Category Archives: CGP News

Fall GME Spotlight


Development and Implementation of a Patient-Centered Discharge Curriculum


Johns Hopkins Bayview Medical Center


Principal Investigator:
Roy C. Ziegelstein, MD, Diversity Council of the
Department of Medicine Chair, Department of Medicine Executive Vice-Chair
Deputy Director of Education

Hospital discharge is a complex process for patients, nurses, and physicians. However, it has been underemphasized in terms of physician training and allocation of institutional resources and time. To ensure the safety of patients when they leave the hospital, it is important to discharge patients in a careful, thorough, and patient-centered manner, but reality often does not match this ideal. Incorporating the patient’s perspective and concerns is a key component of a safe discharge, but traditionally this has been overlooked in the busy hospital setting. The Patient-Centered Discharge Curriculum, which was develop and implemented by a multi-disciplinary team at Johns Hopkins Bayview Medical Center, empowers patients to participate more fully with the medical team in their health care.

Always Events: The inclusion of patients and the patients’ perspective should always be included in discharge communication and the discharge summary should always be provided to the patient.
Overview: In this project, a patient-centered discharge curriculum will be developed and the effects studied in an effort to ensure better care coordination, communication, and patient education at the time of discharge home or transfer to a post-acute setting. This project will be implemented on the Aliki Team, this is a 4-week rotation whose aim is to solidify the importance of getting to know one’s patient as a person. If this project is found to improve trainees’ knowledge, attitudes and practice, and also to improve patients’ health outcomes, it will be implemented throughout the department and then in other departments as well. The overall goal of this curriculum will be to teach interns and residents the skills and attitudes necessary to facilitate safe, effective, patient-centered transitions of care. It is hypothesized that an additional critical element for safe, effective, transitions of care is the inclusion of the patient and significant others as full partners in discharge planning. This project proposes that the inclusion of the patient, and the patient’s perspective, in the discharge communication be an Always Event™.

Your Voice Matters: Going Home from the Hospital

Going Home from the Hospital

Face Sheet: Meet Your Doctors

 

 

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September Spotlight

Riverside Methodist Hospital/OhioHealth Foundation
Project Title: Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation
Principal Investigator: Sara Sukalich, MD

Always Events: Following a medical error, physicians will always provide an explanation to the patient and family regarding what happened, potential implications or consequences of error, a commitment to investigate what went wrong, feedback regarding the findings of the investigation, and an apology or expression of regret.

Dr. Sara Sukalich of Riverside Methodist Hospital in Columbus, Ohio, describes the Graduate Medical Education Challenge Grant Program that is being implementing to educate medical residents about disclosing medical error to patients and their families.

Project Overview: This project will attempt to close the gap by providing a robust training and competency assessment for medical residents on how to disclose medical errors and improve communication skills, using the National Quality Forum’s guidelines. Subjects for this project will be PGY 1 residents in multiple disciplines training at Riverside Methodist Hospital. Training will include didactic sessions, standardized patient encounters involving disclosure of medical error, and debriefing sessions following the encounter to provide formative feedback and performance evaluation. The goal of this project is to ensure that the skills needed to provide full disclosure of medical errors are taught to trainees, and assessment of trainees’ competence in these skills is evaluated.

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August GME Spotlight: MSSM


Mount Sinai School of Medicine
Project PARIS (Parents And Residents In Session)
Principal Investigator: Joel Forman, MD
Co-Investigators: Eyal Shemesh, MD and
Christine Low, LCSW

Project PARIS-Parents and Residents In Session, a research project that is being underwritten by Picker Institute, Gold Foundation, and Mount Sinai, calls for a supervised meeting between a family member of a previously hospitalized child and a resident in the context of their pediatric residency rotation as a way to bring the voice of the patient and patient’s family to the forefront, while educating medical residents about the importance of practicing Patient- and Family-Centered Care.

Project PARIS project team, residents, and family faculty

Following a recent site visit to Mount Sinai, it became quite clear that this initiative is not just educating residents about PFCC, it is touching their hearts and minds and leaving a lasting impact on the ways they practice medicine.

Click here for more information.

 

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June 2011 GME Challenge Grant Spotlight

June 2011 Graduate Medical Education Challenge Grant Spotlight

“How do you have the conversation?” A Curriculum for Residents
Organization: Hebrew SeniorLife/BIDMC
Principal Investigator: Jennifer Rhodes-Kropf, MD
Overview:
Modern medicine has expanded the range of possible treatments that can prolong life without necessarily providing a quality of life that may be acceptable to a patient and her family. The kinds of decisions that have to be made are especially difficult when the patient suffers from advanced dementia and cannot communicate for him or herself.  These are conversations that should always occur in the setting of advanced dementia and we strive to have these conversations led by the outpatient physician before moments of crisis. This project will develop a video and curriculum to teach residents how to discuss goals of care with family members of patients with dementia (Module I) and to develop a video and teaching module so that interns can better understand  what they can expect while they are helping  their patients to complete a living will (Module II). 

“How do you have the conversation?” Discussing goals of care with family members of patients with dementia.

The Conversation Project: A medical student discusses her end of life wishes with her mother.



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2010/2011 IHI Open School Webinar Presentation Materials

Healthcare Communication Across the Lifespan: A Picker Institute/Gold Foundation — IHI Open School Webinar

Hebrew SeniorLife/ BIDMC: “How do you have the conversation?: A learning module for residents.”
Principal Investigator: Jennifer Rhodes-Kropf, MD.
Click here to view videos produced by this initiative


Riverside Methodist Hospital/OhioHealth: “Teaching Disclosure: A patient-centered simulation training curriculum for this crucial conversation”
Principal Investigator: Sara Sukalich, MD


Mount Sinai Kravis Children’s Hopsital: “Project PARIS: Parents and Residents in Session”
Principal Investigator: Joel Forman, MD
Presenter: Christine Low, LCSW


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Conversation with 2008 Grantee MCG

2008/2009 Challenge Grantee

Medical College of Georgia / Georgia Health Sciences University
Center for Patient- and Family-Centered Care Improving Patient Rounds
 
Walter Moore, MD and Christine O’Meara, MA, MPH January 25, 2011

How did your project impact patient-centered care (PCC) at your institution?

  • Raised the level of awareness that PFCC can be carried out in an adult care setting
  • Demonstrated PFCC rounds are beneficial for patients and their family caregivers
  • Helped educate leadership in the Department of Medicine
  • Laid the foundation of increasing emphasis on supporting quality of care and that patients’ families play a role in this
  • Increased awareness of family involvement in care
  • Supported MCG’s philosophy of care
  • Incorporated PFCC educational materials/deliverables into clinical staff training and resident education

Brief project summary  

The IPR project goal was to implement patient- and family-centered care (PFCC) rounds in a general medicine unit in an adult-care inpatient setting as a quality improvement initiative. The project initially followed and measured the performance of one service team practicing PFCC Rounds on a general internal medicine unit with the aim of studying the impact on patient, family, staff, and doctors-in-training satisfaction; unit costs; residents’ and unit efficiency; quality; and safety.

Educational effectiveness and team performance in PFCC Rounds were assessed through the use of the PFCC Rounds observation checklist; written evaluations by students, residents and attending physicians; and student debriefing during focus group sessions. Participating nursing staff were debriefed to ascertain their perceived benefits and challenges associated with rounding with the medical team. Debriefing patients and families following the rounds encounters provided additional insights and information into the patient/family experience and the value of patient/family engagement during rounds.

Project results included:

  • Just-in-time PFCC education and PFCC Rounds orientation for students and residents, as well as PFCC professional development for nursing staff and attending physicians practicing in the  general internal medicine unit study site
  • Identifying steps and strategies to implementing PFCC Rounds applicable to other adult-care units
  • Discovering and overcoming specific obstacles to implementing PFCC Rounds
  • Expanding the role of patient advisors as partners in PFCC education and research

Several tools resulting from the pilot, including a blueprint for initiating and developing PFCC Rounds and a quick reference PFCC Rounds Observation checklist will be helpful to other health care institutions and academic medical centers as they initiate interdisciplinary, bedside PFCC Rounds or modify their existing rounds. These tools can aid attending physicians and residents desiring to integrate and model PFCC practices as they engage patients and their families at the bedside. 

What were the accomplishments of your project?

  • Demonstrated PFCC Rounds are doable in an adult care inpatient setting
  • Expanded the role of patient advisors into quality improvement,  research, and resident and medical student education and training
  • Faculty, clinical nursing staff, residents, students, and patient advisors’ engagement in the project was maintained through monthly newsletters in which patient advisors were also contributing authors  
  • Engaged patients and their families had an enhance patient experience
  • Patients and their families reciprocate
  • Development of evidence-based PFCC checklist
  • Development of PFCC Rounds Guidebook: Navigating Patient- and Family-Centered Care Rounds: A GUIDE TO ACHIEVING SUCCESS and PFCC GUIDELINES Card educational and training tools

What did you learn from your project?

  • Our goals were ambitious, we should have begun with more targeted goals as some data was not feasible to collect (i.e. tracking pages, text messaging to assess time savings)
  • Establishing this project using a case-control approach would have strengthened the methodology
  • Identified the need to financially support PFCC quality improvement in order to carry out and sustain the initiative; more funding was needed  
  • Dissemination can be difficult
  • PFCC practices are variable among physicians and front-line nursing staff
  • PFCC role modeling for doctors-in-training is a critical tool for teaching PFCC
  • If attending faculty are not supportive of PFCC rounds at the bedside, it won’t happen
  • Clinical nursing staff were reluctant to round with physician teams initially but through interdisciplinary rounds they experienced improved communication and see PFCC interdisciplinary rounds as beneficial to nursing staff, patients, and their families
  • The interdisciplinary team should include social workers and other disciplines or specialties involved in patient’s care 
  • Patients and families were engaged and appreciated improved communication and a team approach

How have you disseminated your project findings/project curriculum?

  • Conference presentations
    • Veterans Administration Leadership National Conference Las Vegas, NV – August 25, 2010 with an estimated 3,000 attendees
    •  Planetree Annual Conference Baltimore, M– October 4-7, 2009 podium presentation to approximately 75-100 attendees
    • Accreditation Council on Graduate Medical Education (ACGME) meeting Grapevine, TX – March 5-8, 2009 with 20 attendees
  • Workgroups
    • Workgroup session on PFCC Rounds implementation planning – VA VISN 7 Executive Leadership Meeting Atlanta, GA – September 9, 2010 with 16 attendees 
    • Two breakout sessions VA National leadership meeting August 23, 2010 with 25-30 attendees in the morning and 10-15 attendees in the afternoon
  • Medical Resident Education
    • Family Medicine Residents PFCC introduction and mobile device application testing – December 15, 2010 with 12 participants
    • MCG new medical resident’s orientation – June 25, 2010; 135 PFCC Guidelines cards for orientation packets
    • MCG Residents noon conference – March 3, 2009; incorporated PFCC Rounds checklist into new resident orientation and packets
  • Meetings
    • VA VISN 7 Executive Leadership Meeting (Southeast VA Network representing Alabama, Georgia, and South Carolina) Atlanta, GA – September 9, 2010 with 100 attendees
    • Graduate Medical Education Administrators Meeting  Columbia, SC – February 12, 2010
  • PFCC Learning Labs – Professional development for MCGHealth clinical staff (ongoing)
  • Web site dissemination
  • Information sharing with Beverley Johnson, Executive Director of the Institute for Patient- and Family-Centered Care, who, in-turn has presented the information at regional venues
  • PFCC Rounds Guidebook and PFCC Guidelines Card distribution and sales
  • Converting PFCC Guidelines and Checklist Card to mobile device application for faculty, staff, residents, students, and general public (in development)

Have you been able to sustain your project after the one year grant period and if so, how?

  • We have not been able to sustain the PFCC Rounds program due primarily to the premature death of Pat Sodomka, former Senior Vice President of Patient Family Centered Care at MCG Health, Inc. and PFCC champion in February 2010.
  • The PFCC Rounds coordination would be more likely to be sustained through the efforts of a dedicated staff coordinator; there exists a lack of funding resources to sustain this coordinator role.

 Have you been able to expand your project within your institution/ to other institutions? How?

  • While we have been unable to expand the project within our institution, we have been a resource to other institutions through training, the provision of technical assistance, and PFCC Rounds educational materials distribution.
  • The PFCC guidelines card and checklist developed through this project is being used in MCG professional development through PFCC Learning Labs.

 What recommendations would you make to prospective grantees?

  • Target your proposal
  • Involve a biostatistician early in proposal development
  • Engage in the Human Assurance Committee/Institutional Review Board (HAC/IRB) process early in proposal development
  • Review previously funded Picker Institute projects and scale your project accordingly
  • Engage patient advisors as members of the project team from proposal development to implementation and dissemination

What recommendations would you make to current Challenge Grantees?

  • Document your process in multi-media formats (video, photographs, audio tapes)
  • Your multi-media documentation becomes a dissemination tool


Any other comments. 

The introduction of interdisciplinary PFCC Rounds in an adult care in-patient setting represents a culture change. As part of this process, executive leadership is essential and it is critically important to engage nursing leadership, physician departmental leadership, and graduate medical education leadership in the planning and implementation stages. Maintain involvement and interest of key stakeholders and patient advisors with periodic updates and acknowledgement of vital support. 

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Health Care Transition: A Resident Learning Module

Rhode Island Hospital/Hasbro Children’s Hospital

“Health Care Transition: A Resident Learning Module”

Principal Investigator: Suzanne McLaughlin, MD, MSc           

The project goal was to develop a transition curriculum for medical residents that would enhance residents’ knowledge base of transition issues, develop clinical skills to assess, plan and support transition for adolescent and young adult patients and promote residents’ self-efficacy in the integration of patients and families in the decision-making process through close mentoring of the transition process by faculty and patients who have experienced challenges and success in transition.

Health care transition is the purposeful, planned shift from child-centered to adult-oriented health care.  The goal of transition is to maximize lifelong functioning and potential through the provision of continuous, comprehensive, developmentally-appropriate health care.  Health care transition for adolescents and young adults with special health care needs offers challenges and opportunities in all of the principles of patient-centered care.  Patients and families are an integral part of this process, beginning with needs assessment, progressing through the shared process of developing transition goals that are age- and developmentally-appropriate and, ideally, culminating in a patient and family maximizing their potential to function in and benefit from an adult-centered medical home.

Instructions for My Life, My Health Checklists Ready? Get Set. Go!

Ready?    Get Set.     Go!

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2011/2012 RFP

 

2011/2012 RFP

2011/2012 Graduate Medical Education Challenge Grant Request for Proposal



If you have any questions about past or present Challenge Grant projects or questions about a proposed project you are considering submitting as an Letter of Intent, contact the Challenge Grant Coordinator, Hannah Honor, at hhonor@pickerinstitute.org or utilize the ‘Ask a Question’ option on the Challenge Grant Program website.

 

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Picker Principles of PCC

Picker Institute Principles of Patient-Centered Care

Respect for patients’ values, preferences and expressed needs
Patients want to be kept informed regarding their medical condition and involved in decision-making. Patients indicate that they want hospital staff to recognize and treat them in an atmosphere that is focused on the patient as an individual with a presenting medical condition.

  • llness and medical treatment may have an impact on quality of life. Care should be provided in an atmosphere that is respectful of the individual patient and focused on quality-of-life issues.
  • Informed and shared decision-making is a central component of patient-centered care.
  • Provide the patient with dignity, respect and sensitivity to his/her cultural values.

Video Highlighting the Picker Principle of Respect:

Respect for Patients’ Values, Preferences and Expressed Needs

Coordination and integration of care
Patients, in focus groups, expressed feeling vulnerable and powerless in the face of illness. Proper coordination of care can ease those feelings. Patients identified three areas in which care coordination can reduce feelings of vulnerability:

  • Coordination and integration of clinical care
  • Coordination and integration of ancillary and support services
  • Coordination and integration of front-line patient care

Video Highlighting the Picker Principle of Coordination of Care:

Coordination and Integration of Care

Information, communication and education
Patients often express the fear that information is being withheld from them and that they are not being completely informed about their condition or prognosis. Based on patient interviews, hospitals can focus on three kinds of communication to reduce these fears:

  • Information on clinical status, progress and prognosis
  • Information on processes of care
  • Information and education to facilitate autonomy, self-care and health promotion

Video Highlighting the Picker Principle of Information, Communication & Education:

Information, Communication & Education

Physical comfort
The level of physical comfort patients report has a tremendous impact on their experience. From the patient’s perspective, physical care that comforts patients, especially when they are acutely ill, is one of the most elemental services that caregivers can provide. Three areas were reported as particularly important to patients:

  • Pain management
  • Assistance with activities and daily living needs
  • Hospital surroundings and environment kept in focus, including ensuring that the patient’s needs for privacy are accommodated and that patient areas are kept clean and comfortable, with appropriate accessibility for visits by family and friends.

Video Highlighting the Picker Principle Regarding Physical Comfort:

http://pickerinstitute.org/principles-comfort/

Emotional support and alleviation of fear and anxiety
Fear and anxiety associated with illness can be as debilitating as the physical effects. Caregivers should pay particular attention to:

  • Anxiety over clinical status, treatment and prognosis
  • Anxiety over the impact of the illness on themselves and family
  • Anxiety over the financial impact of illness

Video Highlighting the Picker Principle Regarding Emotional Support:

Emotional Support and Alleviation of Fears and Anxieties

Involvement of family and friends
Patients continually addressed the role of family and friends in the patient experience, often expressing concern about the impact illness has on family and friends. These principles of patient-centered care were identified as follows:

  • Accommodation, by clinicians and caregivers, of family and friends on whom the patient relies for social and emotional support
  • Respect for and recognition of the patient “advocate’s” role in decision-making
  • Support for family members as caregivers
  • Recognition of the needs of family and friends

Video Highlighting the Picker Principle Regarding the Involvement of Family & Friends:

http://pickerinstitute.org/principles-family/

Continuity and transition
Patients often express considerable anxiety about their ability to care for themselves after discharge. Meeting patient needs in this area requires staff to:

  • Provide understandable, detailed information regarding medications, physical limitations, dietary needs, etc.
  • Coordinate and plan ongoing treatment and services after discharge and ensure that patients and family understand this information
  • Provide information regarding access to clinical, social, physical and financial support on a continuing basis

Video Highlighting the Picker Principle Regarding Continuity & Transitions of Care:

Continuity and Transitions of Care

Access to care
Patients need to know they can access care when it is needed. Attention must also be given to time spent waiting for admission or time between admission and allocation to a bed in a ward. Focusing mainly on ambulatory care, the following areas were of importance to the patient:

  • Access to the location of hospitals, clinics and physician offices
  • Availability of transportation
  • Ease of scheduling appointments
  • Availability of appointments when needed
  • Accessibility to specialists or specialty services when a referral is made
  • Clear instructions provided on when and how to get referrals

Video Highlighting the Picker Principle of Access to Care:

Access to Care

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Challenge Grant Spotlight

December 2010 GME Challenge Grant Spotlight

Improving Patient Rounds (IPR)

Medical College of Georgia

Principal Investigator: Walter J. Moore, MD

2008 Challenge Grant Recipient: Medical College of Georgia (MCG)

A Tribute to Pat Sodomka: Internationally Recognized PFCC Advocate

Pat Sodomka in Action: A brief slide show

 

November 2010 GME Challenge Grant Spotlight

Communication in Family Meetings: Developing and Assessing a Curriculum for Residents 

Beth Israel Deaconess Medical Center Department of Medicine

Principal Investigator: Julie T. Irish, PhD

Challenge Grant Spotlight: BIDMC

Resident pocket card

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