Dataset Information

A Consensus Approach to Identify Tiered Competencies in Quality Improvement and Patient Safety.

ABSTRACT:

Background

Quality improvement and patient safety (QI/PS) competencies have been proposed separately for undergraduate medical education (UME) and graduate medical education (GME). The work forms a foundation at each educational level, yet curriculum development would benefit from more specific guidance that considers the continuum of physician training.

Objective

We identified a core set of QI/PS items to be taught during medical school, residency, and independent practice, with specificity to guide curriculum development at each level.

Methods

A panel of 12 QI leaders and educators with backgrounds in internal medicine from 10 academic institutions participated in consensus development using a modified Delphi technique. Three rounds of anonymous surveys were conducted, followed by a teleconference and then a fourth survey round, until consensus regarding the relevance of candidate items was reached. Items considered relevant were recommended for teaching at 1 of the 3 stages.

Results

The panel identified 30 QI/PS items for learners. Of the 30 (80%), 24 were unanimously agreed on as relevant, while 6 of 30 (20%) had the agreement of 11 of the 12 experts and the assent of the remaining expert. Thirteen items were identified as appropriate for undergraduate medical education, 14 for graduate medical education, and 3 for the continuing professional development level.

Conclusions

There was a high degree of agreement among 12 internists from geographically diverse institutions on the relevance of 30 QI/PS items identified for trainees in competency-based educational settings.

SUBMITTER: Kruszewski BD

PROVIDER: S-EPMC6314353 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

A Consensus Approach to Identify Tiered Competencies in Quality Improvement and Patient Safety.

Kruszewski Brennan D BD Spell Nathan O NO

Journal of graduate medical education 20181201 6

<h4>Background</h4>Quality improvement and patient safety (QI/PS) competencies have been proposed separately for undergraduate medical education (UME) and graduate medical education (GME). The work forms a foundation at each educational level, yet curriculum development would benefit from more specific guidance that considers the continuum of physician training.<h4>Objective</h4>We identified a core set of QI/PS items to be taught during medical school, residency, and independent practice, with ...[more]

PMID: 30619521

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Project description:IntroductionResidents are on the front lines of medical care in academic institutions. Their daily interactions are crucial to the quality of care received by patients in these settings, and thus, knowledge of patient safety and quality improvement is essential. The Accreditation Council for Graduate Medical Education requires all residents to participate in quality improvement and patient safety programs as part of their residency training. To meet this need, we developed a curriculum in patient safety and quality improvement for pediatric residents.MethodsThis curriculum describes four short modules focused on quality improvement, patient safety, evidence-based practice, and other quality improvement-related topics. These modules can be given during one rotation, throughout residency, or partnered with a practical application, such as a project. A 17-question quality improvement and patient safety knowledge test was developed after an extensive literature review to reflect module goals and objectives. A validated, 12-question attitudes survey was administered before and after the modules.ResultsOf the 57 eligible residents, 42 completed the knowledge pretest, and 20 completed the posttest. Mean posttest results (M = 91.00 [± 9.12]) were considerably higher than mean pretest scores (M = 75.24 [± 11.74]) when utilizing the independent t test (p < .001). Of the 57 eligible residents, 11 completed the attitude presurvey, and 13 completed the attitude postsurvey. Median responses from the survey mostly fell within the 2-3 range of slightly to moderately comfortable. Significant differences showing improvement between presurvey and postsurvey time frames were found in identifying and comparing best practices (p = .02), using the PDSA model (p = .002), and identifying how data are linked (p = .001).DiscussionKnowledge and perception surveys suggest that resident knowledge and attitudes statistically improved, and faculty and residents participated in even more quality improvement initiatives after completing the curriculum.

Project description:ObjectiveDespite having a detailed MRI-safety questionnaire check at the point of referral, we have encountered a significant number of near-misses with patients being identified with MRI-Unsafe devices at the time of appointments, making this an important safety hazard.Methods and materialsA two-part survey was performed to assess referrer compliance of asking MRI-questionnaires. 120 outpatients across 3 MRI sites were interviewed at the time of appointment to confirm whether their referrers completed the MRI questionnaires with them at the time of referral.Location:Department of Radiology, Ninewells Hospital, Perth Royal Infirmary and Stracathro Hospital in Scotland.ResultsOnly 50-55 % of patients confirmed that they were asked about presence of a pacemaker at the point of referral. Less than 50 % of patients reported being asked about other potential hazards.Suggested strategies for change: (1) Risk Alert-Sent to all MRI referrers in the organization. ( 2) Changes to MRI Safety Questionnaire. (3) Feedback mechanism to referrers-NHS trust website publications on number of recorded near-misses and wasted appointments due to MRI-safety issues. (4) Compulsory education/training of future referrers (junior doctors/allied health professionals). (5) Education of patients/public on MRI safety-Displaying patient information leaflets/posters in waiting areas of the hospital.Key measures for improvement: (1) Reduction in number of recorded near-misses. (2) System improvements, referrer and patient education, reduction of wasted MRI appointments and improvement of waiting-times for MRI appointments Effects of survey and conclusions: The survey highlights the possibility of inadequate referrer attention, and poor patient communication about MRI safety questionnaire with regards to potential hazards of MRI examination in presence of undeclared implants. It initiated several interventions resulting in improved patient safety, with no events in next 12 months, whilst promoting public and referrer's understanding of potential MRI safety issues. Such actions are recommended for all NHS centres across UK since there are significant similarities in functioning across UK.

Project description:BackgroundPrevious research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes.MethodsThe maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates.ResultsOverall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics.ConclusionsWe assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.

Dataset Information

A Consensus Approach to Identify Tiered Competencies in Quality Improvement and Patient Safety.

Background

Objective

Methods

Results

Conclusions

Publications

A Consensus Approach to Identify Tiered Competencies in Quality Improvement and Patient Safety.

Similar Datasets

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