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Large-scale implementation of the I-PASS handover system at an academic medical centre

Quality and Safety in Health Care Journal -

Background

Healthcare has become increasingly complex and care delivery models have changed dramatically (eg, team-based care, duty-hour restrictions). However, approaches to critical communications among providers have not evolved to meet these new challenges. Evidence from safety culture surveys, academic studies and malpractice claims suggests that healthcare handover quality is problematic, leading to preventable errors and adverse outcomes. To address this concern, from 2013 to 2016 Massachusetts General Hospital completed phase I of a multifaceted programme to implement standardised, structured handovers across all departments, units and direct care providers.

Methods

A multidisciplinary Handovers Committee selected the I-PASS handover system. Phase I implementation focused on large-scale training and shift-to-shift handovers. Important features included administrative and clinical leadership support; EHR templates for I-PASS; hospital handover policy revision; varied educational modalities, venues and durations; concomitant TeamSTEPPS training; unit-level I-PASS champions; handover observations; and solicitation of caregiver feedback and suggestions.

Results

More than 6000 doctors, nurses and therapists have been trained. Trended observation scores demonstrate progressive but non-uniform adoption of I-PASS, with significant improvements in the correct sequencing and percentage of I-PASS elements included in handovers. Adoption of Synthesis (readback) has been challenging, with lower scores.

Conclusions

Comprehensive I-PASS implementation in a large academic medical centre necessitated major cultural change. I-PASS education is straightforward, whereas assuring consistent and sustained adoption across all services is more challenging, requiring adaptation of the basic I-PASS structure to local needs and workflows. EHR I-PASS templates facilitated caregiver acceptance. Initial phase I results are encouraging and the lessons learned should be helpful to other programmes planning handover initiatives. Phase II is ongoing, focusing on more uniform and consistent adoption, spread and sustainability.

A growth mindset approach to preparing trainees for medical error

Quality and Safety in Health Care Journal -

Introduction

As medical students transition to become trainee doctors, they must confront the potential for making medical errors. In the high stakes environment of medicine, errors can be catastrophic for the patients and for doctors themselves. Doctors have been found to experience guilt, shame, fear, humiliation, loss of confidence, deep concerns about their professional skills and social isolation, effectively becoming the second victim of an error.1 2

A number of programmes and practices have been suggested to provide psychological first aid to second victims after an error has occurred.3 Little attention, however, has focused on how medical training can prepare doctors for the inevitability of error, and thus help protect them from potentially severe emotional consequences in the future. The WHO has developed the Patient Safety Curriculum Guide for Medical Schools, which includes training on understanding and learning from mistakes.4...

Choosing Wisely should bring the cost of unnecessary care back into the discussion

Quality and Safety in Health Care Journal -

Choosing Wisely (CW) identifies low-value, wasteful medical interventions whose elimination increases the quality of care and likely reduces its costs.1 Since its launch in 2012, this grassroot campaign has galvanised many in the medical world. Physicians acknowledge their collective responsibility in reducing overuse, and patient engagement in the campaign suggests times are changing in the medical office.

CW was set up in response to the publication of a charter coauthored by the American Board of Internal Medicine, ‘Medical Professionalism in the New Millennium’ (2002).2 This physician charter mentioned the principle of ‘primacy of patient welfare’ along with the commitment to ‘a just distribution of finite resources’. Thus, CW would kill two birds with one stone: reduce waste and receive quality and financial sustainability in exchange. However, the CW campaign quickly reached consensus on dropping the cost objective and focusing instead on ‘quality and no-harm’. CW...

Response to 'Choosing Wisely should bring the cost of unnecessary care back into the discussion; Choosing Wisely: a growing international campaign

Quality and Safety in Health Care Journal -

There are now approximately 20 countries worldwide that have launched or are in the process of launching Choosing Wisely campaigns.

As Haverkamp and colleagues have identified,1 Choosing Wisely campaigns have galvanised physicians worldwide to acknowledge their collective responsibility in reducing overuse and reducing harm associated with unnecessary care. And yes, cost is a tension in the campaign, and it would be naïve to say it is not a consideration. However, we maintain that in order to engage physicians in reducing unnecessary care, the focus cannot be on costs, but rather on reducing unnecessary care at each clinical encounter to improve quality and avoid harm.

Physicians' clinical decisions are largely responsible for unsustainable healthcare spending and the great deal of waste we see in healthcare systems worldwide. However, research highlights that physicians struggle with the acceptability of efforts to curb healthcare costs by influencing how they deliver direct...

IHI Partners with South Africa National Department of Health on Initiative to Improve Tuberculosis Care and Outcomes

Institute for Healthcare Improvement -

The Institute for Healthcare Improvement (IHI) has been awarded a $3 million grant from the Bill & Melinda Gates Foundation to support a four-year quality improvement (QI) initiative to reduce deaths from tuberculosis (TB) in South Africa. The initiative has been co-designed with the South Africa National Department of Health (NDoH) and other partners, and will be the first country-wide TB effort of its kind to utilize QI methodologies at both local and national levels.

Patient Safety in the Home: Assessment of Issues, Challenges, and Opportunities

Institute for Healthcare Improvement -

Based on a scan of peer-reviewed and grey literature and subject matter expert interviews, this report examines challenges related to patient safety in the home, including fragmentation of care; household hazards; ill-prepared family caregivers; limited training and regulation of home care workers; inadequate communication among patients, caregivers, and providers; and misaligned payment incentives.

SIDM and IHI Issue RFP for Interventions to Improve Diagnostic Accuracy

Institute for Healthcare Improvement -

​The Society to Improve Diagnosis in Medicine (SIDM) and the Institute for Healthcare Improvement (IHI), which recently merged with the National Patient Safety Foundation, have received a $725,100 grant from the Gordon and Betty Moore Foundation to better understand how delayed or wrong diagnoses happen and to test strategies to reduce them.

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