Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 6, 2022. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection committee chose 34 abstracts-16 select podium, 18 rapid fire. In addition, 66 abstracts were included as electronic poster presentations, an increase of 20 from 2021. Residency and fellowship program directors nominated presentations for the Excellence Awards. The Scholarship Committee chose four to receive travel awards to support the presentation of each project at a national meeting. Excellence Awards were granted to Nada A. Mohamed, MD, Irfan Shehzad, MD, Abirami Subramanian, MPH, MD, and Hadley K. Young, MD. A selection of abstracts is presented here.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 7, 2021. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection of Scholar Day abstracts is presented here.

Learning Collaboratives in Medical Education: Exploring the Impact of Collaboratives' Structure and Resources and Teams' Experience.

The Alliance of Independent Academic Medical Centers (AIAMC) organized and coordinated a multicenter learning collaborative, National Initiative V (NI V), focused on community health and health inequity. A pre-post descriptive study was designed to examine the outcomes of the AIAMC NI V. Data were collected from pre- and post-assessment surveys as well as a project milestone self-assessment survey. Twenty-nine institutions participated. By the conclusion of the NI, the majority of institutions had completed at least 1 of the milestones in each of the pre-work/background (65.52%), measurement (62.07%), methods (62.07%), and implement/sustain (20.69%) domains. Institutions reported a significant association between their readiness assessments prior to the start of the NI compared with their status of activities on completion. Milestone achievement is significantly associated with 3 of the assessment items. Learning collaboratives with thoughtfully integrated structure and support can be impactful on topic readiness for the participating organizations.

Development and implementation of the Women Leaders in Medicine Program at a multispecialty health care system.

Physicians in the USA are experiencing burnout symptoms at alarming rates, with women surpassing men. Many modalities are used to combat burnout. Leadership training is one proven strategy. Baylor Scott & White Health developed a program of systematic leadership development with quantitative and qualitative surveys and feedback from the 200 female participants of the pilot year. The Women Leaders in Medicine Program invited all Baylor Scott & White Health female physicians in both Central and North Texas to leadership training, which focused on (1) peer networking, (2) leadership skill building, and (3) mentoring, advocacy, and sponsorship with system leaders. The program was well received and highlighted the need for more in-person networking and skill-building opportunities for this demographic. Based on the data collected, the investigators are confident that this program is feasible for replication in diverse clinical settings for all female physicians.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day on May 3, 2019. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection committee chose 32 abstracts-12 select podium, 20 rapid fire. In addition, 60 abstracts were included as electronic poster presentations. Residency and fellowship program directors nominated presentations for the Excellence Awards. The scholarship committee chose four to receive travel awards to support the presentation of each project at a national meeting. Excellence Awards were granted to Jasson Abraham, MD, Jerry Fan, MD, Veronica Lozano, MD, and Chhaya Patel, MD. A selection of abstracts is presented here.

Impact of health care adversity on providers: Lessons learned from a staff support program.

BACKGROUND: Health care providers often experience traumatic events and adversity that can have negative emotional impacts on the profession and on patients. These impacts are typically multifaceted and can result from many different events, such as unanticipated outcomes, licensing board complaints, claims, and litigation. Because health care providers are exposed to diverse situations, they require adequate and timely support, imperative for provider resilience and patient safety. This study evaluated the success of an institution's second victim health care support program and best practices in responding to these traumatic experiences effectively. METHODS: Twenty faculty and medical residents who utilized the support program at a large hospital system located in Central Texas from 2001 to 2012 participated in 1 of 6 focus groups. Qualitative data were collected from these groups to describe program requirements for the adequate delivery of health care adversity support and necessary program improvements. Responses were first transcribed verbatim. Each research team member analyzed data using a thematic framework approach. This approach helped to characterize traumatic experiences and to design a support system. RESULTS: The results revealed that (1) provider experiences are traumatic, (2) it is necessary to communicate an adverse event in a confidential and timely manner, preferably with a peer, (3) preemptive education regarding risk management and the legal process is helpful, and (4) there is a need for further support of the specific experience of a board complaint. CONCLUSIONS: Focus group data indicated the complexity of the emotional impact of traumatic experiences. Specific program components are needed to create best practices for providers affected by health care adversity, including support when providers face board complaints. The program's unique combination of support and education allowed us to expand upon leading national health care adversity programs.

Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation.

BACKGROUND: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. METHODS: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. RESULTS: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. CONCLUSION: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers.

Learner Perspectives of a Surgical Educators Faculty Development Program Regarding Value and Effectiveness: A Qualitative Study.

BACKGROUND: The BaylorScott & White Health Division of Plastic Surgery began a faculty development program designed to train clinicians to be better educators. The program consisted of presession reading, 11 small group didactic sessions, and individually chosen educational projects. Cross-discipline collaboration was pursued by enrolling faculty and students from diverse departments. Department chair permission was required for participation. The purpose of this qualitative study was to explore learner perspectives of the Surgical Educators Program. METHODS: Fourteen physicians completed the Surgical Educators Program. Focus groups were held with the learners who completed the 2011 and 2012 programs 6 months after completion. The groups were moderated by an educational faculty member who was not involved in any aspect of the course. Questions were designed to elicit the components of the course curriculum of significance to the learners. Narrative data were digitally recorded and transcribed verbatim, and the investigators performed independent content analyses to identify themes. The data were thematically coded and summarized using calculation of frequencies. RESULTS: Thirteen learners participated in the focus groups. Three main themes were identified. First, the program increased the participants' knowledge and practice of medical education. Second, the structure of the program was a key contributor to the outcomes. Third, the program produced a community of practice. CONCLUSIONS: This study suggests that a faculty development program comprising a diverse group of physicians consisting of readings, guided small group sessions, and a mandatory project can train plastic surgical faculty to become better surgical educators within the constraints of a busy clinical practice.

Improving compliance with cervical cancer screening guidelines.

Current cervical cancer screening guidelines for the care of healthy women include HPV cotesting with all Papanicolaou (Pap) smears after the age of 30. To improve compliance with current guidelines, we instituted two processes: first, simplifying the ordering process to a single order for Pap smear plus HPV cotesting using an electronic medical record system (EMR); and second, providing education for clinic staff. Baseline and postintervention data were collected by retrospective chart review. Patients were selected during three intervals: prior to the transition to Epic EMR, after the transition to Epic, and after an educational intervention. Compliance with standard guidelines was evaluated in relation to the trial intervals, type of provider, patient age, and duration from the previous Pap smear. Provider type was analyzed by considering gynecologists versus nongynecologist providers, and physicians versus mid-level providers. Overall, the percentage of compliance with HPV test ordering did not differ (P = 0.21) between intervals. Univariate analyses performed to identify factors likely to be associated with the practice of ordering HPV cotesting only involved the type of provider. In conclusion, transition to Epic and a training session had minimal impact on compliance with ordering HPV cotesting at the time of a Pap smear except among family practice physicians, who did significantly improve their compliance rate. Gynecologists and mid-level providers were more compliant with ordering HPV cotesting throughout, but did not significantly improve after the interventions.

Patients' Perspectives of Surgical Safety: Do They Feel Safe?

BACKGROUND: Increased focus on reducing patient harm has led to surgical safety initiatives, including time-out, surgical safety checklists, and debriefings. The perception of the lay public of the surgical safety process is largely unknown. METHODS: A 20-question survey focused on perceptions of surgical safety practice was distributed to a random sample of patients following elective operations requiring hospitalization. Responses were measured by a 7-point Likert scale. Qualitative feedback was obtained through nonphysician-moderated sessions. Participation was voluntary and anonymous. RESULTS: Surveys were distributed to 345 patients of whom 102 (29.5%) responded. Overall, patients felt safe as evidenced by scores for the questions "I felt safe the day of my surgery" (6.53 ± 0.72) and "Mistakes rarely happen during surgery" (5.39 ± 1.51). Patients undergoing their first surgery and patients with higher income levels were associated with a significant decrease in specific safety perceptions. Qualitative feedback sessions identified the physician-patient relationship as the most important factor positively influencing patient safety perceptions. CONCLUSION: Current surgical safety practice is perceived positively by our patients; however, patients still identify physician-patient interactions, relationships, and trust as the most positive factors influencing their perception of the safety environment.

A standard handoff improves cardiac surgical patient transfer: operating room to intensive care unit.

BACKGROUND: Patient handoffs are high-risk times associated with sentinel events. Effective handoff processes may enhance patient safety and team member communication. This study assesses the impact of a standardized protocol for handoffs from the cardiac surgery operating room to intensive care unit (ICU). METHODS: Using a prospective pre-post study design, a formalized handoff process was developed including critical handoff elements and a standardized handoff procedure, script, and checklist. Data were collected from 60 handoff observations (30 pre and 30 post), evaluating 52 unique parameters, and survey of providers on perspectives of the handoff process. Results were compared by chi-square test, two sample t-test, or nonparametric Mann-Whitney test. Statistical significance was defined as P ≤ .05. RESULTS: Provider's perspectives showed improved satisfaction with the standardized handoff process through improved responses in 19 of 22 survey items (P < .001). Median time until ventilator connection, ICU monitor transfer, first cardiac index, and chest radiograph were reduced after implementation. Completion of handoff process components also improved after implementation for 36 of 47 nontime parameters. CONCLUSIONS: A standard checklist-driven handoff process can dramatically improve key data transmission and reduce time of critical patient care steps during the high-risk period of patient handoff in a cardiac surgical ICU.

The Trauma Center Organizational Culture Survey: development and conduction.

BACKGROUND: The Trauma Center Organizational Culture Survey (TRACCS) instrument was developed to assess organizational culture of trauma centers enrolled in the American College of Surgeons Trauma Quality Program (ACS TQIP). The objective is to provide evidence on the psychometric properties of the factors of TRACCS and describe the current organizational culture of TQIP-enrolled trauma centers. METHODS: A cross-sectional study was conducted by surveying a sampling of employees at 174 TQIP-enrolled trauma centers. Data collection was preceded by multistep survey development. Psychometric properties were assessed by an exploratory factor analysis (construct validity) and the item-total correlations and Cronbach alpha were calculated (internal reliability). Statistical outcomes of the survey responses were measured by descriptive statistics and mixed effect models. RESULTS: The response rate for trauma center participation in the study was 78.7% (n = 137). The factor analysis resulted in 16 items clustered into three factors as described: opportunity, pride, and diversity, trauma center leadership, and employee respect and recognition. TRACCS was found to be highly reliable with a Cronbach alpha of 0.90 in addition to the three factors (0.91, 0.90, and 0.85). Considerable variability of TRACCS overall and factor score among hospitals was measured, with the largest interhospital deviations among trauma center leadership. More than 80% of the variability in the responses occurred within rather than between hospitals. CONCLUSIONS: TRACCS was developed as a reliable tool for measuring trauma center organizational culture. Relationships between TQIP outcomes and measured organizational culture are under investigation. Trauma centers could apply TRACCS to better understand current organizational culture and how change tools can impact culture and subsequent patient and process outcomes.

Feasibility of "Standardized Clinician" Methodology for Patient Training on Hospital-to-Home Transitions.

INTRODUCTION: Patient engagement in health care is increasingly recognized as essential for promoting the health of individuals and populations. This study pilot tested the standardized clinician (SC) methodology, a novel adaptation of standardized patient methodology, for teaching patient engagement skills for the complex health care situation of transitioning from a hospital back to home. METHODS: Sixty-seven participants at heightened risk for hospitalization were randomly assigned to either simulation exposure-only or full-intervention group. Both groups participated in simulation scenarios with "standardized clinicians" around tasks related to hospital discharge and follow-up. The full-intervention group was also debriefed after scenario sets and learned about tools for actively participating in hospital-to-home transitions. Measures included changes in observed behaviors at baseline and follow-up and an overall program evaluation. RESULTS: The full-intervention group showed increases in observed tool possession (P = 0.014) and expression of their preferences and values (P = 0.043). The simulation exposure-only group showed improvement in worksheet scores (P = 0.002) and fewer engagement skills (P = 0.021). Both groups showed a decrease in telling an SC about their hospital admission (P < 0.05). Open-ended comments from the program evaluation were largely positive. CONCLUSIONS: Both groups benefited from exposure to the SC intervention. Program evaluation data suggest that simulation training is feasible and may provide a useful methodology for teaching patient skills for active engagement in health care. Future studies are warranted to determine if this methodology can be used to assess overall patient engagement and whether new patient learning transfers to health care encounters.

Checklist usage decreases critical task omissions when training residents to separate from simulated cardiopulmonary bypass.

OBJECTIVE: Separation from cardiopulmonary bypass (CPB) requires multiple preparatory steps, during which mistakes, omissions, and human errors may occur. Checklists have been used extensively in aviation to improve performance of complex, multistep tasks. The aim of this study was to (1) develop a checklist using a modified Delphi process to identify essential steps necessary to prepare for separation from CPB, and (2) compare the frequency of completed items with and without the use of a checklist in simulation. It was hypothesized that the use of a checklist would reduce the number of omissions. DESIGN: High-fidelity simulation study. SETTING: University-affiliated tertiary care facility. PARTICIPANTS: Seven cardiac anesthesiologists created a checklist using a modified Delphi process. Ten residents participated in 4 scenarios separating from CPB in simulation. INTERVENTIONS: Each scenario was performed first without a checklist and then again with a checklist. An observer graded participants' performance. MEASUREMENTS AND MAIN RESULTS: A pre-separation checklist containing 9 tasks was created using the Delphi process. Without using this checklist, 4 tasks were completed in at least 75% of scenarios, and 8 tasks were completed at least 75% of the time when using the checklist. There was a significant improvement in completion of 5 of the 9 items (p< 0.01). CONCLUSIONS: A modified Delphi process can be used to create a checklist of steps in preparing to separate from CPB. Using this checklist during simulation resulted in increased frequency of completing designated tasks in comparison to relying on memory alone. Checklists may reduce omission errors during complex periods of anesthesiologists' perioperative workflow.

Surgical safety checklist and operating room efficiency: results from a large multispecialty tertiary care hospital.

BACKGROUND: The Surgical Safety Checklist (SSC) improves patient safety and outcomes; however, barriers to effective use include the perceived negative impact on operating room (OR) efficiency. The purpose of this study was to determine the effect of SSC implementation on OR efficiency. METHODS: All operations at our large multispecialty tertiary care hospital were reviewed for 1-year pre- and 1-year post-SSC implementation. OR efficiency included operating room time, operation time, first starts on time, same-day cancellations, and OR disposable cost. RESULTS: A total of 35,570 operations were reviewed: 17,204 pre-SSC and 18,366 post-SSC. There was no difference between groups for operating room time (P = .93), operation time (P = .66), first starts on time (P = .15), and same-day cancellations (P = .57). The mean OR disposable cost was significantly lower ($70/operation) for the post-SSC group (P < .01). CONCLUSIONS: The implementation of an SSC does not negatively impact OR efficiency and should not be considered a barrier to effective use. Our data suggest that SSC use can reduce overall cost per surgical procedure.

Implementation of a surgical safety checklist: impact on surgical team perspectives.

BACKGROUND: The World Health Organization (WHO) surgical safety checklist has been shown to decrease mortality and complications and has been adopted worldwide. However, system flaws and human errors persist. Identifying provider perspectives of patient safety initiatives may identify strategies for improvement. The purpose of this study was to determine provider perspectives of surgical safety checklist implementation in an effort to improve initiatives that enhance surgical patients' safety. METHODS: In September 2010, a WHO-adapted surgical safety checklist was implemented at our institution. Surgical teams were invited to complete a checklist-focused questionnaire 1 month before and 1 year after implementation. Baseline and follow-up results were compared. RESULTS: A total of 437 surgical care providers responded to the survey: 45% of providers responded at baseline and 64% of providers responded at follow-up. Of the total respondents, 153 (35%) were nurses, 104 (24%) were anesthesia providers, and 180 (41%) were surgeons. Overall, we found an improvement in the awareness of patient safety and quality of care, with significant improvements in the perception of the value of and participation in the time-out process, in surgical team communication, and in the establishment and clarity of patient care needs. Some discordance was noted between surgeons and other surgical team members, indicating that barriers in communication still exist. Overall, approximately 65% of respondents perceived that the checklist improved patient safety and patient care; however, we found a strong negative perception of operating room efficiency. CONCLUSION: Implementation of a surgical safety checklist improves perceptions of surgical safety. Barriers to implementation exist, but staff feedback may be used to enhance the sustainability and success of patient safety initiatives.

House Staff Quality Council: One Institution's Experience to Integrate Resident Involvement in Patient Care Improvement Initiatives.

BACKGROUND: Residents and fellows perform a large portion of the hands-on patient care in tertiary referral centers. As frontline providers, they are well suited to identify quality and patient safety issues. As payment reform shifts hospitals to a fee-for-value-type system with reimbursement contingent on quality outcomes, preventive health, and patient satisfaction, house staff must be intimately involved in identifying and solving care delivery problems related to quality, outcomes, and patient safety. Many challenges exist in integrating house staff into the quality improvement infrastructure; these challenges may ideally be managed by the development of a house staff quality council (HSQC). METHODS: Residents and fellows at Scott & White Memorial Hospital interested in participating in a quality council submitted an application, curriculum vitae, and letter of support from their program director. Twelve residents and fellows were selected based on their prior quality improvement experience and/or their interest in quality and safety initiatives. RESULTS: In only 1 year, our HSQC, an Alliance of Independent Academic Medical Centers National Initiative III project, initiated 3 quality projects and began development of a fourth project. CONCLUSION: Academic medical centers should consider establishing HSQCs to align institutional quality goals with residency training and medical education.