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I-PASS Mentored Implementation Handoff Curriculum: Frontline Provider Training Materials

O'Toole, Jennifer K; Hepps, Jennifer; Starmer, Amy J; Patel, Shilpa J; Rosenbluth, Glenn; Calaman, Sharon; Campos, Maria-Lucia; Lopreiato, Joseph O; Schnipper, Jeffrey L; Sectish, Theodore C; Srivastava, Rajendu; West, Daniel C; Landrigan, Christopher P; Spector, Nancy D; Yu, Clifton E
Introduction/UNASSIGNED:The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. Frontline providers are the key individuals participating in handoffs of patient care. It is important they receive robust handoff training. Methods/UNASSIGNED:The I-PASS Mentored Implementation Handoff Curriculum frontline provider training materials were created as part of the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach with an emphasis on adult learning theory principles. The training includes an overview of I-PASS handoff techniques, TeamSTEPPS team communication strategies, verbal handoff simulation scenarios, and a printed handoff document exercise. Results/UNASSIGNED:As part of the SHM I-PASS Mentored Implementation Program, 2,735 frontline providers were trained at 32 study sites (16 adult and 16 pediatric) across North America. At the end of their training, 1,762 frontline providers completed the workshop evaluation form (64% response rate). After receiving the training, over 90% agreed/strongly agreed that they were able to distinguish a good- from a poor-quality handoff, articulate the elements of the I-PASS mnemonic, construct a high-quality patient summary, advocate for an appropriate environment for handoffs, and participate in handoff simulations. Universally, the training provided them with knowledge and skills relevant to their patient care activities. Discussion/UNASSIGNED:The I-PASS frontline training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.
PMCID:7375701
PMID: 32715086
ISSN: 2374-8265
CID: 4540072

In Reply to Lawson

Calaman, Sharon; Brunsberg, Katherine A; Landrigan, Christopher P
PMID: 31860623
ISSN: 1938-808x
CID: 4243192

Simulation in Medical Education for the Hospitalist: Moving Beyond the Mock Code

Hepps, Jennifer H; Yu, Clifton E; Calaman, Sharon
Simulation in medical education has grown due to an evolution in health care. It uses 4 main modalities to re-create a situation from the clinical environment to allow experiential learning and improve patient care. Simulation must be considered as an educational strategy within a larger curriculum. Building an exercise requires first developing goals and objectives and then designing the scenario. There are 4 phases of implementation, wherein the final debrief phase is critical for learning. Educators have used simulation for multiple curricular needs: communication skills, interprofessional education, clinical reasoning, procedural training, and patient safety, which apply to the inpatient setting.
PMID: 31230627
ISSN: 1557-8240
CID: 4233782

Association of Pediatric Resident Physician Depression and Burnout With Harmful Medical Errors on Inpatient Services

Brunsberg, Katherine A; Landrigan, Christopher P; Garcia, Briana M; Petty, Carter R; Sectish, Theodore C; Simpkin, Arabella L; Spector, Nancy D; Starmer, Amy J; West, Daniel C; Calaman, Sharon
PURPOSE/OBJECTIVE:To determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. METHOD/METHODS:The authors conducted a prospective cohort study from 2011 to 2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burnout and depression using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). A two-step surveillance methodology, involving a research nurse and two physician reviewers, was used to measure and categorize errors. Bivariate and mixed-effects regression models were used to evaluate the relationship between burnout, depression, and rates of harmful, nonharmful, and total errors. RESULTS:A total of 388/537 (72%) resident physicians completed the MBI-HSS and HANDS surveys. Seventy-six (20%) and 178 (46%) resident physicians screened positive for depression and burnout, respectively. Screening positive for depression was associated with a 3.0-fold higher rate of harmful errors (incidence rate ratio = 2.99 [95% CI 1.40-6.36], P = .005). However, there was no statistically significant association between depression and total or nonharmful errors or between burnout and harmful, nonharmful, or total errors. CONCLUSIONS:Resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors. This association suggests resident physician mental health could be an important component of patient safety. If further research confirms resident physician depression increases the risk of harmful errors, it will become imperative to determine what interventions might mitigate this risk.
PMCID:6667283
PMID: 31045601
ISSN: 1938-808x
CID: 4233772

Key Factors in Clinical Competency Committee Members' Decisions Regarding Residents' Readiness to Serve as Supervisors: A National Study

Schumacher, Daniel J; Martini, Abigail; Bartlett, Kathleen W; King, Beth; Calaman, Sharon; Garfunkel, Lynn C; Elliott, Sean P; Frohna, John G; Schwartz, Alan; Michelson, Catherine D
PURPOSE:Entrustment has become a popular assessment framework in recent years. Most research in this area has focused on how frontline assessors determine when a learner can be entrusted. However, less work has focused on how these entrustment decisions are made. The authors sought to understand the key factors that pediatric residency program clinical competency committee (CCC) members consider when recommending residents to a supervisory role. METHOD:CCC members at 14 pediatric residency programs recommended residents to one of five progressive supervisory roles (from not serving as a supervisory resident to serving as a supervisory resident in all settings). They then responded to a free-text prompt, describing the key factors that led them to that decision. The authors analyzed these responses, by role recommendation, using a thematic analysis. RESULTS:Of the 155 CCC members at the participating programs, 84 completed 769 supervisory role recommendations during the 2015-2016 academic year. Four themes emerged from the thematic analysis: (1) Determining supervisory ability follows from demonstrated trustworthiness; (2) demonstrated performance matters, but so does experience; (3) ability to lead a team is considered; and (4) contextual considerations external to the resident are at play. CONCLUSIONS:CCC members considered resident and environmental factors in their summative entrustment decision making. The interplay between these factors should be considered as CCC processes are optimized and studied further.
PMID: 30256253
ISSN: 1938-808x
CID: 4233742

I-PASS Mentored Implementation Handoff Curriculum: Champion Training Materials

O'Toole, Jennifer K; Starmer, Amy J; Calaman, Sharon; Campos, Maria-Lucia; Hepps, Jennifer; Lopreiato, Joseph O; Patel, Shilpa J; Rosenbluth, Glenn; Schnipper, Jeffrey L; Sectish, Theodore C; Srivastava, Rajendu; West, Daniel C; Yu, Clifton E; Landrigan, Christopher P; Spector, Nancy D
Introduction:The I-PASS Handoff Program is a comprehensive handoff curriculum that has been shown to decrease rates of medical errors and adverse events during patient handoffs. I-PASS champions are a critical part of the implementation and sustainment of this curriculum, and therefore, a rigorous program to support their training is necessary. Methods:The I-PASS Handoff champion training materials were created for the original I-PASS Study and adapted for the Society of Hospital Medicine (SHM) I-PASS Mentored Implementation Program. The adapted materials embrace a flipped classroom approach and adult learning theory. The training includes an overview of I-PASS handoff techniques, an opportunity to practice evaluating handoffs with the I-PASS observation tools using a handoff video vignette, and other key implementation principles. Results:As part of the SHM I-PASS Mentored Implementation Program, 366 champions were trained at 32 sites across North America and participated in a total of 3,491 handoff observations. A total of 346 champions completed the I-PASS Champion Workshop evaluation form at the end of their training (response rate: 94.5%). After receiving the training, over 90% agreed/strongly agreed that it provided them with knowledge or skills critical to their patient care activities and that they were able to distinguish the difference between high- and poor-quality handoffs, competently use the I-PASS handoff assessment tools, and articulate the importance of handoff observations. Conclusion:The I-PASS champion training materials were rated highly by those trained and are an integral part of a successful I-PASS Handoff Program implementation.
PMCID:6354793
PMID: 30800994
ISSN: 2374-8265
CID: 4233762

READMISSION AND EMERGENCY DEPARTMENT VISIT RATES IN PEDIATRIC PATIENTS WITH NEW TRACHEOSTOMY [Meeting Abstract]

Eidman, Daniel; Turchi, Renee; Danielle, Casher; Calaman, Sharon
ISI:000498593400349
ISSN: 0090-3493
CID: 4953742

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Khan, Alisa; Spector, Nancy D; Baird, Jennifer D; Ashland, Michele; Starmer, Amy J; Rosenbluth, Glenn; Garcia, Briana M; Litterer, Katherine P; Rogers, Jayne E; Dalal, Anuj K; Lipsitz, Stuart; Yoon, Catherine S; Zigmont, Katherine R; Guiot, Amy; O'Toole, Jennifer K; Patel, Aarti; Bismilla, Zia; Coffey, Maitreya; Langrish, Kate; Blankenburg, Rebecca L; Destino, Lauren A; Everhart, Jennifer L; Good, Brian P; Kocolas, Irene; Srivastava, Rajendu; Calaman, Sharon; Cray, Sharon; Kuzma, Nicholas; Lewis, Kheyandra; Thompson, E Douglas; Hepps, Jennifer H; Lopreiato, Joseph O; Yu, Clifton E; Haskell, Helen; Kruvand, Elizabeth; Micalizzi, Dale A; Alvarado-Little, Wilma; Dreyer, Benard P; Yin, H Shonna; Subramony, Anupama; Patel, Shilpa J; Sectish, Theodore C; West, Daniel C; Landrigan, Christopher P
OBJECTIVE:To determine whether medical errors, family experience, and communication processes improved after implementation of an intervention to standardize the structure of healthcare provider-family communication on family centered rounds. DESIGN/METHODS:Prospective, multicenter before and after intervention study. SETTING/METHODS:Pediatric inpatient units in seven North American hospitals, 17 December 2014 to 3 January 2017. PARTICIPANTS/METHODS:All patients admitted to study units (3106 admissions, 13171 patient days); 2148 parents or caregivers, 435 nurses, 203 medical students, and 586 residents. INTERVENTION/METHODS:Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds ("family centered rounds"), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement. MAIN OUTCOME MEASURES/METHODS:Medical errors (primary outcome), including harmful errors (preventable adverse events) and non-harmful errors, modeled using Poisson regression and generalized estimating equations clustered by site; family experience; and communication processes (eg, family engagement on rounds). Errors were measured via an established systematic surveillance methodology including family safety reporting. RESULTS:26.5% (12.7% to 7.3%), P=0.02) increased. Trainee teaching and the duration of rounds did not change significantly. CONCLUSIONS:Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT02320175.
PMID: 30518517
ISSN: 1756-1833
CID: 3519912

I-PASS Mentored Implementation Handoff Curriculum: Implementation Guide and Resources

O'Toole, Jennifer K; Starmer, Amy J; Calaman, Sharon; Campos, Maria-Lucia; Goldstein, Jenna; Hepps, Jennifer; Maynard, Gregory A; Owolabi, Mobola; Patel, Shilpa J; Rosenbluth, Glenn; Schnipper, Jeffrey L; Sectish, Theodore C; Srivastava, Rajendu; West, Daniel C; Yu, Clifton E; Landrigan, Christopher P; Spector, Nancy D
Introduction:Communication failures during shift-to-shift handoffs of patient care have been identified as a leading cause of adverse events in health care institutions. The I-PASS Handoff Program is a comprehensive handoff program that has been shown to decrease rates of medical errors and adverse events. As part of the spread and adaptation of this program, a comprehensive implementation guide was created to assist individuals in the implementation process. Methods:The I-PASS Mentored Implementation Guide grew out of materials created for the original I-PASS Study, Society of Hospital Medicine (SHM) mentored implementation programs, and the experience of members of the I-PASS Study Group. The guide provides a comprehensive framework of all elements required to implement the large-scale I-PASS Handoff Program and contains detailed information on generating institutional support, training activities, a campaign, measuring impact, and sustaining the program. Results:= 34) of respondents felt the quality of the guide was very good/excellent. Site leads noted that they referenced the guide most often during the early part of the program and that they referenced the sections on the curriculum and handoff observations most often. Discussion:The I-PASS Mentored Implementation Guide is an essential resource for those looking to implement the large-scale I-PASS Handoff Program at their institution.
PMCID:6342372
PMID: 30800936
ISSN: 2374-8265
CID: 4233752

Thresholds and interpretations: How clinical competency committees identify pediatric residents with performance concerns

Schumacher, Daniel J; Michelson, Catherine; Poynter, Sue; Barnes, Michelle M; Li, Su-Ting T; Burman, Natalie; Sklansky, Daniel J; Thoreson, Lynn; Calaman, Sharon; King, Beth; Schwartz, Alan; Elliott, Sean; Sharma, Tanvi; Gonzalez Del Rey, Javier; Bartlett, Kathleen; Scott-Vernaglia, Shannon E; Gibbs, Kathleen; McGreevy, Jon F; Garfunkel, Lynn C; Gellin, Caren; Frohna, John G
BACKGROUND:Clinical competency committee (CCC) identification of residents with performance concerns is critical for early intervention. METHODS:Program directors and 94 CCC members at 14 pediatric residency programs responded to a written survey prompt asking them to describe how they identify residents with performance concerns. Data was analyzed using thematic analysis. RESULTS:Six themes emerged from analysis and were grouped into two domains. The first domain included four themes, each describing a path through which residents could meet or exceed a concern threshold:1) written comments from rotation assessments are foundational in identifying residents with performance concerns, 2) concerning performance extremes stand out, 3) isolated data points may accumulate to raise concern, and 4) developmental trajectory matters. The second domain focused on how CCC members and program directors interpret data to make decisions about residents with concerns and contained 2 themes: 1) using norm- and/or criterion-referenced interpretation, and 2) assessing the quality of the data that is reviewed. CONCLUSIONS:Identifying residents with performance concerns is important for their education and the care they provide. This study delineates strategies used by CCC members across several programs for identifying these residents, which may be helpful for other CCCs to consider in their efforts.
PMID: 29345207
ISSN: 1466-187x
CID: 4233732