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A Dynamic Risk Management Approach for Reducing Harm From Invasive Bedside Procedures Performed During Residency.
Warm, Eric J; Ahmad, Yousef; Kinnear, Benjamin; Kelleher, Matthew; Sall, Dana; Wells, Andrew; Barach, Paul.
Afiliación
  • Warm EJ; E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: 0000-0002-6088-2434 .
  • Ahmad Y; Y. Ahmad is an internal medicine resident, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Kinnear B; B. Kinnear is associate professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: 0000-0003-0052-4130 .
  • Kelleher M; M. Kelleher is assistant professor of medicine and pediatrics and associate program director, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Sall D; D. Sall is assistant professor of medicine, University of Arizona College of Medicine Phoenix, and program director, HonorHealth Scottsdale Thompson Peak Internal Medicine Residency Program, Scottsdale, Arizona.
  • Wells A; A. Wells is a cardiology fellow, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Barach P; P. Barach is clinical professor, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, and lecturer, Jefferson College of Population Health, Philadelphia, Pennsylvania; ORCID: 0000-0002-7906-698X .
Acad Med ; 96(9): 1268-1275, 2021 09 01.
Article en En | MEDLINE | ID: mdl-33735129
Internal medicine (IM) residents frequently perform invasive bedside procedures during residency training. Bedside procedure training in IM programs may compromise patient safety. Current evidence suggests that IM training programs rely heavily on the number of procedures completed during training as a proxy for resident competence instead of using objective postprocedure patient outcomes. The authors posit that the results of procedural training effectiveness should be reframed with outcome metrics rather than process measures alone. This article introduces the as low as reasonably achievable (ALARA) approach, which originated in the nuclear industry to increase safety margins, to help assess and reduce bedside procedural risks. Training program directors are encouraged to use ALARA calculations to define the risk trade-offs inherent in current procedural training and assess how best to reliably improve patient outcomes. The authors describe 5 options to consider: training all residents in bedside procedures, training only select residents in bedside procedures, training no residents in bedside procedures, deploying 24-hour procedure teams supervised by IM faculty, and deploying 24-hour procedure teams supervised by non-IM faculty. The authors explore how quality improvement approaches using process maps, fishbone diagrams, failure mode effects and analyses, and risk matrices can be effectively implemented to assess training resources, choices, and aims. Future research should address the drivers behind developing optimal training programs that support independent practice, correlations with patient outcomes, and methods that enable faculty to justify their supervisory decisions while adhering to ALARA risk management standards.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gestión de Riesgos / Seguridad del Paciente / Pruebas en el Punto de Atención / Medicina Interna / Internado y Residencia Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Acad Med Asunto de la revista: EDUCACAO Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Gestión de Riesgos / Seguridad del Paciente / Pruebas en el Punto de Atención / Medicina Interna / Internado y Residencia Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Acad Med Asunto de la revista: EDUCACAO Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos