Category Archives: Patient Care

Quality Improvement Project Charter

Watch the module from the IHI Online Open School “ QI Project Charter”

  1. Review the purpose of the QI project charter and the steps involved in completing the document.
  2. This module will guide you through the completion of the IHI project charter.

Watch the Ted Talk “Got a Wicked Problem? First tell me how you make toast.

  1. Discover how making steps in a process visible and tangible can lead to improvement by clarifying problems.
  2. This short Ted Talk describes the process map, a critical thinking tool used in quality improvement work to identify steps in a process for possible improvement changes.

IHI Online Open School courses in Quality Improvement and Patient Safety and Certificate program are available for additional support and review.

  1. Utilize the resources from the IHI online open school to provide additional support for project creation.  Interested students may wish to complete any final modules to obtain the IHI Certificate in Quality Improvement and Patient Safety.
  2. The IHI modules will provide a review or additional context regarding the model for improvement and the steps in the quality improvement process.      

 

Trauma Informed Care

Reading Assignment

Matchinger, E, et al. From Treatment to Healing: Inquiry and Response to Recent and Past Trauma in Adult Health Care.  Women’s Health Issues, 29 (2)  2019

Context: This brief article by Matchinger et al describes a trauma-informed approach to inquiring about and responding to patients’ recent and past trauma.  It also provides an overview of the other principles of trauma-informed care.

GoalIdentify components of trauma-informed care and how they apply to inquiring and responding to patients’ previous traumatic experiences within the clinical encounter.  Compare and contrast universal screening, targeted screening, universal education, and universal trauma precautions.

Reflect: How have you seen inquiries about and responses to patients’ experiences of trauma approached in your clinical settings?  What has worked well?  What pitfalls have you seen?  Have you ever been screened for current or past trauma within a clinical encounter?  How have your personal experiences affected the way you approach these encounters with your own patients?

Online Module

Complete Aquifer Trauma-Informed Care: Module 06: Trauma-Informed Care: Practice Patient-Centered Communication and Care

https://owhtic-re.meduapp.com/document_sets/7778

Instructions: Access or set up an Aquifer account using your uw.edu email address.  Complete the 4 cases of Module 06 of Trauma-Informed Care Course.  At the completion of each case, download the case summary PDF, which will summarize the key points of the case and provide you a document to upload as completion of the assignment in Canvas.  Credit for completion will be given when all 4 documents have been uploaded.

Context: Experiences of trauma can affect how patients engage with healthcare providers and how patients are affected by the healthcare encounter. These cases explore concepts of traumatic stress, universal trauma precautions, and other trauma-informed care principles.

Goal: Apply principles of trauma-informed care to the clinical encounter through exploring these four online cases.

Further learning: The entire Aquifer Trauma-Informed Care course is free to students, and contains excellent, clinically relevant information and skills.

Pre-class Required Reflection (bring written answers and a description of case to the small group discussionno submission is required) :

90% of adults have been exposed to trauma in their lives.  A history of trauma can affect how a patient engages with and/or experiences health and healthcare.

Please consider a case you have been involved in where you know or suspect that the patient may have been affected by past trauma, and consider:

  1. How did/may have trauma affect this patient’s health and wellbeing? Consider physical and emotional health, socioeconomic status including employment, relationships, outlook, health “behaviors”, etc.
  2. How did trauma affect this patient’s engagement in the healthcare system?  Consider access to care, followup, participation in care, communication style, behavior in the clinic, etc.
  3. How did trauma affect this patient’s experience of the healthcare encounter? Consider signs or symptoms of trauma that were apparent.
  4. What components of traumainformed care were implemented in the care of this patient? What worked well?  What didn’t work well?
  5. What components of trauma-informed care would have helped this patient or encounter?  What would have been different?
  6. What barriers did you or the team experience that interfered with implementing those aspects of trauma-informed care?  What additional skills or support do you feel you need in order to provide excellent traumainformed care?
  7. If relevant, how has your own personal experience of trauma, or personal experiences of team members, affected the way you engage with patients experiencing the effects of trauma? (Personal experiences will not be shared in class.)  
  8. How can implementation of trauma-informed care provide a safer, more responsive environment for providers as well as patients?

Optional reading:

  • Book: The Body Keeps The Score, Bessel Van Der Kolk MD.  The Body Keeps the Score” is a seminal work by one of the preeminent pioneers in trauma research and treatment. This essential book unites the evolving neuroscience of trauma research with an emergent wave of body-oriented therapies and traditional mind/body practices.”  
  •  Website and TED talk: The Trauma Stewardship Institute, Laara van Dernoot Lipsky. Offers “practical tools for cultivating the deep self-knowledge and systemic insights that are at the core of trauma stewardship.” Addresses self-care for those who care for others experiencing trauma.   Her 20 min TED talk “Beyond The Cliff” is a good introduction.
  • Article: “Violence Is a Public Health Problem”, American Public Health Association Policy Statement Nov 2018 . This 2018 policy statement looks at the rationale for viewing violence as a public health problem. Risk factors for and differential impacts of violence are reviewed. Successful public-health based intervention programs are discussed, and recommendations for physician practice, collaboration and advocacy are made. 
  • Book Chapter: Medical Management of Vulnerable and Underserved Patients: Principles, Practice and Populations, 2e.  Talmage and Wheeler.  “Chap 36: Trauma and Trauma-Informed Care”, Kimberg.
  • Database of Articles: Reducing Firearm Related Injuries and Deaths In the US: Annals of Internal Medicine database:
  • Website: King County Violence Prevention Resources:  Hosted by King County Public Health, this website has excellent general information on prevention of and resources for domestic violence, gun violence, trafficking and suicide.  Most resources are general or national, although some are King County specific. 

Resources:

  1. PEARR tool”

Dignity Health tool outlining trauma-informed approach to identifying and responding to survivors of interpersonal trauma.   https://www.dignityhealth.org/hello-humankindness/human-trafficking/victim-centered-and-trauma-informed/using-the-pearr-tool

  1. Excellent Safety Planning worksheets in multiple languages.

Some of the worksheets include California specific resources, but all include general resources as well.    https://www.leapsf.org/html/safety_plan.shtml

  1. Futures without Violence training videos on implementing universal education using wallet cards  https://www.futureswithoutviolence.org/health-training-vignettes/  and downloads (free) for wallet cards for many different populations https://secure3.convio.net/fvpf/site/Ecommerce/15587835?FOLDER=0&store_id=1241 (Note, in order to download, “add to cart” the pdfs you want, then “checkout” and you will be able to download for free)
  2. MyPlanApp: web or phone based app for patients to assess the safety of their relationship make plans to become safer, and to access resources:  https://www.myplanapp.org/home 
  3. State-by-State reporting requirements for violence towards adults  https://drive.google.com/open?id=1GGGhtc93exi1KuBS42A0acMef5PlUVAN
  4. Gun safe storage “Lock It Up” resources for physicians

https://www.kingcounty.gov/depts/health/violence-injury-prevention/violence-prevention/gun-violence/LOCK-IT-UP/providers.aspx 

7. National hotlines

  • National Domestic Violence Hotline
  • https://www.thehotline.org/ 1800-799-(SAFE) 7233 has online chat
  • National Human Trafficking Hotline
  • 1 (888) 373-7888 SMS: 233733 (Text “HELP” or “INFO”)
  • 200 languages available
  • Website: org
  • National Sexual Assault Hotlineof the Rape Abuse and Incest National Network
  • Call 1-800-656-4673
  • rainn.orgonline chat

SOAP Q Faculty Resources

SOAP-Q: An innovative curricular intervention to promote quality improvement behaviors within the clinical learning environment

Physician competency in quality analysis is necessary to optimize the quality and safety of patient care, yet current undergraduate medical education in these areas remains highly variable. The University of Washington School of Medicine (UWSOM) introduced a novel, pre-clinical phase curriculum (the Ecology of Health and Medicine- EHM- course) encompassing health systems, advocacy, equity, quality, and patient safety beginning in the academic year 2017-2018.  To facilitate experiential learning opportunities within the clinical environment, we created an innovative curricular intervention: the SOAP-Q framework. Medical communication and documentation conventionally rely upon the SOAP format (Subjective, Objective, Assessment, Plan). We add a fifth element to this format, “Q,” triggering students to assess and advocate for quality patient care. We now disseminate this framework to all medical students as they enter the clinical phase and now pilot clinical integration within the Family Medicine clerkship. We hypothesize that students and faculty will respond positively to the framework and student confidence in advocating for quality patient care and in addressing quality gaps will increase.  Subsequent assessment phases will examine impact on student behavioral metrics including documentation of quality assessment, participation in error identification and reporting, and performance on quality measures.   The multiphase project will utilize the framework as scaffolding for student quality improvement project charter design, implementation of projects for fourth year students participating in a quality improvement pathway, and creation of a project catalogue with tiered implementation and mentoring throughout the medical education and faculty continuum.  In utilizing SOAP-Q, the University of Washington offers opportunities for students to build competency in the newest of the AAMC’s Entrustable Professional Activities for Entering Residency, EPA-13.  This EPA calls for the student to identify system failures and contribute to a culture of safety and improvement.

A similar tool, SOAP-V, has demonstrated utility in assessment of high-value, cost-conscious care within the clinical encounter (3).   Initial studies indicated that SOAP-V increased comfort with discussing value and considering cost when providing care.  SOAP-Q utilizes a quality-driven focus rather than cost focus, but is similarly intended to help the learner communicate effectively. The clinician considers the following in every patient encounter:

  • Safety- Conditions contributing to unsafe practice and systems solutions
  • Timeliness– Issues contributing to delay or process lead time
  • Efficiency- Value conscious utilization of resources with minimal waste
  • Efficacy- Evidence-based approaches to improve health outcomes
  • Equity – An approach to care that recognizes sociodemographic drivers of health inequities and actively advocates for equitable outcomes
  • Patient-Centeredness- Patient engagement and patient experience.

An oral case presentation using the SOAP-Q framework integrates an assessment of one of the six STEEEP aims within the body of the presentation.  It calls attention to the aim in a single line callout at the conclusion of the presentation beginning with identification of the aim.  A progress note written in the SOAP-Q framework similarly embeds discussion within the text and delineates the issue in a single line at the conclusion of the note beginning with aim identification.  As faculty, please encourage student use of SOAP-Q format and where appropriate utilize the quality call out as a prompt for discussion and teaching (see the one minute preceptor models for examples).

Faculty resources are below.  Thank you for your support of student programs.   Please help us evaluate SOAPQ by completing a baseline faculty survey at the following link:

LINK TO FACULTY SURVEY

Faculty resources:

References:

  1. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st  Washington, DC: National Academies Press, 2001.
  2. The Core Entrustable Professional Activities for Entering Residency Drafting Panel. Core Entrustable Professional Activities for Entering Residency.  Association of American Medical Colleges 2014.
  3. Moser, EM, Huang, GC, Packer, CD et al. SOAP-V: Introducing a method to empower medical students to be change agents in bed in the cost curve.  J of Hosp Med 2016; 11: 217-220.

 

 

Individualized Development Plans (IDP)

Develop an understanding of the ways IDPs are used by medical trainees and physicians for personal and professional growth by watching this video.

Explain the components of an IDP after reviewing this slide set (presentation has a voice-over, please download presentation and open in PowerPoint to hear audio).

Use this IDP template throughout your medical education.

SOAP-Q

Complete:

SOAP-Q is a communication tool designed to encourage providers to address health care quality effectively within oral case presentations and in note writing. This summary handout covers the basics of the SOAP-Q approach. 

This video demonstrates a third-year medical student modeling the case presentation in SOAP-Q format and this clinical note demonstrates SOAP-Q in note writing.

In both examples, the student implements strategies to advocate for quality patient careoptimal patient care systems, and safety culture within the context of a patient encounter while maintaining psychological safety in the setting of academic hierarchy.   

Additional resources: