scholarly journals An environmental scan of quality improvement and patient safety activities in emergency medicine in Canada

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 535-541 ◽  
Author(s):  
Edmund S.H. Kwok ◽  
Jeffrey J. Perry ◽  
Shawn Mondoux ◽  
Lucas B. Chartier
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Department Chairs ◽  
National Level ◽  
Canadian Medical School ◽  
Environmental Scan ◽  
Funding Model ◽  
Administrative Personnel ◽  
Academic Scholarship

ABSTRACTObjectiveWe conducted an environmental scan of quality improvement and patient safety (QIPS) infrastructure and activities in academic emergency medicine (EM) programs and departments across Canada.MethodsWe developed 2 electronic surveys through expert panel consensus to assess important themes identified by the CAEP QIPS Committee. “Survey 1” was sent by email to all 17 Canadian medical school affiliated EM department Chairs and Academic Hospitals department Chiefs; “Survey 2” to 12 identified QIPS leads in these hospitals. This was followed by 2 monthly email reminders to participate in the survey.Results22/70 (31.4%) Department Chairs/Chiefs completed Survey 1. Most (81.8%) reported formal positions dedicated to QIPS activities within their groups, with a mixed funding model. Less than half of these positions have dedicated logistical support. 11/12 (91.7%) local QIPS leads completed Survey 2. Two-thirds (63.6%) reported explicit QIPS topics within residency curricula, but only 9.1% described QIPS training for staff physicians. Many described successful academic scholarship output, with the total number of peer-reviewed QIPS-related publications per centre ranging from 1–10 over the past 5 years. Few respondents reported access to academic supports: methodologists (27.3%), administrative personnel (27.3%), and statisticians (9.1%).ConclusionThis environmental scan provides a snapshot of QIPS activities in EM across academic centres in Canada. We found significant local educational and academic efforts, although there is a discrepancy between the level of formal support/infrastructure and such activities. There remains opportunity to further advance QIPS efforts on a national level, as well as advocating and supporting local QIPS activities.

scholarly journals P078: An environmental scan of quality improvement and patient safety activities in emergency medicine in Canada

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S91
Author(s):  
E. Kwok ◽  
J. Perry ◽  
S. Mondoux ◽  
L. Chartier
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Medical School ◽  
Department Chairs ◽  
National Level ◽  
Teaching Hospitals ◽  
Canadian Medical School ◽  
Environmental Scan ◽  
Funding Model ◽  
Academic Scholarship

Introduction: Quality improvement and patient safety (QIPS) activities in healthcare have become increasingly important, but it is unclear what the current national landscape is with regards to how individual EM departments are supporting QIPS activities and evaluating their success and sustainability. We sought to assess how Canadian medical school EM departments/divisions and major Canadian teaching hospitals approach QIPS programs and efforts, with regards to training, available infrastructure, education, scholarly activities, and perceived needs. Methods: We developed 2 electronic surveys through expert panel consensus to assess important themes identified by the CAEP QIPS Committee, including a)formal training/skill capacity; b)operational infrastructure; c)educational activities; d)academic and scholarship, and e)perceived gaps and needs. Surveys were pilot-tested and revised by authors. “Survey 1” (21 questions) was sent by email to all 17 Canadian medical school affiliated EM Department Chairs and Academic Hospitals Department Chiefs; “Survey 2” (33 questions) to 11 identified local QIPS leads in these hospitals. This was followed by 2 monthly email reminders to participate in the survey. We present descriptive statistics including proportions, means, medians and ranges where appropriate. Results: 22/70 (31.4%) Department Chairs/Chiefs completed Survey 1. Most (81.8%) reported formal positions dedicated to QIPS activities within their groups, with a mixed funding model. Less than half of these positions have dedicated logistical support. 11/12 (91.7%) local QIPS leads completed Survey 2. Two-thirds (63.6%) reported explicit QIPS topics within residency curricula, but only 9.1% described QIPS training for staff physicians. 45% of respondents described successful academic scholarship output, with the total number of peer-reviewed QIPS-related publications per center ranging from 1-10 over the past 5 years. A minority of participants reported access to academic supports: methodologists (27.3%), administrative personnel (27.3%), and statisticians (9.1%). Conclusion: This environmental scan provides a snapshot of QIPS activities in EM across academic centers in Canada. We found significant local educational and academic efforts, although there is a discrepancy between the level of formal support/infrastructure and such activities. There remains opportunity to further advance QIPS efforts on a national level, as well as advocating and supporting local QIPS activities.

scholarly journals LO093: A national needs assessment survey for the development of a quality improvement and patient safety curriculum for Canadian emergency medicine residents

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S62-S62 ◽  
Author(s):  
L.B. Chartier ◽  
S. Vaillancourt ◽  
M. McGowan ◽  
K. Dainty ◽  
A.H. Cheng
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Patient Safety ◽  
Quality Improvement ◽  
Needs Assessment ◽  
Residency Training ◽  
Royal College ◽  
Assessment Tool ◽  
Postgraduate Medical Education ◽  
Clinical Scenarios

Introduction: The Canadian Medical Education Directives for Specialists (CanMEDS) framework defines the competencies that postgraduate medical education programs must cover for resident physicians. The 2015 iteration of the CanMEDS framework emphasizes Quality Improvement and Patient Safety (QIPS), given their role in the provision of high value and cost-effective care. However, the opinion of Emergency Medicine (EM) program directors (PDs) regarding the need for QIPS curricula is unknown, as is the current level of knowledge of EM residents in QIPS principles. We therefore sought to determine the need for a QIPS curriculum for EM residents in a Canadian Royal College EM program. Methods: We developed a national multi-modal needs assessment. This included a survey of all Royal College EM residency PDs across Canada, as well as an evaluative assessment of baseline QIPS knowledge of 30 EM residents at the University of Toronto (UT). The resident evaluation was done using the validated Revised QI Knowledge Application Tool (QIKAT-R), which evaluates an individual’s ability to decipher a systematic quality problem from short clinical scenarios and to propose change initiatives for improvement. Results: Eight of the 13 (62%) PDs responded to the survey, unanimously agreeing that QIPS should be a formal part of residency training. However, challenges identified included the lack of qualified and available faculty to develop and teach QIPS material. 30 of 30 (100%) residents spanning three cohorts completed the QIKAT-R. Median overall score was 11 out of 27 points (IQR 9-14), demonstrating the lack of poor baseline QIPS knowledge amongst residents. Conclusion: QIPS is felt to be a necessary part of residency training, but the lack of available and qualified faculty makes developing and implementing such curriculum challenging. Residents at UT consistently performed poorly on a validated QIPS assessment tool, confirming the need for a formal QIPS curriculum. We are now developing a longitudinal, evidence-based QIPS curriculum that trains both residents and faculty to contribute to QI projects at the institution level.

scholarly journals Residents’ perspective of quality improvement and patient safety education in Canadian emergency medicine residency programs

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 224-231
Author(s):  
Sachin V. Trivedi ◽  
Riley J. Hartmann ◽  
Justin N. Hall ◽  
Laila Nasser ◽  
Danielle Porplycia ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Royal College ◽  
Free Text ◽  
Safety Education ◽  
Delivery Of Care ◽  
Residency Programs ◽  
Electronic Survey ◽  
Local Setting

ABSTRACTObjectivesQuality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.MethodsAn electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.ResultsOf 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.ConclusionsMany Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.

Emergency Medicine Quality Improvement and Patient Safety Curriculum

2010 ◽  
Vol 17 ◽  
pp. e110-e129 ◽  
Author(s):  
John J. Kelly ◽  
Elaine Thallner ◽  
Robert I. Broida ◽  
Dickson Cheung ◽  
Helmut Meisl ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Medicine Quality

scholarly journals MP25: The quality improvement and patient safety curriculum for emergency medicine residents at the University of Toronto: results from the first cohort

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S49-S50
Author(s):  
A. H Y. Cheng ◽  
S. Vaillancourt ◽  
M. McGowan ◽  
A. Verma ◽  
A. McDonald ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Practical Skills ◽  
Absolute Increase ◽  
Educational Methods ◽  
University Of Toronto ◽  
Curriculum Changes ◽  
The University ◽  
The Impact

Introduction: The 2015 CanMEDS framework requires all residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). We created a longitudinal (4-year), modular QIPS curriculum for FRCP emergency medicine residents at the University of Toronto (UT) using multiple educational methods. The curriculum addresses three levels of QIPS training: knowledge, practical skills at the microsystem level, and practical skills at the organization level. Aim Statement: To increase the UT FRCP emergency medicine residents absolute score on the QIKAT-R (Quality Improvement Knowledge Application Tool Revised) by 10% after the completion of the QIPS curriculum. Methods: Physicians and other healthcare professionals with QI expertise collaboratively designed and taught the curriculum. We used the QIKAT-R as the outcome measure to evaluate QI knowledge and its applicability. The QIKAT-R is a validated measure that assesses an individuals ability to decipher a QI issue within the healthcare context, and propose a change initiative to address it. The first cohort of residents completed the QIKAT-R prior to the first session in 2014 (pre) and at the completion of the curriculum in 2017 (post). Each response was anonymized and scored by physicians with QI expertise. The QIKAT-R scores and comments from course evaluations are used to make yearly iterative curriculum changes. Results: The QIPS curriculum was implemented in September 2014. All nine residents in the first cohort completed the curriculum; they demonstrated an absolute increase of 19.6% (5.3/27) in the mean QIKAT-R score (13.0 +/− 3.3 pre vs. 18.3 +/− 3.8 post, p=0.001). Of the pre-test responses, 26% were categorized as poor, 70% as good, and 4% as excellent, whereas of the post-test 11% of responses were categorized as poor, 37% as good, and 52% as excellent (p<0.001). Two iterative curriculum changes were made at the end of each academic year since 2014: (1) The time between sessions were decreased to promote knowledge retention, and (2) different PGY3 QI practical project options were provided to suit residents individual QI interests. QIKAT-R scores and resident feedback were used to evaluate the impact of the curriculum changes. Conclusion: A collaborative, modular, longitudinal QIPS curriculum for UT FRCP emergency medicine residents that met CanMEDS requirements was created using multiple educational methods. The first resident cohort that completed the curriculum demonstrated an absolute increase in QI knowledge and its applicability (as measured by the QIKAT-R) by 19.6%. Two PDSA cycles were completed to improve the curriculum with the change ideas generated from resident feedback. Ongoing challenges include limited staff availability to teach and supervise resident QI projects. Future directions include incentivising staff participation and providing mentorship for residents with a career interest in QI beyond what is offered by the curriculum.

scholarly journals LO104: A collaborative approach to developing and delivering a multi-modal quality improvement and patient safety curriculum for emergency medicine residents

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S66-S66
Author(s):  
A.H. Cheng ◽  
L.B. Chartier ◽  
S. Hawes ◽  
S. Vaillancourt ◽  
M. McGowan ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Real Life ◽  
Interdisciplinary Teams ◽  
Lessons Learned ◽  
Case Method ◽  
Practical Skills ◽  
Local Resident ◽  
Management Consultants

Introduction / Innovation Concept: The 2015 CanMEDS framework requires all Canadian residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). A survey of the FRCP Emergency Medicine Residency Program Directors in Canada (63% response rate, 8/13) found that 75% (6/8) of programs have QIPS curricula with 84% (5/6) in the form of didactic lectures and 67% (4/6) as resident participation in a local project. Lectures alone do not expose learners to the practicality of conducting a QIPS project, and local resident projects often do not expose learners to the complexities of organization-wide QI initiatives. Furthermore, QI initiatives require working in interdisciplinary teams. We therefore hypothesize that an effective QIPS curriculum will require multiple education methods delivered using a multi-disciplinary lens. Methods: A collaborative longitudinal QIPS curriculum for emergency medicine residents at the University of Toronto (UT) was developed using multiple educational methods by physicians and non-medical QI specialists. The curriculum addresses three levels of QIPS training: Knowledge (lectures in PGY1 and 2), practical skills at the local clinical microsystem level (QI project in PGY3), and practical skills at the organization level (problem solving using the case method in PGY5). Curriculum, Tool, or Material: The lectures are taught by physicians involved in local and organization-wide QI projects and by those in senior management. The PGY3 residents enrol in a co-learning curriculum developed by the Department of Medicine, where residents and faculty conduct a local QI project together. The PGY5 teaching cases were created with management consultants using material from a real hospital QIPS initiative. PGY5s are taught using the case method that places the learner in the role of the organization’s manager who discusses the issues in class and proposes actions. Residents learn about the practicality of their recommendations by discussion with the management consultants, who disclose the case outcomes and review the lessons learned. Conclusion: A longitudinal QIPS curriculum for emergency medicine residents at UT was developed collaboratively. Multiple teaching methods address all three levels of QIPS training. This curriculum represents a novel use of the case method to instruct QIPS project leadership and management outside of the business school setting. Discussions with management consultants provide a different perspective of the real-life challenges of conducting QIPS initiatives.

scholarly journals LO61: A national needs assessment on quality improvement and patient safety education in Canadian emergency medicine residency programs

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S29-S30
Author(s):  
S. Trivedi ◽  
R. Hartmann ◽  
J. Hall ◽  
L. Nasser ◽  
O. Levac-Martinho ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Patient Safety ◽  
Quality Improvement ◽  
Local Environment ◽  
Free Text ◽  
Safety Education ◽  
Cross Sectional ◽  
Current Time ◽  
Residency Programs ◽  
Electronic Survey

Introduction: Quality improvement and patient safety (QIPS) are increasingly recognized as integral to the provision and advancement of emergency medicine (EM) care. In 2015, QIPS were added to the Canadian Medical Education Directives for Specialists (CanMEDS) framework. However, the level of QIPS education and support that Canadian EM residents receive is unknown. In order to better plan national QIPS efforts aimed at enabling EM residents to improve their local care settings, we sought to assess the current state of QIPS education and support in Canadian EM residency programs. Methods: This was a descriptive, cross-sectional electronic survey that was disseminated to all current Canadian EM residents from both Royal College (RC) and Family Medicine - EM training streams. Residents were recruited either directly or through their program's administrative assistant. The survey consisted of multiple-choice, Likert and free-text entry questions. Themes included a) familiarity with QIPS; b) local opportunities for QIPS projects and mentorship; and c) desire for further QIPS education and involvement. The survey was open for a five-week period, with formal reminders after the first and third weeks. Descriptive statistics are reported. Results: 189 (35%) of 535 current EM residents completed the survey, representing all 17 medical schools. 77% of respondents were from the RC stream. 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS. 47.2% of respondents reported “not knowing” or “not having readily available” QIPS projects to participate in their local environment, and 51.5% had equivalent responses with respect to QIPS mentorship opportunities. Only 17.5% of respondents reported that QIPS methodologies were already formally taught in their residency program, and 66.9% indicated a desire for increased QIPS teaching. The majority of respondents were “slightly” (35.9%), “moderately” (23.2%) or “very” (11.3%) interested in becoming involved with QIPS training and initiatives. Conclusion: Responding Canadian EM residents are interested in obtaining greater QIPS education as well as project and mentorship opportunities, but many perceive that they do not have adequate access to these at the current time. As the importance of QIPS increases in the EM community, supporting residents with more robust educational infrastructures may be necessary. Future efforts may include the standardizing of QIPS postgraduate curricula and improving access to QIPS opportunities across the country.

Developing a Quality Improvement and Patient Safety Toolbox: The Curriculum

MedEdPORTAL ◽  
2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Patricia Keefer ◽  
Kelly Orringer ◽  
Jennifer Vredeveld ◽  
Kavita Warrier ◽  
Heather Burrows
Keyword(s):  
Patient Safety ◽  
Quality Improvement
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