Telluride “Old West” Ski Town Embraces Patient Safety in Our Tenth Year Anniversary Celebration

TPSSC_Logo_v3June has always been a very exciting month for me. For the last nine years, I and many others have journeyed west to Telluride, CO, a beautiful mountain town known by many for its skiing as opposed to summer activities. For those outside CO, Telluride may be one of the best kept secrets in the United States. Many of us often choose to take the scenic six-hour journey from the Denver airport to Telluride each year, making our way up the mountain to run our annual Telluride Patient Safety Roundtable and Summer Camps. The trip provides an up close view and reminder of the silent power held within the peaceful surroundings in which we will be teaching for the next two weeks. Over the years, people have asked me “Why Telluride?” My response has always been the same – “Why not?”  Be it the “old west feel” of the town, or the “hypoxic” magic that happens at an elevation of 9,600 feet, Telluride has always been a learning mecca for everyone that joins us during these memorable weeks of high altitude education.

TSRC hosts about 30 scientific programs each summer. We have been fortunate to be one of those chosen each of the last ten years. In fact, out Patient Safety Roundtable and Summer Camps has now become the longest consecutive running meeting that TSRC has agreed to host. The smaller, roundtable format using small group breakouts and learner-centered activities is designed to foster creative thought and consensus building through lively conversation in a relaxed and informal setting. We purposely limit the use of power-point slides to ten each day so learners are fully engaged in the work but not spoon fed the information by people who like to lecture. The students and residents especially love this interactive format. This non-traditional learning environment also attracts patient safety leaders from around the world to Telluride each summer, to “break bread” and share ideas on current issues and challenges. Because of this unique venue and format, a lot of our discovery, sharing of ideas and learning happens on the walking paths, hiking on the mountain trails, in a coffee shop, or over a glass of wine.

Screen Shot 2013-06-02 at 10.46.03 PMThrough the generous support of The Doctors Company Foundation (TDCF), COPIC, Committee of Interns and Residents (CIR) and MedStar Health, about 130 health science students and resident physician leaders will be attending one of four, week-long Telluride Patient Safety Summer Camps this summer. The first two weeks will be held in Telluride and the final two weeks will be held in the Washington DC/Baltimore MD region (“Telluride East”) later this summer. In the summer of 2015, thanks to the continued support of The Doctors Company Foundation, an additional Patient Safety Summer Camp will be held in CA – our new home for “Telluride West”.

Our objectives for the Telluride Patient Safety Summer Camps are the same each year:

  1. To identify and help develop future healthcare leaders and champions in patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  2. To develop a growing number of Patient Safety Summer Camp alumni that serve as role models and mentors to (a) health science students and resident physicians at their respective medical centers and health systems, and (b) health science students and resident physicians enrolled in future Patient Safety Summer Camps.
  3. To create a social networking community where Patient Safety Summer Camp health science students, resident physicians and past alumni can interact with international leaders in patient safety, education and patient advocacy on issues pertaining to patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  4. To help create risk reduction and quality improvement collaborative projects between Patient Safety Summer Camp alumni, faculty and patient advocates that are implemented within the Patient Safety Summer Camp alum’s institution and beyond.

DSC_0684This coming weekend, many wonderful and highly committed patient safety advocates and safety leaders will once again convene in Telluride, CO to continue our mission of “Educating the Young”. Over the past 10 years, we now will have had over 400 Telluride student and resident alumni scholars attend one of our Patient Safety Summer Camps. As you have read on our ETY blog, many have done amazing work in leading change that is helping make care safer and more transparent.

Next week, we will kick off this year’s Patient Safety Summer Camps by welcoming thirty resident physicians into our Telluride Scholars club. They are future physician leaders from all across the country who will be immersed in learning about transparency, patient safety, and patient partnership. It truly is an amazing experience that always leaves me and many others energized for months to follow.

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New Website for Resident Physician Education @CIRSEIU

Dr. David Leach, the former CEO of the Accreditation Council for Graduate Medical Education (ACGME), once wrote that the most important role a Resident Physician has is that of being the “moral agent” for their patients. They have the responsibility of speaking up when harm is near. I love this “moral agent” concept…it is so simple, yet so critically important in the quest for safer, higher quality, patient care. (See ETY, Canary in a Coalmine).

CIRSEIU_Residents_TrainingIn academic medical centers, Resident Physicians spend more time in our hospitals, have more direct contact with our patients, and see many more unsafe conditions and near misses than most caregivers. I hope all residents will be that moral agent – the “sentinel on watch” – for your patients. Report all near misses and unsafe conditions you experience to those in charge. Then help make a difference by working with your leadership to find solutions to those problems.

Today, the Committee of Interns and Residents (CIR, @CIRSEIU) will launch a new educational website for resident physicians (www.QIGateway.org) focused on quality and safety. The QIGateway portal is the first platform of its kind that is focused on patient safety and quality improvement by, and for, medical residents.

I encourage all resident physicians to visit this site, appreciate the growing body of quality and safety work being done by resident physicians across the country, and share your own quality and safety projects with others so that together we can continue to reduce risk and make care safer for all our patients

Through this exciting new educational website, the premise “Educate the Young” now aligns with “Inspire the Young”.  More and more resident physicians are becoming leaders and change agents in quality and safety – being the patient’s “moral agent” that Dr. Leach called for while helping make a difference at their home institutions. It is a brighter day for safe, high quality care at our academic medical centers thanks to the new QIGateway portal.


Telluride Alumnus Shares QI Project Inspired by Conversations at Resident Summer Camp 2012

On the closely approaching eve of the 2013 Telluride Patient Safety Educational Roundtable & Student/Resident Summer Camps (#TPSER9), Nate DeFelice MD, a 2012 alumnus, sent us the following report of a project that was inspired by his time at the Resident Summer Camp last year. Stay tuned for more great stories and learning from this year’s Summer Camps kicking off Sunday night, June 9th.

By Nate DeFelice, MD, Department of Internal Medicine, University of New Mexico Hospital

UNM_Journal_Cover2At the University of New Mexico Hospital, a group of residents across departments created and published a journal featuring resident-led QI projects called, University of New Mexico Journal of Quality Improvement in Healthcare (check it out!). As far as we know, it is the first of its kind in the country, and the 2nd edition was released at the beginning of the month with great excitement.

The journal includes resident-initiated projects, both completed and in-progress, covering a range of topics from readmissions to handovers to medication safety. It is an impressive showcase of the many ways residents have used their energy and time to make the UNMH healthcare system more patient-centered, efficient and safe. This journal has not only increased the level of excitement around QI projects for residents, but we are hopeful that the sharing of ideas will springboard even more innovative work in our departments. The support and commitment to this journal has been inspiring to watch — it’s hard to believe this is only its second year.

On a personal note, this editions includes a project by myself and another internal medicine colleague, first conceived during my time at the Telluride Patient Safety conference last year. During this conference, several residents from other programs across the country, along with director David Mayer MD, discussed the great work they were doing on increasing resident reporting of adverse events and near misses. We decided to give it a try at UNMH, and began an internal medicine resident near miss/adverse event reporting system. The data is still rolling in, but we are hopeful that reporting of near misses has increased, and our patients are safer as a result of our efforts.

The journal was made possible because of a strong collaboration between our resident union, CIR; GME; and UNM Health Sciences Center. Funding for the journal was made possible through funds we negotiated in our last contract that are set aside to assist residents in carrying out QI projects. We imagine after such a strong showing of support it will continue to grow stronger, and the journal will continue to improve while at the same time, making our hospital safer.

For more information on the Telluride Patient Safety Educational Roundtable and Student/Resident Summer Camps, see the following video!


Telluride – “Old West” Ski Town Embraces Patient Safety

Screen Shot 2013-06-02 at 10.45.44 PMJune has always been a very exciting month for me. For the last eight years, Tim McDonald and I have journeyed west to Telluride, CO, a beautiful mountain town known by many for its skiing than summer activities. For those outside CO, Telluride may be one of the best kept secrets around. We often choose to take the scenic six hour journey from the Denver airport to Telluride each June, making our way up the mountain to run our annual Telluride Patient Safety Roundtable and Summer Camps, and to be reminded of the power of the peaceful surroundings we will be teaching in for the next 2-3 weeks. Over the years, people have asked me “Why Telluride?” My response has always been the same – “Why not?”  Be it the “old west feel” of the town, or the magic that happens at an elevation of 9,600 feet, Telluride has always been a learning mecca for us.

Nana Naisbitt, Executive Director of Telluride Scientific Research Center (TSRC) and her son Rory, have been wonderful to work with through the years. TSRC hosts about 24 scientific programs each summer. The smaller, roundtable format we use is designed to foster creative thought and consensus building through lively conversation in a relaxed and informal setting. This format attracts patient safety leaders from around the world to Telluride each summer to “break bread” and share ideas on current issues and challenges. Because of this unique venue, a lot of discovery and sharing of ideas happen on the walking paths, hiking on the mountain trails, in a coffee shop, or over a glass of wine.

Screen Shot 2013-06-02 at 10.46.03 PMThrough the generous support of The Doctors Company Foundation (TDCF), COPIC, Committee of Interns and Residents (CIR), Mag Mutual and MedStar Health, over 100 health science students and resident physician leaders will be attending one of three, week-long Telluride Patient Safety Summer Camps this summer. The first two weeks will be in Telluride and a third week in Washington DC later this summer. Numerous health science students and resident physician leaders from across the country applied for one of the summer camp opportunities.

Our objectives for the Patient Safety Summer Camps are the same each year:

  1. To identify and help develop future healthcare leaders and champions in patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  2. To develop a growing number of Patient Safety Summer Camp alumni that serve as role models and mentors to (a) health science students and resident physicians at their respective medical centers and health systems, and (b) health science students and resident physicians enrolled in future Patient Safety Summer Camps.
  3. To create a social networking community where Patient Safety Summer Camp health science students, resident physicians and past alumni can interact with international leaders in patient safety, education and patient advocacy on issues pertaining to patient safety, transparency and open, honest and professional communication between patients, families and caregivers.
  4. To help create risk reduction and quality improvement collaborative projects between Patient Safety Summer Camp alumni, faculty and patient advocates that are implemented within the Patient Safety Summer Camp alum’s institution and beyond.

Screen Shot 2013-06-02 at 10.46.14 PMNext Monday, many wonderful and highly committed patient safety advocates and leaders will once again convene in Telluride to continue our mission of “Educating the Young”. The first week, we will have twenty-nine resident physicians, future physician leaders from across the country, immersed in learning about transparency, patient safety, and patient partnership. It truly is an amazing experience that always leaves me energized for months to follow.


Are You QI Cool?

By Michael Kantrowitz, DO (Guest Author and Chief Resident, Maimonides Medical Center)

It seems that there is a growing number of residents out there who are.

This past weekend, the Committee of Interns and Residents (CIR) hosted an event called “What’s Your QI IQ? Resident Physicians as Quality Improvement Leaders” in New York City. The program was developed as a partnership between the CIR Policy and Education Initiative and the Healthcare Transformation Project of Cornell University.

The day kicked off with introductions by Dr. Svjetlana Lozo, an ob/gyn resident from Maimonides Medical Center in Brooklyn and Dr. Rick Gustave, an emergency medicine resident at Lincoln Hospital in the Bronx. They described the push towards improved quality, safety, and transparency in medical practice and the central role that residents are beginning to play in leading that charge. Next up was Dr. James Pelegano who is an assistant professor and director of the master’s program in healthcare quality and safety at the Jefferson School of Population Health. Dr. Pelegano discussed his own experience in quality improvement in practice as a neonatologist. He then led us in a root cause analysis exercise using the recent death of Rory Staunton, a pediatric patient who succumbed to sepsis as case example.

Breaking into small groups, we were asked to take on various roles of the multidisciplinary team members who were involved to try to identify the contributing factors that led to the delayed recognition of Rory’s ultimately fatal illness. Many residents had never participated in a root cause analysis before, which sparked much discussion over the clinical and communication issues that could be improved. Dr. Pelegano challenged us to think like a hospital’s administration and find a process improvement that could be implemented within two days. He also discussed tools such as flow charts, Ishikawa diagrams, and PDSA cycles which we could add to our arsenal.

We then heard from three residents at CIR represented hospitals who discussed projects they have worked on at their institutions.

  • Dr. Constance Liu, an ob/gyn resident at Boston Medical Center, discussed efforts to improve resident education and adverse event reporting. Residents at her hospital have received a grant for this work.
  • Dr. Sepideh Sedgh, a pulmonary/critical care fellow, described the work that residents at Maimonides Medical Center have done as part of a joint quality partnership between CIR and the administration. Residents, including myself, took on the task of significantly improving the medication reconciliation process to make patient discharges safer
  • Finally Dr. Say Salomon an internal medicine resident from Woodhull Medical Center explained how their House Staff Safety Council has been enhancing patient care. One project he talked about was a resident-led program to reduce heart failure readmissions through better patient education.

The day ended with an interactive discussion run by Jennifer Weiss, a public health consultant with SAE & Associates. She led a workshop on developing and writing quality improvement and patient safety grant proposals using our own ideas for projects. I plan on using these skills as I look to find funding for future projects of my own.

It’s safe to say that we all left with a boost to our QI IQ and I’m looking forward to more events like this, which will train and challenge our generation of physicians to improve quality and safety.


Upcoming Quality & Safety Educational Opportunities

Following are two exciting, upcoming educational opportunities focused on quality and safety that we would like to share with our ETY readers. Please feel free to share the information with colleagues!

This year, the Committee of Interns and Residents has partnered with the Healthcare Transformation Project of Cornell University to present a series of conferences in the New York metropolitan area providing education around physician leadership in quality improvement and patient safety. The first conference, entitled What is your QI IQ? Resident Physicians as Quality Improvement Leaders, will be held on April 13 in Manhattan. The one day leadership conference focused on residents and medical students has been organized and led by residents, including many from last year’s Telluride Patient Safety Summer Camp.

The conference will feature:

  • Interactive didactic sessions led by Dr. James Pelegano, Program Director for the Jefferson School’s Master’s Program for Healthcare Quality and Safety, and an innovator in the field of Patient Safety and Quality.
  • Small-group breakout sessions that will allow participants to practice and refine the methods they have learned.
  • A panel discussion with resident physicians who are currently leading QI projects in their hospitals.
  • A hands-on workshop on the formulation and writing of QI/Patient Safety project proposals.
  • Where: Executive Conference Centers 1601 Broadway, New York, NY
  • When: Saturday, April 13, 2013, 9:45 am – 4:00 pm (breakfast at 9AM, lunch provided)

The second exciting educational event coming up in June is the fifth annual AAMC Integrating Quality Meeting once again held in Chicago. This year’s meeting, Improving Value and Educating for Quality, is a highly interactive, interprofessional program that brings together healthcare leaders, faculty, educators, trainees and students from teaching hospitals, medical schools, health professions schools, and other healthcare organizations to share strategies for enhancing the culture of quality in clinical care and health professions education.

The program will feature:

  • A number of plenary sessions, interactive workshops, and posters on topics related to aligning organizational goals and strategies around quality and value
  • QI and patient safety education across the continuum
  • Team-based and interprofessional approaches to quality improvement
  • A plenary session by Peter Pronovost, M.D., Ph.D., FCCM, senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine
  • A plenary session by Gary Kaplan, MD, Chairman and CEO of the Virginia Mason Health System
  • Where: Intercontinental Chicago O’Hare Hotel Rosemont, IL
  • When: June 6-7, 2013

The Real Movie Stars of Patient Safety

By Michael Kantrowitz DO (Guest Author, and Chief Resident at Maimonides Medical Center)

It was exciting to be part of the filming of “Breaking the Wall of Silence” a few weeks ago as the filmmakers followed Dave Mayer up to New York where he met with leadership from the Committee of Interns and Residents (CIR).  The next day they came to Brooklyn and followed me around the hospital where I work, Maimonides Medical Center.  In a paradoxical way it was fun (albeit a little nerve-wracking) to be involved in the filming.  The documentary is casting light on some very serious issues regarding transparency and safety in healthcare and it was a privilege to be able to discuss some of the hurdles residents face in being part of the next generation of physicians who will need to address these issues.  There were a few residents who had “cameos” in the filming, who I also wanted to recognize: Drs. Steven Shamah, Nidhi Shah, and Prasun Shah.  They are three of the incredible residents I get to work with everyday, and are proof that there is a changing cultural tide in our cohort of physicians.  As we were filmed on rounds, we discussed safety issues such as the importance of accurate medication reconciliation and fall prevention.

After participating in the Telluride Patient Safety Roundtable last summer, I have tried to integrate what I learned into my role as chief resident.  As a result, I changed much of how I approach patient safety and care quality concerns involving residents from looking to find individual fault to identifying system failures.  That hasn’t happened overnight and I certainly have not perfected this approach, but not surprisingly I’ve found that it more effectively engages residents in the process, as opposed to putting them on the defensive.  In academic medical centers, residents are the front line physician staff.  They typically evaluate patients before the attending physician, and are often the first to respond to acute changes in a patient’s status.  I’ve always enjoyed the opportunity to beat the attending to the diagnosis or stabilize a patient before they arrive because I think it has led to my own growth and independence as a physician.  With such high stakes, however, it is really important to have a clinical environment in which to identify and learn from errors without fear of reprimand or ridicule.  I’ve been fortunate to train in such an environment alongside colleagues like Steven, Nidhi, and Prasun.