UC Irvine Uses AHRQ Program to Create Patient Safety Class for Medical Students
The University of California (UC), Irvine, School of Medicine now requires students to complete a patient safety class that was developed based on information acquired from a program called SAFER California Healthcare, the Strategic Alliance for Error Reduction. SAFER was funded with an AHRQ grant. Another outgrowth of AHRQ funding has also led the medical school to pilot an ethics consultation liaison program in several of its hospital's intensive care units.
Felicia Cohn, PhD, Director of Medical Ethics at the University of California, Irvine, School of Medicine, developed the patient safety class and won approval to include it in the required curriculum for all medical students. The class began in 2003; approximately 100 students complete it annually.
In developing the patient safety class, Cohn first expanded the use of the hospital's incident reporting system, which includes—and encourages the reporting of—near-misses. The goal is to make patient safety an inherent part of the culture of medicine.
While medical students are generally "terrified to be viewed as whistle blowers," Cohn notes, because they fear retribution that could affect their advancement, the hospital has a secure confidentiality system in place. Reports are created under an anonymous "medicine clerkship" profile to allow students to submit information. The UC-Irvine hospital's medical director even visits the class to reassure students that the system will protect their confidentiality and address their concerns as it does with all other reports.
Furthermore, Cohn says, usually when a student reports an incident, it is not the first time a practice or caregiver's behavior has been cited. Patterns in behavior reported are common, further removing a particular student from any likelihood of being identified. It is such patterns that trigger systems-based responses.
"Medical students do more observing of physicians' behavior than anyone else," Cohn explains. "They can be very useful resources for improving the quality of the care delivered."
The class requires each student to create an incident report (labeled "This is a test case") and submit it online in order to pass their Internal Medicine clerkship. In most cases, students report something based in actual fact, though not always occurring at the UC-Irvine hospital. A few times, student reports have developed into actual incident reports after Cohn discusses them in class, and students volunteer more details and provide permission for follow-up.
"We want students to become comfortable with filing reports, which often take less than two minutes to create," Cohn says. After completing the class, some students later file actual incident reports.
Another program Cohn developed is an ethics liaison program that explores the impact of ethics consultation in intensive care units (ICUs). This effort arose both from the AHRQ SAFER grant and an earlier AHRQ grant.
Beginning in December 2005, a group of six ethics committee members (who possess the most clinical ethics experience) regularly visit intensive and specialty care units at the hospital seeking prospective opportunities for ethics issues. The ethics consultants' function is to provide educational content, model clinical communications skills, demonstrate the identification and management of ethical and professional issues, conduct ethics case analysis, and serve as ethics mentors by providing feedback to clinicians-all in an effort to bring about a culture change.
In order to begin this pilot, Cohn found that she had to develop a survey to determine the factors influencing ethical decisions. Were such decisions based on law, risk management, ethical principles, or something else? The survey was administered in November 2005 to all staff, including medical students, in the pediatric, neonatal, and surgical ICUs, as well as the cancer unit. While results of the survey are not yet available, nearly 100 responses were received.
The ICU visit goal is to have two ethics committee members each visit a unit at least once a month. Often the visits are made by participating in weekly unit interdisciplinary rounds, which allows a range of hospital staff members to become familiar with issues that may prompt a need for ethics consultations with Ethics Committee members. Cohn hopes this makes the process more comfortable for everyone and helps change the culture of medicine to incorporate attention to ethical matters before they become problems.
Cohn is grateful for the AHRQ support that has allowed many important initiatives that improve care for patients. "I'm a big fan of AHRQ," Cohn adds. "They do so much worthwhile work."