Patient Safety CME CurriculumPatient Safety CME Curriculum

Patient Safety: The Other Side of the Patient Safety: The Other Side of the Quality EquationQuality EquationUnder a Grant from Under a Grant from

The Agency for Healthcare Research and The Agency for Healthcare Research and QualityQuality

Principal InvestigatorPrincipal Investigator

Christel Mottur-Pilson, PhDChristel Mottur-Pilson, PhDDirector, Scientific PolicyDirector, Scientific Policy

ACP-ASIMACP-ASIM

Patient Safety: Patient Safety: The Other Side of the Quality EquationThe Other Side of the Quality EquationSeven Modules in Ambulatory CareSeven Modules in Ambulatory Care

SystemsSystems The influence of systems on the practice of medicine.The influence of systems on the practice of medicine.

Cognitive CapacityCognitive Capacity Coping mechanisms under information overload and Coping mechanisms under information overload and

time pressurestime pressures

CommunicationCommunication Communication barriers, lack, and unclear Communication barriers, lack, and unclear

communicationcommunication

Medication ErrorsMedication Errors Uniform dosing, look- and sound-alikes, forcing Uniform dosing, look- and sound-alikes, forcing

functionsfunctions

Patient Safety: Patient Safety: The Other Side of the Quality EquationThe Other Side of the Quality EquationSeven Modules in Ambulatory CareSeven Modules in Ambulatory Care

The Role of PatientsThe Role of Patients Patients as allies in patient safetyPatients as allies in patient safety

The Role of ElectronicsThe Role of Electronics Supportive products and processesSupportive products and processes

Idealized Office DesignIdealized Office Design Medical practice design to support patient safetyMedical practice design to support patient safety

LogisticsLogistics

CME: CME: To receive your CME, please fill out the To receive your CME, please fill out the usual formsusual forms

Evaluation formEvaluation form CME formCME form

Research Grant SurveysResearch Grant Surveys• Pre-CME assessment of knowledge levelPre-CME assessment of knowledge level• Post-CME assessment of knowledge Post-CME assessment of knowledge

level level • Six-month follow up to CMESix-month follow up to CME

Virtual Patient Safety Electronic CommunityVirtual Patient Safety Electronic Community

Presentation GoalsPresentation Goals Understanding how communication influences Understanding how communication influences

carecare

Examples of communication breakdowns and Examples of communication breakdowns and how to avoid themhow to avoid them

Take home points to help you apply Take home points to help you apply communication skills in your practicecommunication skills in your practice

This module was developed by Elizabeth C. Bernabeo, MPH and This module was developed by Elizabeth C. Bernabeo, MPH and Christel Mottur-Pilson, Ph.D. for the American College of Christel Mottur-Pilson, Ph.D. for the American College of Physicians-American Society of Internal Medicine.Physicians-American Society of Internal Medicine.

Levels of Communication

Physician Physician Patient Patient

Physician Physician Physician Staff Physician Staff

Levels of Communication

Physician Physician Colleagues (referrals) Colleagues (referrals)

Physician Physician Clinical Support FacilitiesClinical Support Facilities

Why Teach Communication Skills? How we communicate is just as important as How we communicate is just as important as

what we saywhat we say Communication makes evidence-based Communication makes evidence-based

medicine real to patientsmedicine real to patients Communication improves outcomes for both Communication improves outcomes for both

patients and physicianspatients and physicians

Problems in Communication

1 of 5 adults experiences one or more 1 of 5 adults experiences one or more communication problemscommunication problems

Physicians overestimate the time they spent Physicians overestimate the time they spent on explanation and planning by up to 900%on explanation and planning by up to 900%

1 of 4 patients does not always follow 1 of 4 patients does not always follow physician advicephysician advice

1 in 7 patients is dissatisfied with the current 1 in 7 patients is dissatisfied with the current health care systemhealth care system

Barriers to Effective Communication

Time ManagementTime Management Differing Agendas between Doctor and Differing Agendas between Doctor and

PatientPatient The Art of Asking QuestionsThe Art of Asking Questions Working to Achieve Behavioral ChangeWorking to Achieve Behavioral Change

Solutions to Barriers (1)

Remember the SEGUE Framework (adapted Remember the SEGUE Framework (adapted by Northwestern University)by Northwestern University) Set the StageSet the Stage Elicit InformationElicit Information Give InformationGive Information Understand the Patient’s PerspectiveUnderstand the Patient’s Perspective End the EncounterEnd the Encounter

Solutions to Barriers (2)

No need to work faster, just differentlyNo need to work faster, just differently

Effective communication does not prolong time Effective communication does not prolong time with patientswith patients

Investing time now will save time laterInvesting time now will save time later

Solutions to Barriers (3)

Tell the patient what he/she wants to know Tell the patient what he/she wants to know before explaining what you think he/she is before explaining what you think he/she is suffering from.suffering from.

Solutions to Barriers (4)

Keep patients talking about their symptomsKeep patients talking about their symptoms

Understanding a patient’s emotions is crucialUnderstanding a patient’s emotions is crucial

Solutions to Barriers (5)

The mnemonic NURS will help you The mnemonic NURS will help you remember the steps:remember the steps: Name the emotionName the emotion Understand their reactionsUnderstand their reactions Respect the difficulties Respect the difficulties Support the person Support the person

Working to Achieve Patient Change: The 4 E’s

Engage the individualEngage the individual Establish a working agendaEstablish a working agenda Empathize with his/her storyEmpathize with his/her story Educate the patientEducate the patient

Avoid Arguing Avoid Arguing Establish TrustEstablish Trust

Difficult Situations

The Role of the Family: No Patient is an The Role of the Family: No Patient is an IslandIsland

Treating the ElderlyTreating the Elderly Working with Difficult PatientsWorking with Difficult Patients Being Culturally and Gender SensitiveBeing Culturally and Gender Sensitive

Difficult Situations (2)

When delivering bad newsWhen delivering bad news Remember Remember SPIKESSPIKES

SharpenSharpen your listening skills your listening skills PayPay attention to patients perceptions attention to patients perceptions InviteInvite the patient to discuss details the patient to discuss details KnowKnow the facts the facts ExploreExplore emotions and deliver empathy emotions and deliver empathy StrategizeStrategize next steps with patient’s family next steps with patient’s family

Case OneCase One

Patient presents with complaints of shortness Patient presents with complaints of shortness of breathof breath

Physician is forewarned, from his staff, that Physician is forewarned, from his staff, that the patient has chronic obstructive lung the patient has chronic obstructive lung disease.disease.

Case One Take Home PointsCase One Take Home Points

What are some take home points from Case What are some take home points from Case One?One?

Case TwoCase Two

Patient presents with long list of symptomsPatient presents with long list of symptoms

Patient has own agenda of what is wrong, Patient has own agenda of what is wrong, what he needs and wants from the physicianwhat he needs and wants from the physician

Case Two Take Home PointsCase Two Take Home Points

What are the important take home points What are the important take home points from Case Two?from Case Two?

Case ThreeCase Three

Patient’s daughter is upset about the nature Patient’s daughter is upset about the nature and course of her mother’s careand course of her mother’s care

The mother has experienced a return of The mother has experienced a return of breast cancerbreast cancer

Case Three Take Home PointsCase Three Take Home Points

What are the take home points from Case What are the take home points from Case Three?Three?

Case Four

Patient with chronic renal failurePatient with chronic renal failure Workup after complaining of abdominal Workup after complaining of abdominal

painpain You wrote: “CT of abdomen w/o You wrote: “CT of abdomen w/o

contrast.”contrast.”

Case Four Take Home PointsCase Four Take Home Points

What are the take home points from Case What are the take home points from Case Four?Four?

Case FiveGastroenterologist Referral

64- year- old male with positive occult blood 64- year- old male with positive occult blood in stoolin stool

Internist referral to gastroenterologistInternist referral to gastroenterologist ““Evaluate for blood in stool”Evaluate for blood in stool”

Case Five Take Home Points

What are the important take home points What are the important take home points from case five?from case five?

Case Six

76-year-old male with ischemic heart disease76-year-old male with ischemic heart disease

Rx of sublingual nitroglycerinRx of sublingual nitroglycerin

Case Six Take Home Points

What are the important take home points What are the important take home points from case six?from case six?

Case Seven

50-year old woman with type 2 diabetes 50-year old woman with type 2 diabetes

Difficulty controlling blood sugarsDifficulty controlling blood sugars

Rx changeRx change

Case Seven Take Home Points

What are the important take home points for What are the important take home points for case seven?case seven?

Electronic Communication

Increased access to informationIncreased access to information Facilitates communicationFacilitates communication DangersDangers

PrivacyPrivacy EthicsEthics Inaccurate informationInaccurate information

Outcomes of Effective Communication Improved diagnostic accuracyImproved diagnostic accuracy Greater involvement of the patient in decision Greater involvement of the patient in decision

makingmaking Increased likelihood of adherence to Increased likelihood of adherence to

therapeutic regimenstherapeutic regimens Increased patient and clinician satisfactionIncreased patient and clinician satisfaction

Where do we go from here?

Educational Programs work!Educational Programs work! Open Communication Open Communication

Get to know your patientsGet to know your patients Define communication rolesDefine communication roles Empower the patientEmpower the patient Know your mnemonics!Know your mnemonics!

NURS, SPIKES, SEGUE, the 4 E’sNURS, SPIKES, SEGUE, the 4 E’s

Conclusions

Communication is essential to Communication is essential to providing patient centered careproviding patient centered care

The lessons learned apply to all The lessons learned apply to all interactions, be they medical or notinteractions, be they medical or not

Effective communication is both Effective communication is both clinically and personally satisfyingclinically and personally satisfying

Patient Safety Interactive Learning Community (PSILC)

http://www.acponline.org/ptsafetyhttp://www.acponline.org/ptsafety

Program Information & Updates

All Seven Modules Refresher Exercises Email Discussion

Groups

Refresher Exercises

http://www.acponline.org/ptsafetyhttp://www.acponline.org/ptsafety