From the Director
Some great Duke victories this past week! Will there be 2 pick 6’s in the Turkey Bowl?
Thank you for your great energy for recruiting. Couldn’t have asked for a better kickoff week- special thanks to our tour guides, to Nick rohrhoff and Bronwen Garner for presenting at report and chairs, and to Joanne Wyrembak, Jason Zhu, Hal Boutte, Carling Ursem and Chris Hostler for talking with applicants at the end of the days.
Other kudos to Nick Turner from the MICU nurses, Erin Boehm and Amy Jones from the VA teams for taking some extra admits, to Jason Zhu from Nick Rohrhoff for strong work at the VA, and to Myles Nickolich and Brittany Dixon for coming in after a CAD night to say hi to applicants from their med schools. And, from Steve Bergin, a BIG thanks to Jessie Seidelman and Carling Ursem for being more than willing to help out in the very busy, short-staffed ACC last week.
If you haven’t read Chris Hostler’s email about Veterans Day, please do. If you are working at the VA tomorrow (or enjoying a free day on amb bc the clinics are closed), remember to thank a veteran for their service.
Big week this week – come out to watch the Duke-Kansas game, JARs are headed to Dr Klotmans for a networking event with the fellowship directors and division chiefs and we have a med student event on Thursday!
This weeks pubmed from the program goes to alum Steve Sumner! Association Between Earthquake Events and Cholera Outbreaks: A Cross-country 15-year Longitudinal Analysis; Authors Sumner SA, et al, Prehosp Disaster Med. 2013 Oct 29:1-6. [Epub ahead of print]
Have a great week
What Did I Read This Week
Submitted by Joel Boggan, MD
I reread this article this week after hearing about Jenn Rymer’s presentation at the AAMC conference about our housestaff incentive program. The UCSF incentive program, which began in 2007, was the prototype for our program here at Duke, and this paper from BMJ Quality and Safety from earlier in 2013 shows one of the successes they have had engaging residents in program-wide quality initiatives.
Background: Prior to the study, resident discharge summaries were completed at an average of 3.5 days after discharge. The goal of the project, decided on by residents and program leadership, was to have 75% of discharge summaries completed within 24 hours of discharge at UCSF’s main hospital. If this metric was achieved over a year-long period, each resident would receive an additional $300 of salary.Two residents commandeered the effort, leading other residents and faculty through brainstorming, analyzing the data, and performing PDSA cycles about what to include in a new discharge template. These residents also took a lead updating their peers biweekly on the performance metric when they rotated at UCSFMC.
Methods: To improve discharge summary timing, the group created an electronic discharge summary template, which included medication changes and full reconciliation, functional status at discharge, follow-up plans, pending tests and discharge instructions. Any team member could edit the template at any point during the hospitalization, and the template served as the discharge day note if completed on the same date as discharge.
Measurements included the time from patient discharge to resident completion of the discharge summary in days, the proportion of discharge summaries completed on the day of discharge, as well as frequency of use of individual aspects of the template that were considered to be important for a ‘quality’ summary. Assessment of these ‘quality’ measurements from the summaries was performed by chart review and compared results for 80 summaries in the pre-intervention period to 160 from the near intervention (first two months) and further intervention periods (more than six months, with 80 from each period). Chi-square statistics were used to compare proportions completed on the day of discharge and for presence/absence of individual quality metrics. Results were presented to rotating residents twice weekly for the year-long incentive period, although the measurements were continued for an additional six months after the cessation of resident feedback and incentive target date to assess longer-term influence.
Results: 2560 discharges occurred during the study period, and the template was used in more than 96% of the summaries. Average time to completion of discharge summaries decreased from 3.5 days to 0.6 days (p<0.001) and the percentage completed on the day of discharge increased from 38% to 83% (p<0.001). The residents earned their extra $300, and the increased frequency of completion on the day of discharge was sustained for six months after the incentive period finished (see run chart below).
The percentage of summaries that included all recommended quality criteria also increased significantly, from 5% to 88%, including a full medication reconciliation (from 10% to 88%) and pending tests and follow-up (from 34% to 98%, p<0.001 for all).
What does this all mean?
Mostly, it means that engaged residents, like we have here at Duke, make a real difference in care. The residents in this study not only performed the discharge work that determined the success of this project, they also helped choose the metrics and led the project. Furthermore, the residents were motivated by the quality of the work itself: A follow-up survey found that several factors about the project were more important to the residents than the money being offered, including improving workflow by having the summary replace the day of discharge note, sharing the summary as an editable ‘team’ document prior to finalizing it, and that the timeliness of the discharge summary could improve continuity of care.
And, the project did improve continuity of care. Prior to this study, 38% of outpatient providers surveyed by this group saw a patient in the outpatient setting ‘often or always’ prior to receiving a discharge summary. With this project, that number dropped to 4%, and the information provided in the summaries was much more uniform and complete.
Overall, much of what they included in their summary template is already captured in our EPIC and CPRS templates, but I think their discharge timing speed could serve as a potential goal for our program in the future. In the meantime, let’s work on hand hygiene and flu vaccination . . .
From the Chief Residents
SAR Talks, Noon Conference, 11/14/13
12:00-12:30: Angiogenesis and VEGF – The history of Avastin – Ben Heyman, MD
|11/15/2013||Dr. Andrew Wolf|
|11/12||MED PEDS INTERVIEW|
|11/13||Schwartz Rounds||Lynn O’Neill, Lynn Bowlby||12:00||Jersey Mike’s|
|11/14||SAR talks: Angiogenesis and VEGF – The history of Avastin||Ben Heyman||12:00||Domino’s|
From the Residency Office
The Martin Society Invites You To Dinner with Senior Faculty
This is the first in a special series hosted by the Martin Society to provide an opportuity to meet with senior faculty and discuss key topics over a light dinner.
Watch for the “INVITE” in your email, and please respond no later than Friday, November 14th, so that we can plan accordingly
Choosing a Career as a Clinician Educator
Presented by Diana McNeill, MD
Monday, November 18th at 7:00 PM
Medical Residents Library
10 Searle Drive, DUMC 3702, Durham, NC
Geriatric Curriculum Needs Assessment Survey (submittted by Tom Dalton, MD)
“This is a request for you to participate in a multi-institutional research study. The goal of the research is to understand the need for further development of educational initiatives aimed at caring for hospitalized older adults. We would like to know how often internal medicine and family medicine residents are assessing common issues that arise in this patient population.
To this end, we are asking you to complete an anonymous survey. This survey will take about 2 minutes. Taking part in this study is voluntary. If you would like to participate, please click on the link below and complete the anonymous survey. Please do not record your name or other identifying information on the survey form.”
Please feel free to contact Thomas Dalton (firstname.lastname@example.org) with questions
GME Research Training Series for Residents
Registration for the SATURDAY sessions (November 16th and 23rd) will close on Monday, November 11th.
Take note of the learning opportunties shown below, offered by Duke’s GME office. These sessions focus on enhancing resident QI and research experiences, and help ensure residents follow sound research principles and practices now and upon graduation.
|1. Human Subjects Research &Research Data Collection and Security
|Tuesday||October 22, 2013||7:00am – 9:00am|
|Saturday||November 16, 2013||8:00am – 10:00am|
|Wednesday||January 15, 2014||12:00pm – 2:00pm|
|Thursday||March 6, 2014||4:00pm – 6:00pm|
|2. How to Ask and Answer Research Questions Using Library Resources &Ethics of Conducting Research||Tuesday||October 29, 2013||7:00am – 9:00am|
|Saturday||November 16, 2013||10:15am-12:15pm|
|Wednesday||January 22, 2014||12:00pm – 2:00pm|
|Thursday||March 13, 2014||4:00pm – 6:00pm|
|3. IRB Overview, Informed Consent and Regulations||Tuesday||November 5, 2013||7:00am – 9:00am|
|Saturday||November 23, 2013||8:00am – 10:00am|
|Wednesday||January 29, 2014||12:00pm – 2:00pm|
|Thursday||March 20, 2014||4:00pm – 6:00pm|
|4. Presentation and Dissemination of Data||Tuesday||November 12, 2013||7:00am – 9:00am|
|Saturday||November 23, 2013||10:15am – 12:15pm|
|Wednesday||February 5, 2014||12:00pm – 2:00pm|
|Thursday||March 27, 2014||4:00pm – 6:00pm|
|Training in Advanced Research Principles and Practices||Saturday||February 8, 2014||8:00am – 12:30pm|
|Saturday||April 26, 2014||8:00am – 12:30pm|
If you have questions, please feel free to contact:
- Alisa Nagler in the GME office
- Holly Tiemann in the DOCR office
**REMINDER: The deadline to submit your abstract(s) is Saturday, December 14, 2013 at midnight.**
The North Carolina Chapter is excited to announce the Call for Abstracts for the 2014 Chapter Scientific Session, taking place February 28 – March 1 at the Grandover Resort in Greensboro, NC.
This competition is open only to Associate and Medical Student members of the ACP North Carolina Chapter. First authors must be Medical Students or Associate-level members of ACP or have made official application for membership in order to enter this competition. There will be no exceptions to this requirement. If you have not joined ACP (medical students join for free; associates should contact their residency program directors), please visit ACP Online to find out more and apply.
Each abstract will undergo careful review and will be ranked for scientific merit, originality, proper presentation, and clinical application. To view ACP’s guidelines and tips on preparing an abstract, click here.
We will accept as many posters for display and judging as time and space permit.
The deadline for submitting entries is Saturday, December 14, 2013 at midnight.
Abstracts can be submitted electronically online only. To electronically submit an abstract, visit the Online Abstract Submission Form.
- Educational opportunity to showcase your work.
- Best Clinical Research, Basic Research, Clinical Vignette, QI, and Student Poster will each receive a cash award of $300 and reimbursement of travel expenses to the 2014 ACP Internal Medicine Meeting to present their poster.
- Best Overall Poster will receive an additional cash award and reimbursement of travel expenses to the 2014 ACP Internal Medicine Meeting to present the winning poster.
- Free meeting registration for all Associates and Students who attend.
For questions concerning this abstract competition, please contact Nancy Lowe, CMP, Associate Director of the North Carolina Chapter, at email@example.com.
Byron J. Hoffman, Jr., MD, FACP
ACP Governor, North Carolina Chapter
General Medicine Grand Rounds on Tuesday, November 12, 2013
“Clinical Psychology in treating Chronic Pain (and other diseases)”
Presented by: Katherine L. Applegate, Ph.D
7:30am to 8:15am
3024 Pickett road, 2nd floor
Durham, NC 27705
AAIM Offers Free AJM Subscriptions to Residents in 2014! Sign Up by December 6
Details on the attached flyer
Upcoming Dates and Events
- November 13: Networking Event at Dr. Klotman’s! (An opportunity for JAR’s, fellowship directors, and division chiefs to connect!)
- November 28: Annual “Turkey Bowl”
- January 15th: “Voices in Medicine”
- Main Internal Medicine Residency website
- Main Curriculum website
- Ambulatory curriculum wiki
- Department of Medicine
- Confidential Comment Line Note: ALL submissions are strictly confidential unless you chose to complete the optional section requesting a response.