Telluride Patient Safety Roundtable 2012 – Resident UpdatesPosted: November 12, 2012
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!