GRADUATE MEDICAL EDUCATION Preliminary Feedback from ACGME CLER Site Visit August 19-21, 2014 2014...

GRADUATE MEDICAL EDUCATION

Preliminary Feedback from ACGME CLER Site Visit

August 19-21, 2014

2014 Program Director Retreat

Alan J. Smith, PhD, MEdAssistant Dean and Director for GME

ACGME Designated Institutional Official (DIO)

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Components of the ACGME Next Accreditation System (NAS)Annual Data Collection and Review

Milestones

10 year Self-Study Visit

prn Site Visits (Program or Institution)

Continuous RRC and IRC Oversight and Accreditation

Clinical Learning Environment ReviewCLER Visits

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CLER

• CLER emphasis on responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care.

• Assessment in six focus areas: Patient Safety; Quality Improvement; Transitions in Care; Supervision; Duty Hours Oversight, Fatigue Management and Mitigation; and Professionalism

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CLER

• The visit addressed the following questions: – What organizational structures and administrative and

clinical processes does the hospital have in place to support GME learning in each of the six focus areas?

– What is the role of GME leadership and faculty to support resident and fellow learning in each of the six areas?

– How comprehensive is the involvement of residents and fellows in using these structures and processes to support their learning in each of the six areas?

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We were #203


CLER Visit Structure

• Visit involved only University Hospital; future visits may involve other clinical sites and affiliated hospitals.

• Visit began with CLER team meeting with senior leadership group: CEO, DIO, CMO, CNO, GMEC Chair, and resident GMEC member.

• Additional group meetings with residents and fellows, program faculty, program directors, senior leaders of patient safety and quality management.

• Series of one-on-one discussions with individual residents and staff (e.g., nursing) on 4 walking tours of various clinical sites within the hospital.

• Final debriefing/feedback session with senior leadership group.

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Impressions from CLER visit

• CLER team cordial, professional, but tight-lipped.• Special attention directed towards CEO during both

opening and closing sessions.• Emphasis on role of patient safety/quality

improvement personnel in integration of resident Q/PS projects.

• Much discussion on health care disparities & need for hospital plan.

• Team observed transitions of care in multiple clinical areas; noted need for standardized process.

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Oral Report: Quality and Patient Safety

• Need to increase awareness of hospital’s strategic goals for quality and patient safety among residents, faculty and program directors.

• Address under-reporting of errors & near misses by residents and faculty; over reliance on nurses to report; provide feedback; implement new system & train in use.

• Increase understanding of the range of reportable events among residents, faculty and program directors (i.e., what should be reported).

• Increase understanding of quality & patient safety “terms” among all groups.

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Oral Report: Quality and Patient Safety

• Noted differences among residents, faculty and program directors regarding knowledge of hospital’s quality/patient safety priorities.

• Standardize time outs for bedside procedures.• Link resident Q/PS projects to hospital

strategic goals.• Increase opportunities for interprofessional

Q/PS projects.

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Oral Report: Transitions of Care

• Develop common approach across clinical areas for hand offs (e.g., standard acronym for hand offs).

• Increase attending monitoring and participation in hand offs.

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Oral Report: Supervision

• Implement supervision process to reduce situations where lack of supervision can lead to patient safety events.

• Develop objective, accessible system for attending physicians & nurses to know resident competencies for performing procedures.

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Oral Report: Duty Hours/Fatigue Management & Mitigation

• Provide areas where residents can nap/rest when fatigued.

• Better education and monitoring of fatigue; reduce tendency to “power through” when fatigued.

• Closer monitoring of moonlighting hour reporting.

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Oral Report: Professionalism

• Reduce incidents of unprofessional behavior among faculty; provide faculty development/education on professionalism.

• Clarify and educate residents about process for reporting mistreatment/unprofessional behavior.

• Promote culture of professionalism.

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Oral Report: Healthcare Disparities

• Develop institutional plan for identifying and addressing healthcare disparities.

• Communicate hospital’s priorities for addressing healthcare disparities to residents, faculty and PDs.

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Written Report 6-8 weeks after visit

• Report will contain raw data (responses) from resident, faculty and program director responses in group sessions (audience response system).

• Observations from interactions with residents, faculty, nurses & others during walk-arounds.

• Information from meetings with leadership and QI/Patient Safety staff.

• Provides reflections and observations rather than recommendations.

• We will have opportunity to respond (optional).16


What the report might look like … (example from Fletcher Allen Healthcare, University of VT)

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GRADUATE MEDICAL EDUCATION18


Next Steps

• Assess findings and recommendations in the CLER written report.

• Prioritize and implement improvements and measure outcomes.

• Incorporate improvements into annual program and institutional reviews/reports.

• Incorporate CLER Pathways to Excellence.

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Sincere thanks to everyone who participated in the CLER site visit!

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GRADUATE MEDICAL EDUCATION Preliminary Feedback from ACGME CLER Site Visit August 19-21, 2014 2014...

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