Winter/Spring 2012
The Residents Report Newsletter of the Office of Graduate Medical Education I University of California, San Francisco
APeX Implementation Update Michael Blum, MD, Chief Medical Information Officer Kim Cloidt, APeX Communications Manager Amy Day, MBA, Director, Graduate Medical Education
APeX Implementation Update
in this issue APeX Implementation 1 News from SFGH 3 Out n’About 4-7 10 Questions 8-10
Currently, the inpatient pharmacy and 107 clinics with more than 5,500 providers and staff are using APeX in the UCSF Medical Center. APeX provides a single, patient-centered medical record to facilitate seamless interaction with patients and caregivers to improve collaboration, quality and patient safety. By providing a single tool to share information, UCSF is transforming how providers, staff and patients exchange information across all care settings. At every point in the care process, APeX supports clinical decisions to protect patient safety and encourage compliance to organizational best practices to deliver better quality of patient care.
Resident Council 11 CTSI Update 11 Procedures Consult 12 Incentive Update 13 GME Events Gallery 14 GME Diversity 15 GME Cypher 16
eMar and BCMA On February 26th, the new APeX inpatient pharmacy module with the electronic medication administration record (eMAR) and barcode medication administration (BCMA) went live at Parnassus and Mount Zion. Pharmacists, pharmacy technicians, nurses, and respiratory therapists are using this medication safety system with advanced bar code technology for drug identification and a single integrated medication record to improve the coordination of care and patient safety by dramatically reducing the risk of transcription and medication errors. Inpatient Implementation and Training On June 2, 2012, APeX will be rolled out across all UCSF hospital settings. This marks the transition of our inpatient systems from paper to almost completely electronic and includes: inpatient clinical documentation, computerized provider order entry (CPOE), scheduling, registration, admissions, discharges, transfers, and billing. The inpatient implementation represents a major change from past practice and presents many challenges in the short term. Proper training for all providers, particularly residents and clinical fellows, is essential for a smooth go-live. All providers, including those that have completed ambulatory training, must complete additional training prior to using APeX in the inpatient setting.
UCSF School of Medicine Graduate Medical Education 500 Parnassus Avenue MU 250 East, Box 0474 San Francisco, CA 94143 tel (415) 476-4562 fax (415) 502-4166 www.medschool.ucsf.edu/gme
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A comprehensive training program of online and classroom training is required for all providers, including residents and clinical fellows. Having learned a great deal from the ambulatory deployment, significant changes were made to the training in order to provide a more targeted and effective experience. Required training is dependent upon each individual resident and clinical fellow’s rotations, but all providers must complete a combination of webbased and classroom training. Web-based training must be completed prior to classroom training and will take approximately four to six hours on average. The Training Plan Finder, a new tool developed to help providers determine the web-based training they must complete, is available at http://apextraining/providers/index.html and residents and clinical fellows are
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APeX implementation update (continued from page 1)
encouraged to use this tool to access their web-based training using their UCSF employee ID or Medical Center provider ID. Classroom training will take another four to eight hours on average. Classroom training sessions will begin April 23, 2012. Program coordinators will schedule classroom training on behalf of their respective residents and clinical fellows. After completion of all training, residents and clinical fellows will receive access to the training playground to practice prior to go-live. Access to the APeX inpatient system will be automatically granted on June 2nd.
Additional Computer Work Stations In addition to training providers and other APeX users to ensure a successful go-live, there must also be a sufficient number of computers available on all floors and services in the hospital. More than 180 computers have been placed on all patient units at Moffitt-Long and Mount Zion, increasing the number of available computers from 245 to 428. As of February 2012 every patient room has a computer. In the ICU there is a COW (computer on wheels) in each patient room, one outside of each room, and additional computers at each of the nurse substations. To solve space issues old linen closets on Long 6 through 15 were converted to alcoves that hold three stand-up computer work stations. There are also plans to add 10 to 14 new computers in the operating rooms and PACU. View Only Access Residents and clinical fellows who are not yet trained to use APeX, but are current UCare users have been granted “view only� access to APeX and may use their UCare log-in and password. For brief training on view-only access and eMAR, residents and clinical fellows should go to the UC Learning Center If you have questions, contact the IT Service Desk at 514-4100. Wave 4 Ambulatory Implementation In addition to the inpatient implementation, there are still clinics and other ambulatory services that will go-live between April and September. Due to the complexity and geographic diversity of the clinics and services, Wave 4will be completed in a phased approach. The following is an overview of Wave 4 clinics. For more information please go to http://myapex.ucsf.edu/ambulatory/overview/waves.html - Wave 4a, April 18, 2012: Satellite Clinics, Reproductive Genetics, Neurosurgery, Surgery Clinics, Ophthalmology, Proctor Foundation, and Physical Therapy/Rehabilitation Services (adult and pediatrics) - Wave 4b, June 1, 2012: Solid Organ Transplant, Orthopaedic Institute, Center for Reproductive Health, Radiation Oncology, Pediatric Rehabilitation, and Spina Bifida - Wave 4c, September 18, 2012: Infusion/Transfusion (Parnassus and Mount Zion), General Otolaryngology, Osher Center, and Headache Center Additional Information For more information regarding APeX, go to the APeX intranet at myapex@ucsf.edu or email questions, comments, or concerns to. AskAPeX at askapex@ucsfmedctr.org Technical issues and questions should be directed to the APeX Service Desk at 514-APEX (2739). 2 www.medschool.ucsf.edu/gme
NEWS FROM SFGH Doug Eckman, MBA Operations Manager, SFGH Dean’s Offfic
SFGH REBUILD HITTING MAJOR MILESTONES After months of digging and underground foundation work the SFGH Rebuild is moving upwards. Steel construction began in late December and is progressing quickly. Over 11,000 beams will be bolted and welded into place to form the nine-story hospital. Look for an invitation to celebrate the placement of the final steel beam in fall of 2012! HEROS AND HEARTS The seventh-annual Heroes & Hearts Luncheon took place on February 9, 2012 recognizing people in the San Francisco community who have demonstrated exceptional community service. The event benefits the San Francisco General Hospital Foundation and has become one of the city’s most popular and moving occasions. This year’s heroes include our own Richard Coughlin, MD. He is co-founder of the Institute for Global Orthopaedics and Traumatology at San Francisco General Hospital and Trauma Center (SFGH). Coughlin was nominated for the award by a U.S. Army Iraq War veteran who survived a suicide bomber attack in July 2011 when his vehicle was hit while serving as a private security contractor. After being stabilized in Iraq and Germany, he was evacuated to SFGH and was treated by Dr. Coughlin as his surgeon. NEW BIKE STORAGE AT SFGH The repair of a design flaw in the new double-deck bike enclosure is complete. The new bike cage has been available as of early April. The storage area is located south of the main hospital entrance. It has two levels of racks that will expand the capacity for secure bike storage at SFGH. The area is lit and electronic access allows employees with a hospital ID to open the bike enclosure gate with a SFGH ID badge. Housestaff should contact their SFGH site coordinator if they need a SFGH ID badge.
Upcoming Events GME GRAND ROUNDS What Residents and Nurses Know about Healthcare Systems (and others don’t). April 17, 2012, N-217, noon-1p.m. Doris Quinn, PhD & John Bingham Office of Performance Improvement UT M.D. Anderson Cancer Center *
“Comfortable being uncomfortable”; Accepting risk, uncertainty, and doubtA Surgeon’s perspective May 15, 2012, N-217, noon-1p.m Wen T. Shen, MD, MA Asst. Professor, UCSF Department of Surgery
Confidential GME Helpline
415-502-9400 Confidential line for housestaff,
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“Documenting Reality and the Reality of Documentation”: Key lessons in billing and quality for UCSF and beyond June 19, 2012, HSW-303, noon-1p.m. Michelle Mourad, MD Asst. Professor, UCSF Department of Surgery 2010 UCSF PPD CLINICS April 23 & 25 - Moffitt 195 (Old Discharge Room) - 4pm-6:30pm 2012 SPRING TEACHING SKILLS WORKSHOP May 29, 2012 Faculty Alumni House - 3p.m. to 6p.m. RESIDENT AND FELLOWS COUNCIL Third Monday of each month - 5:30p.m. to 7:30p.m.
faculty, and program administrators to voice their questions, comments, or concerns 24 hours a day. The Office of Graduate Medical Education will respond to all messages. 3 www.medschool.ucsf.edu/gme
OUT & ABOUT from the Resident and Fellow Affairs Committee Where members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF.
Ice Hockey in the Bay Area Ellen Haller, MD, Professor of Clinical Psychiatry and Program Director, Psychiatry Residency Program Amy Day, MBA, Director of Graduate Medical Education
Did you know there are more than 13,500 adult, amateur ice hockey players registered with USA Hockey in the state of California alone, which is the second highest in the country only to Michigan (22,500)? Once you start paying attention, you notice hockey sticks in the backseats of cars; people with gigantic duffle bags walking into ice rinks; and men and women at public skate with fancy moves like crossovers skating backwards faster than you skate forward. If you think hockey is only played by those with anger management issues who are missing teeth you are sorely mistaken! In fact, we’d be willing to bet you have worked with at least one or two ice hockey players at UCSF in your tenure here, who still have all of their teeth and haven’t ever punched anyone during a game. The Bay Area has so much to offer to those of us with a love of this often misunderstood sport. Ice Rinks There are rinks all over the Bay Area that offer ice ideal for playing hockey, figure skating, and other ice sports like curling, as well as simply for an hour or two of ice skating. Public skate times, which are offered at all of the rinks listed below, are perfect for honing your skills, entertaining your children, or just doing something different for a couple of hours. Some of the more popular rinks in and around San Francisco are: Yerba Buena Ice Skating and Bowling Center, San Francisco (www.skatebowl.com); Ice Center at San Mateo (www.icecenter.net/sanmateo/); Belmont Iceland (www.belmonticeland.com); Ice Oasis, Redwood City (www.iceoasis.com); Ice Center at Cupertino (www.icecenter.net/cupertino); Sharks Ice at San Jose (www. sharksiceatsanjose.com); Sharks Ice at Fremont (www.sharksiceatfremont.com); and Oakland Ice Center (www.oaklandice.com). Lessons and Practice Like any hobby or sport, with hockey, practice makes perfect! While you may wear your ever-stylish and very flattering hockey gear to public skate (which is highly recommended to avoid injury), you cannot take your stick or pucks on the ice. Therefore it is advisable to attend open ice times for hockey players, which are affectionately called Stick and Puck Time or Gretzky Hour (you cannot go on the ice without full gear). These are often held at odd hours and can get very full, so get there early and be ready to dodge pucks and crazy skaters! In addition to these practice times, the rinks mentioned above also offer group hockey skills and skating classes as well as private lessons. Where to Play So, we’ve convinced you and now you want to play? The best way to play in the Bay Area is to join a league. For men, there are leagues that play at the rinks listed above. Many of these rinks also host co-ed leagues. Keep in mind that it can be very difficult for men to get onto a league team. Most teams are formed through invitation only or try-outs. However, some of the beginning divisions/leagues are linked to hockey classes at some of the rinks mentioned above, so that’s always a good way in. 4 www.medschool.ucsf.edu/gme
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For women, the premiere league (we both play in this league, so we are biased!) in the Bay Area and also the largest women’s league in the country is the Northern California Women’s Hockey League (NCWHL). There are four divisions to accommodate all levels of play – beginner to absolutely amazing! It is a fun, collegial environment and no prior hockey experience is required (that’s how Amy Day started a year ago after only skating a few times as a kid!). The league hosts several Give Hockey a Try Days throughout the year for women to preview the sport. The league provides all needed protective equipment for these GHATDs, as they’re affectionately known, and all coaching is by women—including Ellen Haller! (www.ncwhl.com). Other opportunities to play in a hockey game or two in the Bay Area are regularly occurring pickup games at most of the rinks listed above (schedules can be found online). Some games are more challenging than others, so it’s a good idea to call ahead to know what you are getting into. Where to Buy Gear Be forewarned…hockey gear can be expensive, but once you buy your equipment you’ll have it for a really long time unless you really catch hockey fever and want to upgrade to the next best thing! While there is a lot of it, most individual pieces of equipment can be purchased relatively inexpensively. However, spending a little more money on your skates isn’t a bad idea. Local purveyors of a wide selection of gear as well as excellent customer service and vast knowledge include Hockey XSport in Oakland (http://www.hockeyxsport.com) and PowerPlay Hockey in San Jose (http://www.powerplayhockey.com). And as with any type of shopping, you can always find great deals online. Watch Hockey If even after reading about the abounding opportunities to play hockey in the Bay Area you still aren’t ready to jump on the ice, maybe you should consider going to a game to see how the professionals do it. The San Jose Sharks have been representing the Bay Area in the NHL at HP Pavilion in downtown San Jose since 1993. The six time division champions, who took second in the 2011-2012 season, greet their adoring fans each game by skating through a gigantic shark head with a 17-foot open mouth and sinister flashing red eyes. Teal and black adorned fans doing “The Chomp” at the beginning of each Sharks power play to the Jaws theme will be rewarded for their dedication if the team scores in the final two minutes of the second period with two free tacos from Jack in the Box. Everyone should experience the thrill of the Shark Tank at least once by watching Captain Joe Thornton lead his Sharks to a victory with a few good checks into the boards and a punch or two along the way! http://sharks.nhl.com/index.html After more than 15 years, professional hockey returns to San Francisco later this year. The San Francisco Bulls, the newest member of the ECHL “AA” hockey league, will play their first game at their new Cow Palace home in October 2012. The schedule has yet to be released, but season tickets are already available for purchase. The ECHL is the primary developmental league for the NHL. http://sfbulls.com
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OUT & ABOUT from the Resident and Fellow Affairs Committee Where members of the Resident and Fellow Affairs Committee recommend their favorite scenes outside UCSF.
Golf in California Lessons I often am asked about lessons; my answer varies according to level of player. As someone who has taken a lot of lessons in my life (including flying across the country to find the perfect instructor) I have plenty of opinions about teaching pros, swing theories, etc. Bottom line is I won’t commit to an answer in this article but am happy to give advice in person!
Patricia Cornett, MD Professor of Medicine Associate Chair for Education SF Veterans’ Affairs Medical Center Captain, United States Curtis Cup Team, 2012
Here in San Francisco, we are fortunate to live in one of the premier golf areas of the world. As a native Northern Californian and as someone who has played a fair amount of golf, I wanted to share some of my recommendations on practicing and playing golf in the San Francisco area. Driving Ranges Before scheduling that dream round, one should make a few trips to the practice range. I personally like grass ranges; the only public grass range in SF is located at the Presidio Golf Course and even then, they limit access to grass depending on weather and day of the week. The other downside to this range is hitting downhill (better than uphill!) plus the often intense wind. Other choices for golf ranges down the Peninsula include San Bruno, Mariners Point and Burlingame. Each of these has artificial mats but you may also be able to pay extra to hit off grass. In Marin, Peacock Gap has a nice grass range with good balls. The other choice in Marin is McGinnis, located off of Smith Ranch Road. 6 www.medschool.ucsf.edu/gme
Golf Courses There are a number of ratings searchable on the internet for golf courses in Northern California. Below I list my recommendations by category. Best Courses for Beginners Mariners Point (a par three executive course) • Lincoln Park (and what a view on #17!) • McGinnis Park (a par three executive) Best Public Courses Within 30 miles of SF • Harding Park—hard to beat if you are a City resident! • Half Moon Bay- 2 courses to choose from, the Ocean (with better views and newer), the Old Course; both of these are somewhat pricey but fun to play • San Geronimo—I think this makes the 30 mile limit, located out on Sir Francis Drake towards Pt Reyes; this course is in generally good shape, is relatively inexpensive and often has nice weather when SF is fogged in. • Stanford Golf Course—Well, kind of public if you can know an alumnus. This course has a wonderful layout, in good shape and features great weather. • Poppy Ridge- This is an NCGA course so if you are a member, you can play here for about $50. There are 3 nines, all are very well maintained. This may be outside of 30 miles but worth the trip! (continued on page 7)
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Best Private Courses Within 30 miles (Note, many faculty are members, you just have to identify them and then twist their arms!) • Olympic Club: 2 full courses and an executive course. The Lake course is a top 10 course. Access will be limited in 2012 as it will be hosting the US Open in June. • San Francisco Club: A Tillinghast design, this is a top 50 course. • Meadow Club: A McKenzie design and located in Marin, this is a very special place! • Lake Merced CC: A wonderful layout with challenging holes; it will host the US Junior Girls in 2012. Best Long Weekend Trips for Golf Monterey: Nothing beats the Monterey Peninsula for golf. Public play choices include Pebble Beach, Spyglass, Spanish Bay (all quite pricy),Poppy Hills (another NCGA course and for NCGA members, moderately priced), Del Monte, Bayonet. One can also play at Pacific Grove Golf Links, the “poor man’s Pebble Beach”. Consider going over highway 17 on the way down or up and play Pasatiempo just outside of Santa Cruz (another McKenzie design). One tip would be to join the Dukes Club; membership gives you discounts to playing Del Monte, Spyglass and Spanish Bay. You can find out more details on the internet. Also, don’t bother with the Peter Hayes nine holes layout at Pebble Beach! Bandon Dunes: Well, maybe this beats Monterey. They now have 4 incredible courses, with terrific accommodations. This trip is great for golf buddies; non-golfers would get bored much too easily. Consider booking off season to get better rates as one can sometimes luck out on the weather in March and November. Downside is that there is absolutely no easy way to get there; I have as yet to leave home and get to the first tee in under 10 hours! Bring some money for the poker games in the Bunker Bar!
Sierra Nevada: There are wonderful courses in the Lake Tahoe and Reno areas and non golfers would have much to do for entertainment. Other Thoughts Consider a day trip to Sacramento—courses there are cheaper to play and in the summertime, you can get out of the fog belt! My personal favorites are Teal Bend, Whitney Oaks, Turkey Creek. And if you are up in this area, you have to stop at Haggin Oaks; It has the most amazing golf store in Northern California. Don’t miss the separate golf shoe store! Stevenson Ranch near Turlock; I have always enjoyed this course in the Valley; you can find special rates and the course is designated as an Audubon Signature course, with very nice views of birds and wildlife on the premises. Somehow, shooting a bad score here doesn’t feel so bad! San Juan Oaks near San Juan Bautista: This course winds through the hills in a rural setting and has a very nice ambiance. And then, you can stop at the San Juan Bautista bakery and have a nice dinner in town! - Eagle Ridge near Gilroy - Cinnabar Hills in San Jose: 3 nines to choose from. - The Bucket List for Serious Golfers, i.e. somehow, someway, figure out how to play these courses. - Pebble Beach (Public) - Spyglass (Public) - Cypress Point (Private) - San Francisco Club (Private) - Olympic Club (Private) - Pasatiempo (Public) I hope you enjoy these courses and please, do feel free to send me an email or stop by my VA office for any questions! 7 www.medschool.ucsf.edu/gme
10 QUESTIONS FROM THE RESIDENT AND FELLOW AFFAIRS COMMITTEE organizations to accelerate the rate of improvement and efficiency in their clinical care and maximize reimbursement.
Erica Lawson, MD, fellow in Pediatric Rheumatology, and Tracey McLean MD, 4th year resident in Obstetrics-Gynecology, represented 1. Can youhousestaff describe the malpractice insurance the UCSF at the Studer Group’s 9th annual What’s Right in Health Care® in October 2011, in Chicago. They join coverage forconference UCSFheld trainees? Is there tail with Mary McGrath, MD, GME Director of Resident and Fellow Affairs, to answer questions about the role RFA that theCommittee Studer Group® will play at 10 Questions.....from the UCSF.
1) What is the relevance of the Studer Group® to UCSF? The Studer Group® was engaged by UCSF Medical Center as a partner for a three year period beginning in November 2011. A principal consultant from the Studer Group® began visiting UCSF to interview physicians and staff in September 2011 and she and others from the organization will continue on-site to provide coaching and education for UCSF leadership, physicians, and staff. Inclusion of UCSF residents and fellows was a priority from the outset since the topics of physician engagement and physician communication will figure prominently. 2) What is the Studer Group®? Studer Group® works with over 800 healthcare organizations in the U.S., teaching them how to achieve, sustain, and accelerate exceptional clinical, operational, and financial outcomes. The goal is readying the organizations to be able to execute quickly in the face of the rapid changes occurring in the healthcare industry due to the Patient Protection and Affordable Care Act ushering in the pay-forperformance era. As publically reported healthcare metrics expand—and as reimbursement is increasingly tied to these results—organizations are vying to get progressively better at providing demonstratively high quality care. Studer Group® coaches their partner 8 www.medschool.ucsf.edu/gme
3) What are the goals of the Studer Group®? The Studer Group® offers a wide range of services and works across all facets of a hospital. They engage hospital employees of all stripes, including physicians, nurses, staff, and hospital leadership, to help align organizational goals. Among the Studer Group’s goals is helping partner organizations achieve favorable HCAHPS results. HCAHPS, or Hospital Consumer Assessment of Healthcare Providers and Systems, is a national standardized survey tool used to measure adult inpatient perception of the quality of care they receive at an acute care hospital. The 27-question survey was created in 2002 by the combined efforts of The Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ). Scores are publicly posted four times a year at www.hospitalcompare.hhs.gov Essentially, the scores are a measure of patient satisfaction. Since 2007 most hospitals have been required to submit HCAHPS results in order to receive full Medicare payment. In the future HCAHPS will play an even larger role in reimbursement. The Patient Protection and Affordable Care Act, signed into law in March 2010, establishes a Value-Based Purchasing (VBP) plan beginning in FY2013 (based on hospitals’ performance in 2012 on measures that are part of the hospital quality reporting program). This will transition providers from HCAHPS pay-forreporting to HCAHPS pay-for-performance. The Studer Group® has developed evidence-based tools and tactics that are proven to elevate patient perception of care. The organization reports that their partners consistently enjoy higher HCAHPS results than non-partners do, - outperforming them by an average of 20 percentage points across HCAHPS measures. 4) What approach does the Studer Group® take to improve quality? With the help of a dedicated Studer coach, a hospital pinpoints areas that need improvement and starts implementing tools to overcome these obstacles. A framework called “Evidence-Based Leadership” is used to identify goals the hospital wants to set for
10 Questions.....from the RFA Committee improvement, the tactics and “must-have” behaviors to achieve those goals (examples might be: Standards of Behavior, Rounding, Selecting and Retaining Talent), the standard processes that would be utilized throughout the hospital, as well as the “accelerators” that would hold all employees accountable. The Studer Group® describes “Five Pillars” to guide a medical center’s organizational work: Quality & Safety, Service, People, Education & Research, Growth & Finance. With these five focuses, hospitals have been shown to move the patient experience, improve the relationships between patients and associates, and enhance the organizations’ culture and performance. The idea is that these are fundamentals for the efficiency, discipline, and accountability that culminate in improved quality. 5) What has the Studer Group® accomplished at other hospitals? According to Center for Medicare and Medicaid Services data as of August, 2011, hospitals that implemented Studer’s “Evidenced-Based Leadership” framework outranked non-partner hospitals on the following measures reported in patient surveys (present difference in score): Overall rating 25% Willingness to recommend 22% Pain management 21% Doctor communication 9% Nursing communication 21% Communication about medications 14% Discharge information 11% Quietness at night 11% Responsiveness of staff 10% A few examples of success with specific tools include the information that partner hospitals that implemented an evidence-based practice known as Hourly Rounding (by nurses) reduced pressure ulcers, falls, and call light rings. The reported average return on investment for partnerships is greater than 5:1. 6) Can you give us some practical examples of how-to’s that the Studer Group® provides? One important emphasis is that placed on “Talent”. This is described as finding high-performing staff persons with a “customer-service” oriented attitude. Expectations of excellence are integrated into the orientation process and performance evaluations
which hold everyone accountable at all levels of the organization. A “Leadership Evaluation Module” is integrated as a way to hold high-level managers and executives accountable for reaching their personal goals. Best Practices at other institutions that might be incorporated into operations include: post-discharge phone calls, team rounding for outcomes, managing low performers up or out, thank you notes, leadership development programs, patient prioritization initiatives, staff engagement surveys, staff forums and nursing town hall meetings, senior leader rounding to hospital departments. 7) Where does the physician fit into this model of performance improvement? Physician coaching is an integral component and physicians at other medical centers have responded well to focused, data driven coaching. As a measure of success, patients’ satisfaction with their physicians scores measured by Press-Ganey or HCAPS surveys have shown steady and significant improvement at these institutions. Importantly, the Studer Group® approach emphasizes improved physician satisfaction as much as improved patient satisfaction. Very briefly, a curriculum for the physician coaching includes executing the goals of (1) communicating the purpose and vision of the coaching initiative effectively to the doctors, (2) creating an effective physician leadership model, (3) setting performance measurement goals, (4) facilitating a higher level of professionalism for physicians, (5) implementing strategies and tools that improve patient perception of care, and (6) improving physician satisfaction. For more information about physician involvement, go to http://www.studergroup.com/physicians 8) Where do UCSF residents and fellows fit into the initiative? Residents and fellows will be included in the physician coaching and will have the opportunity to receive training in Studer Group® methods and to participate on the service excellence teams. Medical staff involvement has not yet been defined since the partnership is still in its fact-finding stages. The consultants are meeting with both medical center and medical school physicians, including house-officers, (continued on page 10)
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10 Questions.....from the RFA Committee (continued from page 9)
to survey and analyze UCSF specific needs; from this a comprehensive physician coaching plan and strategy will be formulated in collaboration with UCSF physician faculty and house-officers. 9) What has the Studer GroupŽ already done at UCSF? The Studer GroupŽ partnered with the UCSF Emergency Department in March 2011. Since then, there has been a Studer GroupŽ representative on-site in the ED one day a month to conduct full-day sessions of training classes and workshops for the entire multidisciplinary ED team. An experienced physician coach was brought in to meet with the ED residents. The coaches have focused on patient flow models, techniques for keeping patients updated and informed about their progress through the ED, and strategies to improve overall patient satisfaction. The Studer GroupŽ engagement with the ED will extend through July 2012, and preliminary results show improvements associated with the changes in workflow and patient care practices. 10) How is the Studer GroupŽ initiative different from other quality improvement initiatives at UCSF? One primary difference is the emphasis on people, positive relationships, and creating a positive work culture in the healthcare industry. In his book, Hardwiring Excellence (Fire Starter Publishing, 2003), Quint Studer defines “excellence� as “when employees feel valued, physicians feel their patients are getting great care, and patients feel the service and quality they receive are extraordinary�. Reducing hospital-acquired conditions and preventable readmissions takes measurement, analysis, planning, and education. But, after identifying best practices and building systems that minimize the chance of error, delivering and sustaining excellent care requires people. Studer argues that there are skilled, caring people working in medicine, but that our institutions do not support passion, creativity, commitment, joy, and pride. The Studer GroupŽ ranks improved patient and employee satisfaction as an element as important as patient satisfaction.
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UCSF RESIDENT AND FELLOW’S COUNCIL Robin Horak, MD and Lisa Le, MD Resident and Fellow’s Council Co-Chairs
The Resident and Fellow’s Council (RFC) continues to advocate for UCSF h ousestaff, on issues ranging from quality of life to training and education. Here is what we have been working on this year. This spring we are coordinating tips from multiple departments to improve the consult calling experience. The hope is to consolidate this information into an accessible format for fellows and residents to make the consulting experience more helpful and educational. So far psychiatry and pathology have created helpful handouts that will soon be on the web. We hope to have this list expanded by the end of the year. Fortunately, resources continue to be available in the Patient Care Fund for resident and fellow designed projects to improve the patient experience. With the fall application process we were able to fund four projects, with several other applications channeled for direct funding from UCSF Medical Center. Funded projects include a piano for the 11L solarium, resources to create a pediatric asthma education video, educational and instructive Neuroboards for inpatient and outpatient Neurology, and pilot funding for a discharge medication co-pay fund. In addition, we are luckily able to offer a second funding cycle. An additional round of applications were accepted through February. For more information on the Patient Care fund please go to http://medschool.ucsf.edu/gme/residents/pcf.html. We continue to support resident representation and leadership throughout the Medical Center. To support this goal, we have been hard at work placing residents and fellows on various committees throughout the Medical Center, and have succeeded in matching residents and fellows to over 18 committees. If you have an interest in sharing a resident voice on a committee please contact us as there are regular openings. Finally, we continue to lobby for resident needs from re-working the new resident and fellow relocation reimbursement, a library/study space at Mission Bay, pager etiquette, and shuttle accessibility. If you have questions, ideas, or concerns please consider joining us at our next meeting. In general we meet the third Monday of each month. To get involved please contact us, your department representative… or come to a meeting!!! New members are always welcome.
CTSI UPDATE: Training and Funding Opportunities for Spring 2012 Christian Leiva, CTST Coordinator
The Resident Research Training Program (RRTP) of UCSF’s Clinical and Translational Science Institute (CTSI) offers several programs and support to help promote resident career development - http://www.epibiostat.ucsf.edu/courses/schedule/course_descriptions.html The annual Resident Clinical and Translational Research Symposium (RRSy) will be held on Wednesday, May 2, 2012, in Millberry Union from 4 pm –7:30 pm and provides an opportunity for residents to present their work and to develop cross-departmental collaboration. Awards for outstanding research and mentoring will be announced. For more information, please go to http://accelerate.ucsf.edu/training/resident#research The Resident Research Travel (RRT) Program provides up to $600 of travel funding per academic year to full-time UCSF residents to present their clinical or translational research abstract at a clinical or scientific conference. For more information, please go to http://accelerate.ucsf.edu/funding/funding-for-residents#travel. The Resident Research Funding (RRF) Program provides up to $2000 per academic year to residents for qualified clinical and translational research expenses not covered by their mentor or other sources. The sing 2012 cycle application deadline is Sunday, May 13, 2012. For more information, please go to http://accelerate.ucsf.edu/funding/ funding-for-residents#funding The Resident Research Scholars (RRSc) Program awards full tuition, a research stipend and provides co-mentoring for up to two highly qualified UCSF residents who enroll in Advanced Training in Clinical Research (ATCR), a one-year training program sponsored by the Department of Epidemiology. The application deadline is Monday, May 14, 2012. For more information, please go to http://accelerate.ucsf.edu/funding/funding-for-residents#scholar he Clinical & Translational Research (CTR) Pathway provides a more structured program that promotes and recognizes research scholarship. As each individual resident may complete the requirements for the Pathway over the course of their residency, participation is done via Open Enrollment. For more information, please go to http:// accelerate.ucsf.edu/training/resident#clinical As in previous years, we plan to offer Designing Clinical Research for Students and Residents (Epi 150.04 and 150.04/150.05) during the calendar months of August and October 2012. Residents may enroll for free..
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Procedures Consult: An Online Resource to Review Key Clinical Skills Susan Promes, MD, Director, Curricular Affairs, GME Josephine Tan, MLIS, Education and Information Consultant
“See one. Do one. Teach One…Made Better and Safer”. That’s the tagline of Procedures Consult, an online resource that is available to you thanks to the UCSF Medical Center and the Library’s joint efforts to set up a subscription to this tool. This comprehensive and concise procedural reference tool details how to prepare for, perform and follow up on the most common medical procedures. Procedures Consult can be accessed at http://www.library.ucsf.edu/db/procedures consult
Key features include: Videos and illustrations for each procedure Self-directed procedures training and testing with trackable results Pre-, During, and Post-procedure reference Procedural checklists and Universal protocols Billing codes for procedures Additional educational benefits: Highlights when patient “informed consent” is required Reinforces Joint Commission patient safety concepts Conforms to ACGME and ABMS (American Board of Medical Specialties) standards Searching or browsing this resource is simple. Helpful ways to browse the content from the Procedures Consult homepage are to: (a) look under the Procedures by specialty listed in the left menu bar (b) type a specific procedure into the search box, or (c) select a particular region on the illustration of the human body. On the right is an example of what a procedures listing contains. Go to http://tinyurl.com/pconsult to view a short narrated video tutorial on how to navigate Procedures Consult. Options of where to access Procedures Consult: Listed under the Popular Resources section on the Library’s homepage Download the Clinician’s Toolbar to your browser for a one click link to Procedures Consult How to access this resource on your mobile device: Go to m.proceduresconsult.com Also check out the UCSF mobile page at m.ucsf.edu developed by the Library Top 4 Reasons to use Procedures Consult: Clear and concise information about how to perform major medical procedures Excellent self-review of information you need to know for critical clinical skills training Ideal teaching tool to offer residents, students, and other medical trainees that allows them to track their learning via self-paced tests [You tell us.] Test drive Procedures Consult and let us know what you think: Where else should we make a link available to this resource? Is it comprehensive enough to suit your needs? Contact Susan Promes susan.promes@ucsf.edu ) or Peggy Tahir peggy.tahir@ucsf.edu with feedback or questions. Josephine Tan is on leave through May 16, 2012; in her absence, please contact Peggy Tahir. 12 www.medschool.ucsf.edu/gme
INCENTIVE UPDATE Glenn Rosenbluth, MD Director, Quality and Safety Programs, GME
We are pleased to share the mid-year results from the Housestaff Incentive Program incentive goals. As you can see, we are making great progress in two of our goals: Patient Satisfaction: (goal is to maintain an average mean score of 90.7)
Hand Hygiene: (goal is 85% compliance)
However, Lab Test Utilization still needs improvement for us to achieve success. As a reminder, our goal is to decrease by 5% utilization of our most commonly used tests. We aren’t far from our goal, but utilization hasn’t improved at all this year! I encourage you to take a few moments to discuss with your teams strategies to decrease lab test utilization. (continued on page 15)
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GME EVENTS GALLERY UCSF GME at National Meetings February - April 2012
UCSF GME participates in the Latino Medical Students Association (LMSA) Conference in Boston, February 3 - 5, 2012 Rene Salazar, MD, GME Director of Diversity with UCSF Residents at the Student National Medical Association (SNMA) Conference in Atlanta in April 2012
UCSF GME Second Look Program & Reception at Circolo Restaurant January 20, 2012 Applicants at the Second Look Program at UCSF
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Second Look event reception for applicants at the Circolo restaurant
GME DIVERSITY Rene Salazar, MD GME Director of Diversity
Our fifth annual Diversity Second Look program was held on January 20, 2012. Several departments participated in this opportunity for applicants to revisit UCSF and learn more about our training programs including our commitment to promoting diversity in our residency training programs. Activities included a discussion entitled “Diversity at UCSF” led by Dr. René Salazar, GME Director of Diversity. This was followed by a panel discussion with current housestaff led followed by a reception at Circolo Restaurant in San Francisco’s Mission District. Over 40 applicants, faculty, fellows and housestaff from several departments attended the evening reception. Thank you to everyone who participated and to Paul Day who helped organize this year’s activities. The 7th Annual National Latino Medical Student Association Conference was held on February 3-5, 2012 at Harvard Medical School. GME participated in this year’s residency fair reaching out to Latino and other underrepresented medical students from across the country. Thank you to Leticia Rolon (PGYII Medicine) and Anneliese Johnson (PGYII Medicine) for attending and representing UCSF at this meeting. GME sponsored an exhibit booth at the tudent National Medical Association meeting on April 5-8, 2012 in Atlanta, GA. For more information or to learn how you can get involved, please contact Dr. René Salazar, GME Director of Diversity via email: salazarr@medicine.ucsf.edu or phone (415) 514-8642. INCENTIVE UPDATE...
(continued from page 20)
Below, you can see a “price list” of tests. This is what your patients see for every lab test ordered: UCSF Clinical Laboratory Price List CBC Sodium Chloride Potassium Total CO2 BUN Creatinine Calcium Magnesium Alk Phos ALT AST Total Bilirubin
$ $ $ $ $ $ $ $ $ $ $ $ $
107.00 60.59 58.47 58.47 61.65 48.90 63.78 64.84 83.98 64.84 65.91 64.84 64.84
Here are some great tips provided by Tim Hamill, Director of UCSF Clinical Laboratories; remember – the goal is to reduce only the unnecessary testing
Calcium, Magnesium Phosphorus These tests seem to just ‘roll off the tongue’ as if they represent a single test. The actual incidence of magnesium and/or phosphorus abnormalities, except in fairly specific clinical conditions is relatively low and so these test often come back within the normal range. If you feel that it is clinically appropriate to check magnesium and/or phosphorus levels in your patient, do so. But if normal, consider only rechecking these if clinical symptoms or the patients underlying disorder justifies re-checking. Electrolytes Except when needed for assessing the anion gap there is often little justification for ordering all four ‘electrolytes’ simultaneously as a group (e.g. Na, K, Cl, CO2). This is particularly true for Chloride and Total, CO2 which rarely add additional information outside of assessing the anion gap. Order only the electrolyte(s) that you want to assess rather than all four tests. BUN and Creatinine While there are certainly clinical indications for ordering both of these tests to assess renal function it is typically not necessary to order BOTH tests for ongoing patient monitoring. The information provided by these tests is often redundant and unnecessary. While there are advocates for each of these individual tests in specific populations or clinical circumstances it is beyond the scope of this ‘tip’ to try to argue for one in favor of the other. Pick whichever test you prefer but simply get into the habit when monitoring a patient to only order one, not both. 15 www.medschool.ucsf.edu/gme
THE OFFICE OF GRADUATE MEDICAL EDUCATION
G M E
Welcomes New Program Directors and Program Coordinators
C Y P H E R
Solve the Winter 2 0 1 2
C y p h e r
Program Directors
Hubert Kim, Orthopaedic Surgery Ngoc Ly, Pediatric Pulmonary Robin Randall, Child and Adolescent Psychiatry Stephen Rosenthal, Pediatric Endocrinology Siegrid Yu, Procedural Dermatology
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Nick Chapman, Preventive Medicine (Occupational and Environmental Medicine) Caren Hale, Molecular Genetic Pathology Joannie O’Leary, Urology Sharon Poisson, Vascular Neurology Happy retirement to Ira Lezcano, Molecular Genetic Pathology!
The Residents Report
Editorial Staff: Amy Day Paul Day Gitanjali Kapur Sharon Freeman
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Program Coordinators
Winter/ Sprint 2012
Instructions: The above is an encoded quote from a famous person. Solve the cypher by substituting letters: Send your answers to Sharon Freeman: freemans@medsch.ucsf.edu Correct answers will be entered into a drawing to win a $50 gift certificate!
Many Thanks The Office of Graduate Medical Education would like to thank the following contributors for submitting articles.
Contributors
Faculty and Staff Assistance Program University of California San Francisco 3333 California St., Suite 293 San Francisco, CA 941430938 (415) 476-8279
For additional information, please visit our website at: http://ucsfhr.ucsf.edu/index.php/assist/ For an appointment, please call (415) 476-8279
Michael Blum Kim Cloidt Patricia Cornett Amy Day Doug Eckman Ellen Haler Robin Horak Erica Lawson Lisa Le Christian Leiva Mary McGrath Tracy MClean Susan Promes Glen Rosenbluth Rene Salazar Josephine Tan
Important GME Contact Information Office of GME
(415) 476-4562
GME Confidential Help Line
(415) 502-9400
Director, GME Associate Dean, GME UCSF Faculty & Staff Assistance Program (FSAP) GME Website
(415) 514-0146 daya@medsch.ucsf.edu (415) 476-3414 baron@medicine.ucsf.edu (415) 476-8279 www.medschool.ucsf.edu/gme
UCSF School of Medicine Graduate Medical Education 500 Parnassus Avenue MU 250 East, 0474 San Francisco, CA 94143 tel (415) 476-4562 fax (415) 502-4166 www.medschool.ucsf.edu/gme
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