Telluride Patient Safety Educational Roundtable and Resident Physician Summer Camp 2013

Posted: November 30, 2012 | Author: | Filed under: Medical Education, Patient Centered Care, Patient Safety, Transparency | Tags: , , , | 1 Comment

PATIENT SAFETY SUMMER CAMPS FOR RESIDENT PHYSICIANS

Through the generous support of COPIC, CIR and MedStar Health, we have scheduled a week for resident physicians at the Ninth Annual Telluride Patient Safety Educational Roundtable and Student Summer Camps, so that resident physicians will again also have the opportunity to engage with leaders, educators, and advocates in patient safety in a relaxed and informal setting to discuss, develop and refine health science in ways that support a culture of patient safety, transparency and optimal outcomes in patient care.

As mentioned in my previous post announcing the 2013 Student Summer Camp dates and submission information (click here for information), the Telluride Patient Safety Resident Summer Camp is a similar one-week experience that will provide attendees an in-depth understanding of current patient safety issues, risk reduction strategies, and the power of transparency in achieving optimal patient care. The Resident Physician Summer Camp will be held June 10th-13th, 2013 in Telluride, CO at the Telluride Science Research Center.

Chief Resident Michael Kantrowitz at Maimonides Medical Center, a summer of 2012 attendee, recently posted on ETY (Telluride Patient Safety Roundtable 2012 Resident Updates) providing updates on the quality improvement projects he and fellow attendees from the New York area are working on as a result of their experience in Telluride. His one sentence summary is a wonderful outcome of our work there this summer, as Kantrowitz says:

“It is clear that our week in Telluride transformed our thinking about quality and patient safety.”

Jon Hatoun, PGY2, who posted his reflections on the Transparent Health blog over the summer, shared his experience as the following:

If I had spent the last four days locked in a library researching the patient safety literature non-stop, I would not have walked away with as much knowledge, enthusiasm, and support as I acquired participating in the Transforming Mindsets: Patient Safety Summer School for Resident Physicians in Telluride, Colorado.  The collective efforts, shared experience, and mutual support of everyone involved made for a special atmosphere (in the already special atmosphere of nine thousand feet) that allowed each of us to rise above our prior potentials.  Within an hour of resuming clinical duties today, I was already championing our collective cause, walking a fourth year medical student through an incident report about a delayed dose of nevirapine in a newborn; her initial grimace at the optional “name of reporter” question eventually morphing into an enthusiastic smile as she entered her name following our discussion about the benefits of reporting and transparency. I couldn’t be more excited right now to motivate these types of small shifts towards a safety mindset while also pursuing large-scale systems shifts that ensure safety as well.  Thank you to all the faculty and especially to the other residents!

Click on this video clip for a more in-depth view of the Student and Resident Summer Camps, as well as alumni reflections on their experience in Telluride. Additional residents interested in applying for the 2013 Summer Camp would need to secure funding for their participation and should have their program director contact David Mayer MD at (david.b.mayer@medstar.net).

What Is Flow And How Can It Improve Healthcare?

Posted: November 29, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education | Tags: , , , , | Leave a comment

Last week’s post, Achieving A Flow State In Healthcare… briefly introduced Mihaly Csikszentmihalyi’s concept of flow which describes the linear relationship of an optimal experience as an individual’s skill level, or perceived skill level, being equal to the challenges in front of them. The higher the skill level someone achieves, the higher the challenge that must be sought to achieve flow–or the feeling that time is standing still, and all consciousness of self and others is lost to the task at hand. Some describe the feeling as being “in the zone” — or “time flying by” when working at a task. In Csikszentmihalyi’s TED Talk below, he speaks of flow as a state of mind similar to all, but achieved via individual routes, unique to each person’s abilities and desires. According to him, flow can be achieved with intention, and is a way to experience life to the fullest.

MedStar Health’s Institute for Innovation is also a believer in flow. Below, Dr. Mark Smith, Director of the Institute for Innovation, introduces Dr. Allan Hamilton, a neuroscientist who Smith enlisted to introduce his healthcare administrator and provider audience to the concept. Flow, as Hamilton sees it, defines life’s exceptional moments. Since so many moments of our lives are spent at work, which for healthcare providers includes the influence and impact on patients’ live, it would make sense to learn the skills which make those moments–those interactions–exceptional.

Telluride Patient Safety Educational Roundtable and Summer Camps for 2013

Posted: November 27, 2012 | Author: | Filed under: Education Technology, Medical Education, Patient Centered Care, Patient Safety | Tags: | 1 Comment

PATIENT SAFETY SUMMER CAMPS FOR HEALTH SCIENCE STUDENTS

Through the generous support of The Doctors Company Foundation and MedStar Health, we have scholarship funding to bring 40 medical student and 20 nursing student leaders this coming summer to engage with leaders, educators, and advocates in patient safety for the Ninth Annual Telluride Patient Safety Educational Roundtables and Student Summer Camps.

The Telluride Patient Safety Student Summer Camp is a one-week experience that provides students an in-depth understanding of current patient safety issues and risk reduction strategies for optimal patient care. These one-week summer camps will be offered twice this coming summer:

Sunday June 16th – Wednesday June 19th, 2013 (to be held in Telluride Colorado)

Thursday August 1st – Sunday August 4th, 2013 (to be held in Washington, DC)

Over the last eight years, interprofessional leaders from the AMA, ANA, Joint Commission, NBME, ACGME, Lucian Leape Institute, patient safety, informatics, simulation and health science education have been joined by patients, residents and students in beautiful Telluride, Colorado to address current patient safety educational issues. Because of the growing interest in patient safety education, this coming summer we will be holding a second student summer camp week in Washington, DC.

This year’s roundtables will once again bring critical stakeholders together in a highly interactive and productive format to addresses ethical, professional, legal and economic dilemmas regarding patient safety, transparency, disclosure and the growing need for open and honest communication skills when medical errors and adverse events occur. Following is a short video clip sharing the purpose of the Summer Camps, and alumni reflections on their experience in Telluride:

Telluride Roundtable Vision:

To create an annual retreat where experts in patient safety and health science education can come together with patients, residents and students in a relaxed and informal setting to discuss, develop and refine health science education that supports a culture of patient safety, transparency and optimal outcomes in patient care.

Students interested in applying for this opportunity should send the following information to Dr. David Mayer (david.b.mayer@medstar.net):

  1. Two-page maximum CV
  2. Personal statement highlighting their interest in patient safety, and why attending the Patient Safety Summer Camp would complement that interest
  3. One letter of support from a faculty/mentor highlighting leadership and patient safety engagement
  4. First and second choice preferences for the summer camp weeks (Telluride, CO and Washington, DC)

Patient and Family Advisory Councils – The Importance of the Patient Voice in Our Safety and Quality Work

Posted: November 26, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education, Medical Error, Patient Advocacy, Patient Centered Care, Patient Safety, Transparency | Tags: , , , , , , , , , , | 2 Comments

Patient and Family Advisory Councils are forming in many hospitals across the country. Some institutions, like the Dana Farber Cancer Institute and Cincinnati Children’s Hospital have had “Patient Partnership” Council’s in place for over a decade, inviting the patient into healthcare decision-making and strategic planning, setting examples for those just starting the process. Aurora Health in WI, who received AHRQ funding to look at best practices around the formation of a Patient Safety Advisory Council for outpatient medication safety has provided guidelines for all to follow if they so desire to set up their own Patient Advisory Council.

But with many now rushing to engage patients, a few leading patient advocates have become a bit skeptical. Engaging patients is more than just addressing the call from the Institute of Medicine in their September report. It’s more than gathering people in a boardroom, serving lunch and feeling good about ourselves. It’s more than just checking the patient council box when the Joint Commission comes visiting. And it’s more than just asking patients about hospital room colors. It’s about true partnerships that define, and then measure, patient safety and quality improvement outcomes from projects that directly result from the time invested in these types of meetings.  When done correctly, these partnerships become powerful and lead to positive changes in a number of areas. The culture of medicine is in transition, and like any industry, changing culture takes time, courage and the ability to take action outside our normal comfort zones.

This week, I had the great pleasure of spending time with a number of leading patient advocates – people who have devoted their careers to helping patients, caregivers and health systems better understand what is needed to lower risk and improve quality in patient care. Many are good friends and have been personal mentors to me through the years. People like Helen Haskell, Carole Hemmelgarn and Patty Skolnik, three remarkable women who continue to share their personal stories of loss so others can learn, and make care safer.  People like Rosemary Gibson, Michael Millenson, Sorrel King and Victoria Nahum who have touched us all through their writings, educational materials and collective call for change.  They have graciously agreed to help us at MedStar Health better understand and appreciate what terms like patient-partnership, shared decision-making, and transparency really mean to our patients. Their definitions and perspectives can be quite different at times from those I have thought were correct and published in the literature through the years. Many times I think I get it, only to realize that “I don’t know what I don’t know”. Tim McDonald, a good friend, mentor and patient safety leader, always likes to say we can be “unconsciously incompetent” when describing this phenomena.

We all met as a group last week, and the conversation took on a life of its own. With the advocates asking the tough questions, the conversation and discussions evolved organically and led to the open, honest discourse we all know is critical if real change has a chance to occur. Rosemary challenged the leadership in the room to measure our success by striving for the day when every healthcare provider working in our system was one that we as caregivers would refer a family member to – no hidden secrets on who we know is good, and who we would take our loved ones to for care. A second recommendation focused on outcomes data, and how to present it in a meaningful way–in a way that patients could truly understand, and then use it for decision-making. And more than one of our advocates implored us to create educational tools that patients could not only use to guide them through their hospital stay, but also make it clear they were a welcome and engaged part of the care team. Many health systems like MedStar already have different patient educational tools in place, but the group pushed us to think differently and be even more innovative in our approach to patient education.

The day ended with excitement around the different opportunities to create change right in front of us, and in fact, work has already begun on more than one consensus recommendation resulting from the meeting. We all look forward to the continued sharing of ideas with our council members, and graciously thank them for their insight and resolve to push us past our limits in the best interest of our patients.

After the Patient Goes Home: A Thanksgiving Perspective

Posted: November 23, 2012 | Author: | Filed under: Medical Education, Patient Advocacy, Patient Centered Care | Tags: , , | Leave a comment

Following is an email my brother sent last week. I wanted to share it with our ETY readers because it’s a gentle reminder that the real bravery in healthcare often occurs far from the hospitals in which we work. Patients are the real heroes in healthcare–their courage to face illness, the love and support they give one another in times of weakness, the new-found strength of a young father to cry when afraid–these are the lessons not taught in medical school. These are life lessons that not all of us will have to face, but if we do, I only hope we rise to the occasion with the same grace and resolve as Ev and Eric. You are both an inspiration–as is my brother who lives each day with the knowledge that the “important things” in life are family, love and fun.

From: Steve Granzyk
Date: November 15, 2012, 11:52:03 AM MST
Subject: Thanksgiving

As we move towards Thanksgiving (and what it means to us), check out the following post from Tracie Wilcox, who puts things into perspective (Eric gets his 2nd chemo infusion the day before Tday)…I’ve spent some time with him recently and he looks good, but he’s visibly fighting through some nausea and a constant fever. He’s incredibly strong and his head is right, so I’m not surprised that he continues to be there for his family and amazingly, he is still working.  The group of guys that I grew up with have been coming through for him “big time” (he works for Joe Wall And Johnnie Maz, other friends of ours) and Mike is also in regular contact with Eric and Tracie also.

Eric’s life has been tough (lost his sister when she was in her late twenties), but his positive push forward at this time is a reminder that we should be counting our blessings and not focusing on what we don’t have or how rough times can be.

 Equally, we have to thank Ev and Will for maintaining the strength to fight through Ev’s chemo. Ev took cancer head on, and is beating it like a drum.  Not surprisingly, she never complained about symptoms that come with Chemo (fatigue, nausea, insomnia), she just flat out dealt with it.  I knew she was heading in the right direction when I heard she was having Mia shave her head, rather than let the treatments take it from her.  She took things into her own hands, sturdy as they are.  Once again, blessed.

 I know it’s a bit early, but we want to wish a Happy Thanksgiving to all.  Positive thoughts and thanks to all of you from our crew.

 Love and prayers, Steve, Megan, Vince and Payton. 

 November 13 (?) 2012 Posted 12 hours ago

Hope everyone is doing well! A lot of people have been emailing and texting asking how Eric is so I wanted to let everyone know that he is tolerating the first Yervoy infusion and has his 2nd one the day before Thanksgiving. From what I understand, the medicine has a delayed response so hopefully he doesn’t experience any of the ugly side effects. He is still taking the Zelboraf and will continue until he’s finished with the bottle he has left.

Eric had an appointment to check a couple areas on his back that I was concerned about and the doctor agreed with me on 2 of them and did a shave excision right in the office and sent the tissue out for biopsy. We should get the results next week.

We hope everyone has a great Thanksgiving as I know that this day truly brings on a whole new meaning for me. I give thanks for my husband still by my side and for his strength to be able to fight this awful disease. I give thanks for my children helping me make it through each day even if they exhaust me 🙂
I give thanks to my family for being by our side and taking care of us and our house. I give thanks to all of our family and friends for your encouraging words, dinners, advice and support during this terrifying time in our lives. To Eric’s “other” family at work, you all are amazing and thank you for allowing Eric to take off work if and when needed. I am truly grateful for all of you. Eric and I couldn’t do this without all of you!

Xoxo
Tracie

Click on Eric’s Caring Bridge page for contact information if you have further insight into the treatments he is receiving.

Giving Thanks: Remembering Those Who Have Helped Change the Delivery of Care

Posted: November 20, 2012 | Author: | Filed under: Leadership, Medical Education, Patient Centered Care, Patient Safety | Tags: , , , | Leave a comment

Michelle Ballog was a 39-year-old mother of two young girls when she went in for what should have been a simple outpatient procedure. Lewis Blackman was a 15-year-old aspiring athlete, actor and all-around American boy when his life was cut short by medical error. Michael Skolnik was barely old enough to order a beer for himself and studying to be a nurse when the healthcare system failed him. Yet all three families continue to give back to a healthcare system that took their loved ones from them, helping educate all of us on how to be safer caregivers and health systems. We owe thanks on this day of Thanksgiving to them and to the many others like them who do this important work. I am thankful for having had the opportunity to meet and get to know each of these families, saddened by their losses, and continually amazed at their ability to push all of us to improve the delivery of care so that others do not suffer similar unthinkable losses. I am thankful for the way they challenge us to keep the patient at the center of our care at all times. And I am thankful to call them friends.

As healthcare providers, we entered into our profession to care for others–to keep them safe at all costs while under our care. As students and residents, many of you are just now beginning to understand that the complexities of medicine reach far beyond understanding lipid metabolism, memorizing the cranial nerves or learning to put in a central line. Basic science is simple compared to the complexities of human behavior we experience not only with our patients, but even more so with our peers and colleagues. How good a caregiver you become, or even are today, hinges more and more on your ability to engage with your patients in meaningful, shared decision-making conversations based on their unique values, preferences and goals — not ours, and to be open and honest with them at all times no matter what the conversation entails.

Rosemary Gibson said it best at a recent MedStar Health Quality and Safety Retreat when she paraphrased Gandhi while leading a patient-partnership session: “A patient is the most important visitor on our premises. They are not dependent on us – we are dependent on them. They are not an interruption in our work – they are the purpose of it. We are not doing our patients a favor by serving them, they are doing us a favor by allowing us to serve them.”

Happy Thanksgiving to all.

Storytelling and the Reality of Medicine

Posted: November 19, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education, Patient Centered Care, Storytelling | Tags: , , | Leave a comment

Digging through the web archives of storytelling in healthcare and medicine, I’m finding what once may have been considered an unlikely marriage of various industries, including healthcare, with leadership in storytelling. For example, in a 2003 Harvard Business Review article, Storytelling That Moves People, I found an interview with Robert McKee, who I referred to in the recent post, How Do Great Storytellers Create Empathy? McKee, aka The Script Doctor, has instructed Microsoft employees for years on the elements of story to improve adoption of business cases, and has consulted with many corporations who, when giving life to the story behind their spreadsheets and business plans, were more likely to gain Wall Street support, also known as venture capital funding, also known as money. By creating a storyline around products and services that have yet to be proven, potential funders find reason to believe in the potential of a 3-D printer that might one day generate new veins or vital organs, or in a molecule that may cure Alzheimer’s disease.  For the skeptics, it’s not manipulation by pulling on heartstrings either, as McKee so eloquently puts it, “the fact is that statistics are used to tell lies and damn lies, while accounting reports are often BS in a ball gown—witness Enron and WorldCom.”

How does this link to healthcare? The storyline in medicine has lacked what reality TV executives have found drive prime time ratings. Instead of being open and honest with patients and families around the events that occur during their care–the mistakes that are made or almost made, the lives that are lost as well as saved, and the fear of litigation that surrounds both–humanity has been slowly stripped from the patient-provider relationship. If providers cannot admit to themselves they are fallible, how can they authentically relate to a patient who is in their most vulnerable state? Care providers have an opportunity to meet another person, just like themselves in many ways, at a time they are most in need–when the masks we wear come off, and the walls we have built around the stories of our lives go down, if only for the time of illness. These real life stories have the power to change both provider and patient, and therefore healthcare, if we open ourselves up and face what is really happening, in the moment. As McKee says:

The great irony of existence is that what makes life worth living does not come from the rosy side. We would all rather be lotus-eaters, but life will not allow it. The energy to live comes from the dark side. It comes from everything that makes us suffer. As we struggle against these negative powers, we’re forced to live more deeply, more fully.

Leadership and Love

Posted: November 15, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education | Tags: , , , , | 1 Comment

Those of us in the patient safety field have had the great experience through the years of listening to Don Berwick’s keynote speeches and writings. Be it his Escape Fire talk at one of the IHI Annual Meetings, the speech he gave at his daughter’s medical school graduation, or his personal story published in JAMA, entitled, To Isaiah,–the stories he tells and the important messages he shares move and inspire all of us. As the power of storytelling to create change across industries continues to rise to the forefront, Don Berwick has been doing this naturally through the years. And his audience has grown over the years as well–perhaps as a result of his gifted ability to share the stories of his life and career in ways that move others, but also because his passion for improving healthcare sets a true north all can follow. Here is his Harvard medical school address from 2012, where he advises that in confusing times, it is even more important that a physician’s true north remains his/her oath to care for all patients:

I read a beautifully written piece on leadership and love this past week that was right up there with many of Dr. Berwick’s powerful messages, and felt it was important to share it with the health science students, resident physicians and medical educators following our ETY blog. For those of you that enjoy Paul Levy’s blog like I do, this past week we were treated to Peter Pronovost’s message to Parkland Hospital regarding the choice of their next CEO, in a post entitled, Pronovost advises all boards and CEOs. Having recently moved to the Baltimore/DC region in assuming my new role as Corporate Vice President for Quality and Safety at MedStar Health, I have had the great pleasure of spending some time with Peter (a fellow anesthesiologist), as both our integrated health systems make up a significant portion of patient care in the Mid-Atlantic region. His passion, commitment and accomplishments in the field of patient safety are unrivaled, as is clearly displayed in some of his comments I share below–truly Berwick-like and extremely powerful, inspiring words for all of us in healthcare:

Historian Rufus Fears [right] notes that great leaders — leaders who changed the world — have four attributes: a bedrock of values, a clear moral compass, a compelling vision and the ability to inspire others to make the vision happen. Parkland needs one of these great leaders.

The key values of the next CEO should be humility, courage and love — and these values must guide the leader’s behavior…The leader must be able to live with the paradox of being humble yet confident.

Yet perhaps the greatest value will be love. Avedis Donabedian, one of the fathers of quality improvement, was interviewed on his death-bed by a student. The student asked, “Now that you have been a patient and devoted your life to improving care, what is the secret of improving quality?” Donabedian told him, “The secret of quality is love. If you love your God, if you love yourself, if you love your patients, you can work backwards to change the system.”

The next CEO must recognize this and seek to understand rather than judge, to learn and improve rather than blame and shame.

Achieving A Flow State In Healthcare: Can We Do It?

Posted: November 14, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education | Tags: , , | Leave a comment

While attending grad school in Colorado, the locals were quick to indoctrinate me into the yearly ritual of welcoming ski and snowboarding season by attending the Denver release of Warren Miller’s annual epic ski/snowboard film. As an athlete, traveler, and former sport psychology student studying behavior change, including Mihaly Csikszentmihalyi’s concept of Flow, the images Miller captured were intoxicating–then and now. Today, Miller’s team continues to exceed expectations, each effort better than the previous year, as he finds athletes who push beyond the physical and mental limits of what skiers and snowboarders do with, on, and in, snow. The location scouts for his films are genius too, with remote and picturesque mountain peaks around the world serving as heliports for the athletes and production crew to begin their descent, capturing indigenous wildlife along the way while the overwhelming power of mountains, snow and sky inspires athletic improvisation by those on skis and boards. The music chosen to accompany the silence of fresh tracks down a pristine Asian mountainside, or rock through the festive streets of Park City, UT is something to look forward to as well (click here for soundtrack).

The concept of flow is defined by Csikszentmihalyi as achieving a state of mind, or being, where time stands still and an individual is so in tune with the moment, and so engrossed in the activity that all awareness of self or self-consciousness is overtaken by the activity at hand, and a feeling of well-being is experienced. Warren Miller’s movies have always been visual examples of flow to me–the athletes themselves, able to transcend what appears to be average human physical limits with pure joy and love for what they are doing. This year’s film is appropriately titled, “Flow State”, and the trailer follows–please comment, or better yet, try to see the film still playing out west:

In his writing, Csikszentmihalyi speaks of flow experienced by athletes, surgeons, chess players, talented teens and more. When Dr. Lucian Leape speaks of finding joy and meaning in work within healthcare, I immediately translate that to finding flow within the delivery of healthcare. If everyone in healthcare experienced flow, or joy and meaning in their work, would we be talking about having to lay the ground work for a just culture? Wouldn’t that already exist? The good news is that flow states can intentionally be achieved with practice. More information on how that is accomplished will be shared here on ETY in the days to follow. For now, as good luck will have it, I will be in Denver on Saturday night at the same time the Warren Miller Entertainment crew makes a stop at the Paramount Theater. I promise to give a full review on the film next week, as we continue a series on Flow in Healthcare in the days ahead.

Telluride Patient Safety Roundtable 2012 – Resident Updates

Posted: November 12, 2012 | Author: | Filed under: Just Culture, Leadership, Medical Education, Patient Safety, Transparency | Tags: , | 2 Comments

By Michael Kantrowitz

Dr. Michael Kantrowitz is Chief Resident, Internal Medicine at Maimonides Medical Center, and member of the first class of Resident Scholars at the Telluride Patient Safety Educational Roundtable — Summer, 2012.

A few weeks ago, a small group of the New York contingent that attended the 2012 Telluride Patient Safety Roundtable met over Chinese food in Manhattan to update one another on our progress since June. Hilary Kunizaki and Justin Wood, who are roundtable alums, organized the meet up. They are staff members at the Committee of Interns and Residents dedicated to supporting resident’s work in patient safety and quality. It is clear that our week in Telluride transformed our thinking about quality patient safety.

  • Dr. Frances Briones, Chief Resident in Internal Medicine (2011-2012) and current Gastroenterology fellow at Harlem Hospital has been hard at work implementing a system for identifying medication ordering errors. In collaboration with the pharmacy department at Harlem Hospital, she was able to determine medication errors that were caused by house staff orders. Dr. Briones began offering monthly one-on-one feedback to residents in the Department of Medicine to educate them about causes of errors or apparent errors (such as delays in deliveries of non-formulary medications.) Since her educational intervention, monthly data has shown that the numbers of errors associated with house staff orders have been significantly reduced. Dr. Briones and CIR are planning to continue the work with the current leaders of the hospital’s house staff patient safety council.
  • Dr. Nate Margolis is a chief resident in radiology at NYU and Bellevue hospitals. He has been exploring the reasons why house staff report very few errors and “near miss” events in the NYU-Bellevue system. One of the major contributors to the problem is simply a lack of awareness of the hospital’s reporting system. Dr. Margolis set out to educate his colleagues about the reporting system. He is working with chief residents and members of the NYU and Bellevue house staff patient safety council to give presentations in each department. He plans to study the effectiveness of this educational intervention by measuring the number of house staff-reported events and near misses logged in the system.
  • My project has involved improving the quality of resident progress notes and development of care plans. As a chief resident in internal medicine at Maimonides Medical Center, I have been working with several faculty members in my program. We observed that patient progress notes written by residents using an electronic tool sometimes results in copying previous notes and failure to fully capture changes in patients’ condition or prognosis during a hospitalization. In the digital age, it is important that residents are trained in proper use of electronic resources. We will be using a 9-point evaluation tool developed at Columbia University Medical Center (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347480/). A team of faculty, chief residents, and peer residents will perform evaluation of notes. Improvement will be measured by scoring a random sample of notes on each monthly rotation through the hospital’s inpatient floors.

Unfortunately the busy lives of resident physicians made it hard for the all of the Telluride alums from New York to attend but we’ve been able to keep in touch and have heard about some of the exciting quality improvement project they have started in their hospitals. We plan to organize additional events that will continue to build on the work we started in Colorado. We hope to have some more updates soon!

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