Rounds

Speaker: Christine Soong

Title: Reducing inappropriate urinary catheter use among general medical inpatients

Description: Responsible resource utilization is a growing area of interest among clinicians engaged in quality improvement. Highly publicized campaigns such as Choosing Wisely in Canada and the US are encouraging physicians to reduce unnecessary testing and/or procedures that may lead to harm. Urinary catheterization is a common occurrence in the inpatient setting that is associated with preventable adverse events such as nosocomial urinary tract infections. This talk provides an overview of the development of local interventions to reduce inappropriate urinary catheter use.

Christine is a Clinician in Quality and Innovation in the Division of General Internal Medicine at the University of Toronto. She is the Director of the Hospital Medicine program at UHN/MSH and Co-Chair of the Choosing Wisely Canada Committee for the Canadian Society of Internal Medicine. Her career in quality improvement began as an academic hospitalist at Johns Hopkins University and led to the completion of a Master’s of Science degree in Quality Improvement and Patient Safety at IHPME in 2013. Her research interests includes resource stewardship, and improving transitions of care for hospitalized patients.

Speaker: Andrea Bishop

Title: Building the Connection for Patient Safety

Description: Greater engagement of patients in their care may contribute to safer healthcare, but it is unclear what factors facilitate such engagement and how such factors differ between patient involvement in factual and challenging patient safety practices. This research used the Health Belief Model (HBM) as a framework to understand how patient and provider perceptions of benefits, threats, cues to action, and self-efficacy play a role in the likelihood of patients becoming involved in patient safety practices. Andrea C Bishop, MHSA, PhD, is a postdoctoral fellow at Saint Mary’s University, Halifax, Nova Scotia, Canada. Andrea completed her doctoral work at Dalhousie University on the topic of patient engagement in patient safety and is currently exploring patient experiences while hospitalized and how they relate to safety culture. Andrea is also a research associate with SafetyNET-Rx (www.safetynetrx), an outreach program that encourages and supports an open dialogue regarding medication errors and quality within community pharmacies in Nova Scotia.

Speaker: Tobias Everett

Title: Do Pediatric Operating Room Critical Event Checklists Improve Patient Safety?

Description: Adult operating room critical event checklists improve performance in adult operating room crisis simulations. What has yet to be demonstrated is that the same applies in the pediatric operating room or, more importantly, whether this is translated to improved real-life practice with a tangible impact on patient safety. There is literature to support impact of cognitive aids, but barriers to implementation means that uptake is not widespread. These issues will be discussed along with the plans for the largest in our series of international multicentre simulation studies aimed at answering some of these unknowns.

Tobias Everett is a Pediatric Anesthesiologist at the Hospital for Sick Children, Toronto, and an Assistant Professor at the University of Toronto. He graduated from University of Bristol Medical School, in the United Kingdom. He completed a Senior House Officer rotation in Emergency Medicine, Respirology, Anesthesia and Critical Care in Cornwall, UK before beginning his Specialist Registrar rotation in Anesthesia in the Severn Deanery, UK. Dr. Everett is a fellow by examination of the Royal College of Anaesthetists (UK), has subspecialty certification in regional anesthesia from the European Society of Regional Anaesthesia and is fellowship trained in pediatric anesthesia by the Hospital for Sick Children, Toronto. He is currently completing a Master of Science degree in Clinical Epidemiology from the University of London, UK. His academic interests include simulation-based medical education and medical education research. He is the principal investigator in international multicentre education research studies and has received grant funding from the Royal College of Physicians and Surgeons of Canada and the Canadian Anesthesiologists’ Society. He has recently been awarded the Canadian Anesthesiologists’ Society Award for Best Paper in Education 2013.

Speaker: Martin Marshall

Title: Research and evidence in guiding innovation and health policy in the NHS

Description: Professor Marshall’s talk will focus on why the NHS is a source of experimentation for health policy and practice, to what extent it has used HSR evidence to guide what it does, how successful it has been and how evidence could be used differently for it to have greater impact.

Speakers: Tania Principi and Jerome Leis

Title (Tania Principi): The Effective Care Project – developing a novel system to communicate with patients post discharge

Title (Jerome Leis): Modified urine culture reporting as a strategy to decrease antimicrobial therapy for asymptomatic bacteriuria: a controlled time series analysis

Speaker: Brian Wong, MD, Associate scientist, Evaluative Sciences – Veterans and Community Program, Sunnybrook Research Institute

Title: Limitations of Trigger Tools in Tracking Event Rates and Stimulating Improvements

Description: Trigger tools are a widely recommended means for assessing rates of harm, identifying areas for improvement, and tracking progress over time. This session will present the results of an enhanced trigger tool in which, instead of retrospective chart review, triggers were identified in quasi-real time, with additional details about the clinical events gathered from staff and case summaries discussed by in weekly meetings of a multidisciplinary research team.

This prospective application of the trigger tool method was designed to detect more events in richer detail. This did occur, but, for any given type of event, the numbers of events were small – we suspect too small to allow tracking over time or to identify underlying causes. These unpublished results will be presented with a view to discussing the implication for trigger tools in general. The format for the round will be that of a “Research in Progress” with interactive discussion, debate, and feedback welcome.

Speaker: Matt Scanlon, MD, Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin

Title: Understanding Work in the Context of Patient Safety

Study interests: Bar coding, engineering, epidemiology of pediatric critical care, human factors, patient safety, quality improvement, quality measurement, systems design, technology assessment, usability.

Education: Medical degree, Loyola Stritch School of Medicine, Chicago, 1988-1992; residency, Pediatrics, Loyola Stritch School of Medicine, Chicago, 1992-1995; chief resident, Pediatrics, Loyola Stritch School of Medicine, Chicago, 1995-1996; fellowship, Pediatric Critical Care Medicine, Medical College of Wisconsin, Milwaukee, 1996-1999; patient safety leadership, American Hospital Association, National Patient Safety Foundation, 2003-2004.

Speaker: Pat Croskerry, MD, PhD

Title: Clinical Decision Making in Patient Safety – A Case of Neglect

Pat Croskerry is a professor in emergency medicine at Dalhousie University, Halifax, Nova Scotia, Canada. He holds a cross-appointment in the Faculty of Medical Education and in 2002 was appointed a senior clinical research scholar at Dalhousie. He has worked in the area of patient safety for the last 15 years. His research is principally concerned with the impact of cognitive and affective error on clinical decision-making, specifically on diagnostic error. He has published over 50 articles and 24 book chapters in the area of patient safety and medical education reform. He has given over 300 presentations at local, national, and international levels. He is senior editor on a major text, Patient Safety in Emergency Medicine (2008). His most recent paper, “A Universal Model of Diagnostic Reasoning” was published in Academic Medicine in August 2009.

Eight years ago, Croskerry implemented the first undergraduate course on medical error in Canada at Dalhousie University. In 2006, he received the Association of Faculties of Medicine of Canada Ruedy Award for innovation in medical education. In the same year was appointed to the board of the Canadian Patient Safety Institute.

Speaker: Dr. Eduardo Salas

Title: How do you turn a team of experts into an expert team

Specific Learning Objectives:
What are the required team-based competencies
What effective teams do
How team training and simulation-based training helps

Speakers: Dr. Anthony Easty and Dr. Kaveh Shojania

Title: Computerized reminders, decision support and order sets: Promise vs. Reality