Study Shows Peer Interventions Help Behavior of High-Risk Physicians
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(Oak Brook, Ill.) Today Joint Commission Resources announced the release of the October 2013 issue of the “The Joint Commission Journal on Quality and Patient Safety,” featuring an article on the success of a peer messenger program to provide feedback to physicians who engage in behaviors and performance that undermine a culture of safety. In “An Intervention Model That Promotes Accountability: Peer Messengers and Patient/Family Complaints,” James W. Pichert, Ph.D., and his co-authors detail how physicians at medical centers across the United States agreed to be trained as messengers to share information with fellow physicians who have been the subject of multiple patient/family complaints.
Using the process designed by Vanderbilt University Medical Center’s Center for Professional and Patient Advocacy (CPPA), a total of 178 physician “peer messengers” conducted interventions from 2005 through 2009 on 373 physicians identified as “high risk” on the basis of patient complaints. The eight-step Awareness intervention, described in detail in the article, relied on a review of data related to patient/family dissatisfaction with the high-risk physician and the peer messenger’s encouragement for the physician to reflect on the causes of the complaints. The study shows that 97 percent of the high-risk physicians received the feedback professionally and that 64 percent were categorized as “Responders” in that risk scores subsequently improved at least 15 percent. Responders were more often physicians practicing in medicine and surgery than emergency medicine physicians, had longer organizational tenures, and engaged in lengthier first-time intervention meetings with peer messengers.
The authors suggest that the study shows that peer messengers, who are recognized by leaders and appropriately supported with ongoing training, high-quality data, and evidence of positive outcomes, are willing to intervene with colleagues over an extended period of time. Pichert and colleagues also conclude that the physician peer messenger process reduces patient complaints and is adaptable to addressing unnecessary variation in other quality/safety metrics.
“The Joint Commission Journal on Quality and Patient Safety,” published monthly by Joint Commission Resources, is a peer-reviewed journal, available by subscription, that serves as a forum for practical approaches to improving quality and safety in health care.
The Safe Patient Flow Initiative: A Collaborative Quality Improvement Journey at Yale-New Haven Hospital
Jillian Jweinat, M.S.; Peter Damore, BBA, BS; Victor Morris, M.D.; Richard D’Aquila, M.P.H.; Sandra Bacon, RN, M.S.N.; Thomas J. Balcezak, M.D., M.P.H.
At Yale-New Haven Hospital (YNHH), process changes were made in various departments: organizationwide method changes involved standardizing the discharge process, using status boards for visual control, and improving data entry. Between 2008 and 2011, YNHH experienced an 84% improvement in discharges by 11 a.m. The average length of stay decreased from 5.23 to 5.05 days, thereby accommodating an additional 45 inpatients on a daily basis, contributing to YNHH’s positive operating margin.
Teamwork and Communication
460 Using “Best-Fit” Interventions to Improve the Nursing Intershift Handoff Process at a Medical Center in Lebanon
Lina A. Younan, RN, M.S.N., D.N.P.; Maryann F. Fralic, Dr.PH., RN, FAAN
Labib Medical Center in Lebanon conducted a project to improve the quality of nursing intershift handoffs. “Best-fit” interventions addressed the identified barriers to effective intershift handoffs: absence of a standardized intershift communication tool, inadequate training of registered nurses on communication, and interruptions during shift reports. The mean number of omissions per handoff subsequently decreased from 4.96 to 2.29 (p = .000), as did the mean number of interruptions per intershift report (2.17 to 1.26; p = .008). Registered nurses’ knowledge of the criteria to be communicated suggested an improved appreciation of their own contribution to patient safety.
Methods, Tools, and Strategies
468 Miscount Incidents: A Novel Approach to Exploring Risk Factors for Unintentionally Retained Surgical Items
Timothy J. Judson, M.P.H.; Michael D. Howell, M.D., M.P.H.; Charlotte Guglielmi, M.A., B.S.N., RN, CNOR; Elena Canacari, RN, CNOR; Kenneth Sands, M.D., M.P.H.
A cohort study of all consecutive operative cases during a 12-month period was conducted at a large academic medical center to identify risk factors for surgical miscounts. Of 23,955 operations, 84 resulted in miscount incidents (0.35% [95% confidence interval: 0.28% to 0.43%]). Case duration and number of providers present were independently associated with a more than doubling of the odds of a miscount. The internally developed Incorrect Count Safety Checklist, as triggered by miscounts, can be used to determine whether a count completed at the procedure’s conclusion is consistent across disciplines.