The 1-minute preceptor to improve diagnostic reasoning in a primary care nurse practitioner residency program.

BACKGROUND: The One-Minute Preceptor (OMP) model to teach diagnostic reasoning and Reporter, Interpreter, Manager, and Educator (RIME) framework to measure progress are used in physician training. Little is known about the use of these tools in nurse practitioner (NP) training. LOCAL PROBLEM: Precepting NP trainees at the Veterans Affairs (VA) is not standardized. A standardized approach to precepting NP residency trainees using the OMP model and RIME scoring was evaluated for improvement and helpfulness. METHODS: A quality-improvement project with two Plan-Do-Study-Act (PDSA) cycles were conducted over a 12-week period. Mean RIME scores, preceptor self-efficacy, and use of teaching skills were measured preintervention and postintervention. Data were analyzed using a paired sample t-test and descriptive statistics. INTERVENTIONS: A convenience sample of preceptors and trainees was recruited from a large VA medical center. A 1-hour workshop educated preceptors with role playing and return demonstrations on OMP techniques and RIME scoring. The teachings were applied to standardize precepting and assess diagnostic reasoning. Trainee self-scoring and results triggered conversations to fulfil the identified gaps. RESULTS: Mean RIME scores improved (1.62 [0.17] vs. 2.23 [0.38], p < .001) post 12-week intervention. Mean RIME scores improved between PDSA cycle 1 and cycle 2 (2.07 [0.25] vs. 2.48 [0.39], p < .001). Preceptors (91%) and trainees (100%) found the OMP model and RIME framework helpful. CONCLUSION: Use of the OMP improved diagnostic reasoning in NP trainees. The OMP and RIME framework provided standardization of precepting and trainee discussions on improvements.

A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic.

BACKGROUND: Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for suicide risk screening in October 2018, which was instituted at the West Los Angeles Veterans Affairs Medical Center Homeless Patient Aligned Care Team (HPACT) clinic. METHODS: This article examines the results of the screening initiative after implementation, describes difficulties faced in implementation, and suggests strategies that might be used to overcome those challenges. RESULTS: Over 1 fiscal year (October 1, 2018 to September 30, 2019) the HPACT clinic had 2932 unique veterans assigned to its care; 1876 (64%) received a primary screen of suicide risk, 523 (18%) were not screened, and 533 (18%) were exempt from screening by protocol. Of the 523 (18%) unscreened patients, 331 (11%) patients had no HPACT visit and 132 (5%) did not visit any VHA site during the period. There were 192 (7%) patients who visited but were not screened of which 19 (1%) declined screening. CONCLUSIONS: Most missed screening opportunities were due to patients being lost to follow-up. There were 5 challenges identified for screening implementation, including health record factors, communication, clinician buy-in, system factors, and patient factors. Thus, promoting interprofessional collaboration, visualizing effective process flows, establishing clear lines of communication and roles for involved staff, and opening avenues for continuous feedback and troubleshooting were all effective in increasing comfort with suicide assessment and screening rates.