Role of the Office of Clinical Affairs

Patient Safety

Goal: Safest Health System in the U.S.

Clinical Quality

Chief Medical Officer

Patient Safety Risk Management Infection Control

Clinical Information and Decision Support

Services

Quality Improvement HO Patient Safety

Chief of Staff

Associate Chiefs of Staff

Medical Staff Bylaws

Medical Staff Quality & Peer

Review

Medical Staff Services

Executive Director

Chief Physician Assistant

-P hysicansE valuatingE ffectivenessR egularly

Faculty Member Orientation

Office of Clinical Affairs

Office of Faculty Affairs

FacultyGroup

Practice(Provider Enrollment)

A.C.E.

Peer Review ProcessData Subjective

Measurement Measurement Rate-based Referral

Case-based Concern

Department Supervision

OCA Intervention

“TheCheck-up”(OPPE/FPPE Report Card)CORE COMPETENCIESHOUSE OFFICER

EVALUATIONSPOLICY ADHERENCE

(e.g. documentation compliance, hand hygiene)

ATTENDANCE CONTINUING MEDICAL

EDUCATIONPATIENT SAFETY

INDICATOR PERFORMANCE

RISK CLAIMS DATA

AdvocacyASSESSMENTEDUCATION•Guest Speakers•Service Chief Workshops•Conference compensation

PERIODIC FEEDBACK•360 Surveys•Patient Relations Reports•Patient Satisfaction Surveys

MARKETING •The Chief Brief

Reconciliation of Measures

REAPPOINTMENT

Peers evaluating Peers to ensure the Highest Standard of UMHHC Medical Staff Quality and Safety

The UMHS Office of Clinical Affairs program of support for Medical Staff Members.

3/25/09

HW/MS

Key PoliciesPRIVACY

Federal regulations – HIPAA – limit access to patient medical records to a “need to know” basis for the patient and physician’s protection.

Never give out your password to someone or allow them to use your sign-on to access patient information.

COMPLIANCEAs Medical Staff

members, you are required to report violations of policy and law, including fraud, abuse, falsification and/or criminal activity.

Compliance concerns can be reported via the 24-hour hotline at (866) 990-0111.

PEER REVIEWPeer 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.

Speak UpTo Care Enough, to Report Concerns

Resident suspected a peer was struggling with alcohol or drug use, “smelled of alcohol”

Junior resident observed a senior resident sexually harassing another staff member

Residents observed faculty member’s behavior as disruptive – threatens others, shouts, throws things, nurses and residents afraid to approach

Pharmacy tech concerned about an insulin order, resident and pharmacy supervisor approved the order. Technician continued to question, moved up the chain of command.

Reported anonymously to the Office of Clinical Affairs

Resident received help, successfully completed program

Incident was not reported for fear of “ruining his career”

16 mos later a patient complained

Reported to Service Chief Counseling/limit setting, helped the

faculty member improve.

I.V. drip stopped serious medication error averted.

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: http://www.med.umich.

edu/i/oca/code/index.htm

Respect & Cooperate

Perform Duties

Report Impairment

Report Conflicts of Interest

Maintain Confidentiality

Act Ethically & Responsibly

Supervisory Expectations• Members of the Medical Staff will actively

supervise Clinical Program Trainees (CPT) and appropriately document this supervision in the medical school.

• Attending Physician responsibilities:– Personally involved in, and responsible for, directing

the evaluation and management of individual patients under his/her care and supervision

– Provides oversight and supervision of all care provided by trainees

– Documents involvement, including all CPT history and physicals, operative reports, and discharge summaries

For more details, see UMHHC Policy 04-06-043 Global Clinical Program Trainee (Resident) Supervision at http://www.med.umich.edu/i/policies/umh/04-06-043.htm

House Officer Communication

• The House Officer is obligated to report significant changes in the patient’s condition to the Attending Physician. Situations that automatically qualify as "significant changes” include: – Admission to hospital of any unstable patient – Transfer of the patient to the intensive care unit – Need for intubation or ventilatory support – Cardiac arrest or significant changes in hemodynamic status – Development of significant neurological changes – Development of major wound complications – Medication errors requiring clinical intervention – Any significant clinical problem that will require an invasive procedure

or operation

Hand Off and Transitions Standard Workflow• Use of CareWeb hand off tools

– Surgery– Internal Medicine– Pediatrics– Psych

• Medication Reconciliation at key points along the care continuum– Inpatient admission, transfer and discharge– Clinic Visits, Ambulatory Care Procedural and Surgical

Suites, ED– CareWeb Problem Summary List

• Things “fall between the cracks” when transferring patients from on unit to another. (reverse worded)

• Important patient care information is often lost during shift changes. (reverse worded)

• Problems often occur in the exchange of information across hospital units. (reverse worded)

• Shift changes are problematic for patients in this hospital. (reverse worded)

Hospital Handoffs and Transitions

% of respondents in each department responding with

“Strongly Disagree” or “Disagree” when asked these questions.

Clinical Home Page

• Clinical Home page– General References– Paging

• Clinical References– Infection Control– Pharmacy Services– Patient Education– Health Sciences Library

• Clinical Resources– UMHS Resources– Consent Forms– Clinical Support

• Connect to Other Systems– CareWeb– Centricity– Other Electronic Health Record Systems

Clinical Home Page

Clinical References

Clinical Resources

Connect to Other Systems

Inpatient Units

• University Hospital– Emergency Department: UH B1– TBICU (Trauma/Burn Intensive Care): UH 1– PACU (Pre & Post Anesthesia Care): UH 1– NICU (Neuro Intensive Care): UH 4DS– SICU (Surgical Intensive Care): UH 5D– CICU (Cardiac Intensive Care): UH 7DN

• Mott/Women’s Hospital– WHBC (Women’s Hospital Birth Center): MCHC 4– Holden NICU (Neonatal Intensive Care): MCHC 4– Pediatric PACU (Pre & Post Anesthesia Care): Mott 3– PICU (Pediatric Intensive Care): Mott 5 Pods B & C– PCTU (Pediatric Cardiology/Transplant): Mott 5 Pod A

• Cardiovascular Enter– CPU (Cardiac Procedures Unit): CVC 2A– CVC ICU (CVC Intensive Care): CVC 4– PACU (Pre & Post Anesthesia Care): CVC 4

CareWeb Overview

• CareWeb is a web-based clinical patient record developed at UMHS specifically for use by clinicians and clinical support staff.

• It provides rapid access to patient data from a wide variety of clinical systems, including lab, radiology, registration, medical records, cardiology, neurology, and others.

• Most Information in CareWeb is as "real-time" as possible; data drawn from source systems (done via Clinical Data Repository) is available in CareWeb within seconds of posting to the source systems.

Connecting to CareWeb from Home

• CareWeb can be accessed via 2 methods:– Level-1 firewall authentication from

the clinical home page, – Virtual Private Network application

(via the core image laptop only)

• For more information about Level-1 authentication or access from home, contact MCIT at 936-8000.

Create Document Overview

• The Create Document (Create Doc) application allows users to bypass the dictation system and directly upload documents to the electronic medical record.

• 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)

• 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.

• Templates for Create Document are approved through Health Information Management.

CentricityTM

Clinical Information View (CIV)

• CentricityTM

is the electronic clinical documentation system used in the UMHHC Operating Rooms, Emergency Department and most inpatient units (CVC, UH and Mott).

• CIV is Web based access to all clinical information in Centricity.

• CIV can be accessed from CareWeb via the ED/OR/TB systems button.

CareLink

• UM-CareLink is a computerized provider order entry (CPOE) system that will improve the quality and safety of inpatient care in our Health System.

• UM-CareLink allows caregivers to:– Electronically order tests, procedures, and medications – Maintain clinician worklists and nursing medication

documentation – Receive decision support information about drug

interactions, patient allergies, and more.

Connecting to CareLink from Home

• Using UM-CareLink from non-UMHS computers outside UMHSIf you are not using a UMHS "Core Image" computer, you can access UM-CareLink via the Clinical Home Page using Citrix. To do this, you must:– Have a working Internet connection – Use a supported web browser

(Internet Explorer 6.0) – Enable ActiveX support in the browser

(adding "med.umich.edu" as a Trusted Site in IE can enable this) – Have the Java Runtime Environment installed. This free software will let your

computer communicate to our Citrix server. Download it here: http://java.com/en/download/windows_ie.jsp?locale=en&host=java.com.

– Avoid firewalls that block Citrix traffic. Many firewalls automatically allow Citrix traffic. If you are having difficulty accessing UM-CareLink from home, you may have a firewall that blocks Citrix traffic. If you suspect this may be the case, contact your Internet Service Provider. Port 1494 should be open on TCP and UDP, and others may be needed.

Documentation & Dictation Tips

• Tips:– State date of service, name, department, service, and location of visit.– Do not use instant messaging (IM) words, unapproved medical

abbreviations, or slang.– Complete and authenticate documentation within policy guidelines.

• Outpatient clinic notes should be completed as soon as possible or within 30 days of the patient encounter per CMS guidelines

• Operative notes must be completed as soon as possible or within 24 hours of the procedure

• Admission H&Ps must be completed within 24 hours of the admission• Documentation completion is monitored by Health Information Management

with follow up by OCA when further action is needed– Update the Problem Summary List. This is the source for allergy

information and medication reconciliation.

For more Documentation and Dictation tips and aids, go to the Health Information Management web site at: http://www.med.umich.edu/i/him/doc/index.html. You may also contact HIM by telephone at 936-5340.

IT Systems Resources

• Resources for help with documentation systems:– CareWeb Help:

http://www.med.umich.edu/mcit/carewebwe/help/newindex.html– Create Doc Help: Call Central Transcription Service at 936-5325– Centricity CIV Help: Contact the CAS (Clinical Application Services)

team by calling 936-9096 or by contacting the MCIT Help Desk at 936-8000.

– CareLink Training: http://www.med.umich.edu/i/carelink/training/physiciantraining.htm. CareLink staff are available 24/7. For assistance, call: 936-2222

– Health Information Management web site: http://www.med.umich.edu/i/him/doc/index.html

Pharmacy Support

• Clinical Pharmacists• Drug Information Services

–936-8200• Available 24/7 by page at 1945

Telephone Resources

• If dialing an internal number from within the hospital, use the last five digits of the phone number, i.e. 93(6-1111)

• If dialing into the hospital from an outside line, the full prefix will be needed:– 2-1111 = 232-1111– 3-1111 = 763-1111– 4-1111 = 764-1111– 5-1111 = 615-1111– 6-1111 = 936-1111– 7-1111 = 647-1111– 8-1111 = 998-1111

• Nextel phones are also used in the facility. The prefix of these phones is 216. These need to be dialed externally.

• To get an outside line from within the hospital, dial 97 then the number.

Paging

• 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.

• 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.

• Hospital Security Services will facilitate pager repairs 24 hours a day, 7 days a week.

• Paging online is also available at the Clinical Home Page.

Paging Services web site: https://ummcweb33.mcit.med.umich.edu/pager/

search.cfm

PDAs and Smartphones

• PDAs and Smartphones– MCIT Desktop Support currently offers basic

installation and support for PDA devices to support Outlook calendars, contacts, and email.

• 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.

For technical questions, please contact the MCIT Help desk at (734) 936-8000

Welcome to the University of Michigan!

QuestionsThank you

The Office of Clinical Affairs is a resource for both Departments and Faculty.