist/Assistant Professor. CS&E Participant

• Joyce Ornelas RN, Roselle Cabagay RN, Wen Pao RN, Rosette Atienza RN, Leticia Wilson RN, Katherine Cox RN, Esther Hazelwood RN, Carol Monk RN, Jennifer Mapa RN, Deanne Richter RN, Lorisa Gray RN, Liza Paulma RN, Shiji Paulson RN, Cecile Ferrer RN, Renimol Kochumon RN, James Jorgensen PhD, Rosemary Paxson MT(ASCP), Charles Reed RN, 8th floor nursing staff

• Wayne Fischer, Ph.D. • Facilitator Amruta Parekh MD MPH 16

OUR AIM STATEMENT

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The aim of our project was to reduce the blood culture contamination rate to less than 2% by August, 2009, on the 8th floor of the University

Hospital. We implemented our interventions in May 2009.

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Standardize sterilization of skin with chlorhexidine. Avoid contamination of sterilized site prior to blood

draw. Prep Blood Culture bottle tops with alcohol swabs. Sterilize claves with chlorhexidine, switch claves on

central lines. Avoid use of peripheral IV lines for blood culture

draws. Use standardized kits that have all supplies ready for

the nurses along with the instruction sheet. Feedback to nurses regarding their contaminated

blood cultures. 20

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Contaminated Blood Cultures on 8th Floor of UH

7.1%6.6%

3.2%

5.3%

1.7%

4.7%

5.8%

3.2%

1.1%

3.0%

5.1%

8.1%

3.5%

9.4%

3.3%

2.3%1.8%

2.8%

5.2%

3.0%

1.6%

2.6%

1.4%

3.6%

2.0%

1.1%

2.9%

CL

0.019

UCL

0.102

0.000

0.020

0.040

0.060

0.080

0.100

0.120

0.140

0.160

JulA 08

JulB 08

AugA 08

AugB 08

AugC 08

SepA 08

SepB 08

OctA 08

OctB 08

NovA 08

NovB 08

DecA 08

DecB 08

JanA

09

JanB

09

JanC

09

FebA 09

FebB 09

MarA 09

MarB 09

AprA 09

AprB 09

MayA 09

MayB 09

JunA

09

JunB

09

JulA 09

JulB 09

AugA 09

AugB 09

AugC 09

SepA 09

SepB 09

Two Week Intervals

% o

f Blo

od C

ultu

res

Con

tam

inat

ed

Pre-intervention Post-intervention

CS&E Annual Survey of Graduates

• Purpose: – Determine extent to which course goals are

achieved – Identify opportunities for improvement – Identify individuals demonstrating exceptional

quality improvement expertise • Electronic survey - 2011-2012 response – 40%

Is your CSE project still alive?

Has your CS&E project spread to other areas of your institution?

Since your CS&E Graduation, how have you continued active participation in quality improvement or patient safety projects?

Performance Improvement CME

Scholarship and Publications • >20 publications by CSE graduates in peer-reviewed journals • Dozens of presentations by CSE alumni at national and state meetings • Increasing number of UT System CSE Annual Conference presentations by

UTHSCSA alumni • Recognition of UTHSCSA project at the UT System CSE Annual Conference,

2010 • National recognition of Center as “Outstanding Educational Program

2011” by the Association for Prevention Teaching and Research. • Faculty team invited to present at Josiah Macy, Jr. Conference on IPE in

Washington DC, April 2012. Attended by national SOM and SON leaders

Comments about the course ‘The CS&E course has been one of the best professional experiences of my career. I cannot say enough about its impact and lasting effects.’ ‘The course is terrific and I am strongly recommending it to teaching faculty within our HSC’ ‘Love this program, making a huge impact at my institution. The San Antonio CS&E course is transforming the institution.’

New Curriculum Concepts • Lean Thinking

• Team STEPPS® www.teamstepps.ahrq/gov

– Team Strategies to Enhance Performance and

Patient Safety

• Disclosure Training

• Return on Investment training

• Calculator developed by UT Austin Red McComb’s

School of Business

Impact on Graduate and Undergraduate Training Programs

• Faculty development in QI and patient safety • Integrated quality and patient safety inter-professional

education into medical and nursing students curriculum

• Established internal medicine and family medicine residency rotations focused on QI and patient safety principles

• Anesthesiology rotation involves students and residents in ongoing QI project on hand-offs in the OR

• QI principles and projects presented at Grand Rounds in multiple disciplines

Directions for Future

• Increase collaborations with other UT health centers

• Increase on-line training • Diversify funding

–Clinical affiliates • Enhance community opportunities