Class o f Cohor t 13Clinical Safety & Effectiveness Program

GraduationFriday, January 17, 2014

UT Health Science Center Main Campus Academic Administrative Building (AAB) - Rooms 114/116/118

7703 Floyd Curl Drive, San Antonio, TX

Special Thanks to

Chancellor Francisco G. Cigarroa MD, Past President, UT Health Science Center San Antonio, who supported the initiation of the Center for Patient Safety & Health Policy.

Francisco González-Scarano, MD, Dean, School of Medicine, UT Health Science Center San Antonio, for his encouragement and support of the Clinical Safety and Effectiveness Course, and the aims of the Center for Patient Safety & Health Policy.

William L. Henrich MD, President of UT Health Science Center San Antonio, who made the initiation of the Center for Patient Safety & Health Policy possible. We thank him for his support of the Center and its aims, including the Clinical Safety and Effectiveness Course.

Raymond Greenberg, MD, Executive Vice Chancellor for Health Affairs, who continues to support the legacy of the Center for Patient Safety & Health Policy .

Kenneth Shine MD, Special Advisor to the Chancellor, whose vision was to execute a structured and uniformed training course at all UT System health campuses and inspired the Center for Patient Safety & Health Policy and the Clinical Safety and Effectiveness Course at the UT Health Science Center San Antonio.

This program is supported in part by educational grants from Pfizer, Inc.

UT System, UT System Patient Safety Grant UTHSCSA, CME Grant, University Health System, UT Medicine, and UTHSCSA School of Medicine Dean’s Office

Welcome to the graduation for the Clinical Safety & Effectiveness Course at UT Health Science Center San Antonio. This program was developed by the Center for Patient Safety & Health Policy in collaboration with the MD Anderson Cancer Center, Houston, TX. The current complex status of our healthcare delivery system deems it necessary to provide healthcare professionals, including faculty, with a specialized skill set to help them integrate quality and safety into their everyday work. Knowledge acquired through the course will empower health professionals with necessary acumen.

The following pages give a brief overview of the course, a synopsis of the didactics and the projects completed by this cohort’s graduates. We expect that with the help of their unrelenting leadership, we can disseminate the course and its objectives within the institution.

We are excited and pleased to celebrate the graduation of the 13th cohort attendees with you!

Special Thanks,

Jan E. Patterson MD, MS, FACP, FIDSA, CPE, CCMEPAssociate Dean for Quality and Lifelong LearningDirector, Center for Patient Safety & Health PolicyProfessor of Medicine (Infectious Diseases) and PathologyUT Health Science Center San Antonio

Center OverviewThe Center for Patient Safety & Health Policy was established in April 2008 as a new initiative at UT Health Science Center San Antonio (UTHSCSA) with Dr. Jan E. Patterson as the Director for the Center. Dr. Patterson is a Professor of Internal Medicine (Infectious Diseases) and Pathology and is the Associate Dean for Quality and Lifelong Learning.

Mission To increase quality and safety of clinical care, enhance clinical effectiveness, and integrate quality improvement efforts into health services research and health policy, train the next generation of health professionals to incorporate quality improvement practices in their work.

Aims Integrate quality and safety concepts into our everyday work

– Increase quality and safety of clinical careEnhance organizational knowledge through dissemination of successful practices

- Enhance productivity and efficiencyIntegrate quality improvement efforts into health services/outcomes research and health policyTrain the next generation of health professionals to incorporate quality improvement practices in their work

Objectives• Train a core of individuals at UTHSCSA in quality improvement methods • Implement quality and safety through project-based learning at levels of UTHSCSA• Contain costs by improving infrastructure and support systems• Disseminate of quality improvement methods within and outside of the system Methods• Educational program that meets the needs of each stakeholder• Eight days, eight hours/day over six months• Project–based, to demonstrate use of quality concepts and tools• Attendees are taught how to build an Aim Statement for their projects using the S.M.A.R.T technique i.e. it should be Specific, Measurable, Achievable, Realistic and Timely • They are then taught quality tools including cause and effect diagrams and flowcharts to get a better understanding of the existing process flow for the project• Using Statistical Process Control charts, the attendees are able to clearly identify “Special Causes” in the Preintervention period. The teams can decide what interventions are required to improve the process , the quality and safety of care imparted to the patients.• Didactics include talks by nationally acclaimed speakers and locally renowned faculty concentrating on patient safety, quality and process improvement, health professionals roles in improving quality and safety of care, team management and statistical and improvement tools

Participant Selection and Commitment• Recruited by the Center or nominated by Department Chair

• Projects are selected on a priority basis with the approval of the Department

leadership, team members and Director of the Center

• Course dates are provided well in advance so that the participants are able to commit completely to the course

• Course ends with a graduation ceremony with the presentation of the completed projects and outcomes

• Presentation at national meetings and publication of relevant findings is encouraged and supported by Center staff

Improvement Tools Course Curriculum

Day 1 † Plan Project IntroductionIntroductory Speech Quality ToolsPatient SafetyFacilitator IntroductionTeam Building

Course Overview & ExpectationsProject IntroductionAim StatementTeam Building and SelectionTimeline

Day 2 & 3 Do Presentation by Dr. Brent JamesPDCAFlow ChartCause & Effect DiagramIdentification of Data Points...

Elevator Speech by Brent JamesFacilitator works with teams on Flow charts and Cause and effect diagrams using graphic softwareRevisit aim statementNumerator and denominator identified

Day 4 & 5 Do QI Tools: Box Plot, Pareto,HistogramsRun ChartsSPCLEAN in Healthcare

Statistical Process Control Baseline Data SPCSPC and QI MacrosVariation and Special Cause IdentificationProject Update to Dept. Chairman and Center DirectorUsing LEAN Principles for Project

Day 6 † & 7 StudyAct

Baseline Data Evaluation Intervention planPost-Intervention Data CollectionGraduation PPT TemplateReturn on Investment Calculations

Revisit Aim StatementTeam decides on intervention and educates Dept. chief and staffCompare data collected throughout the implementation of the project Work with facilitator on templateFinancial data collection and evaluationConclusive Assessment of Project

Graduation Act Presentation of OutcomesFuture DirectionProject Completion

Final PresentationPoster

Center for Patient Safety & Health Policy Jan E. Patterson, MD, MS, FACP, FIDSA, CPE, CCMEP, DirectorKaren L. Aufdemorte, MHA, Clinical Research Project Manager

Hope Nora, PhD, Independent Healthcare ConsultantAbbie Rizik,MBA, Independent Healthcare Consultant

Edna Cruz MS, RN, CPHQ, Independent Healthcare Consultant

CONTINUING EDUCATION STATEMENTSThe UT Health Science Center San Antonio School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The UT Health Science Center San Antonio School of Medicine designates this live activity for a maximum of 39.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Other healthcare professionals will receive a Certificate of Attendance. For information on applicability and acceptance, please consult your professional licensing board.

UT Health Science Center at San Antonio is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity provides up to 35.16 contact hours.

† This presentation meets the Texas Medical Board criteria for formal Continuing Medical Education involving the study of medical ethics and/or professional responsibility.

The UT Health Science Center San Antonio School of Medicine designates this PI CME activity for a maximum of 20.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

FINANCIAL DISCLOSURE As an ACCME-accredited CME provider, the UT Health Science Center at San Antonio School of Medicine (UTHSCSA SOM) must ensure that its CME activities are independent of the control of commercial interests. All speakers and planning committee members for UTHSCSA sponsored programs are expected to disclose (prior to the activity) all “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. (“Relevant” financial interest or other relationships can include such things as grant or research support, employees, consultants, major stockholders, members of speaker bureau, etc.)

The UTHSCSA CME Office and Jan E. Patterson, MD, MS, CCMEP course director and content reviewer for the Clinical Safety & Effectiveness Course Cohort 13, has reviewed all financial disclosure information for all speakers, facilitators, and planning committee members; and determined and resolved all conflicts of interests.

National Improvement Leaders– Center SpeakersMark Graban, MS, MBAChief Improvement OfficerKaiNexusFinancial Disclosure: Mr. Graban has no relevant financial relationships with commercial interests to disclose.

Brent James, MD, MStatExecutive DirectorInstitute Health Care Delivery Research Intermountain Health Care UtahFinancial Disclosure: Dr. James has no relevant financial relationships with commercial interests to disclose.

James Reinertsen, MD, FACPSenior Fellow Institute for Healthcare ImprovementFormer CEO Dana Farber Cancer Institute Expertise in Patient-Family Centered Care and Leaders Role in QualityFinancial Disclosure: Dr. Reinertsen has no relevant financial relationships with commercial interests to disclose.

Alan H. Morris, MDProfessor of Medicine & Adjunct Professor of Medical InformaticsUniversity of UtahDirector of Research & Associate Director of Pulmonary Function & Blood Gas LaboratoriesLDS Hospital, UtahFinancial Disclosure: Dr. Morris has no relevant financial relationships with commercial interests to disclose.

Local Center Speakers

M. Danet Lapiz-Bluhm, PhD, RNAssistant Professor/Research School of NursingUT Health Science Center San AntonioFinancial Disclosure: Dr. Lapiz-Bluhm has no relevant financial relationships with commercial interests to disclose.

Angela Myatt, M.Sc.Curriculum Liaison LibrarianDolph Briscoe Library UT Health Science Center San AntonioFinancial Disclosure: Ms. Myatt has no relevant financial relationships with commercial interests to disclose.

Robert Nolan, MD †Assistant Dean—Graduate Medical EducationProfessor and Associate Chairman—

Department of PediatricsUT Health Science Center San AntonioFinancial Disclosure: Dr. Nolan has no relevant financial relationships with commercial interests to disclose.

Jan E. Patterson, MD, MS, CCMEP †Professor of Medicine CCMEP Associate Dean of Quality and Lifelong Learning UT Health Science Center San AntonioFinancial Disclosure: Dr. Patterson has disclosed that she is an investigator - UT System, VA and IHI and her spouse, Thomas Patterson, MD is a consultant/advisor for Basilea, Merck, Pfizer, and Toyoma and an Investigator for Astellas, Basilea, Merck, and Pfizer.

UT System Center Speakers Wayne G. Fischer, BS, MS, PhDStatisticianUniversity of Texas Medical BranchGalveston, TXFinancial Disclosure: Dr. Fischer has no relevant financial relationships with commercial interests to disclose.

Doris Quinn, PhD, MSN, RNCenter DirectorProcess Improvement and Quality EducationUT MD Anderson Cancer Center Financial Disclosure: Dr. Quinn has

no relevant financial relationships with commercial interests to disclose.

Eric Thomas, MD, MPHAssociate Professor of MedicineUniversity of Texas Houston Medical SchoolHouston, TXFinancial Disclosure: Dr. Thomas has no relevant financial relationships with commercial interests to disclose.

Cohort 13David A. Abramson, MBAAssociate DirectorFinance & AdministrationDepartment of Cardiothoracic Surgery UT Health Science Center San Antonio Financial Disclosure: Mr. Abramson has no relevant financial relationships with commercial interests to disclose

Adewale Ajumobi, MD, MBA GI FellowDepartment of GastroenterologyUT Health Science Center San Antonio Financial Disclosure: Dr. Ajumobi has no relevant financial relationships with commercial interests to disclose

Karen L. Aufdemorte, MHAClinical Research Project ManagerCenter for Patient Safety and Health PolicyUT Health Science Center San Antonio Financial Disclosure: Ms. Aufdemorte has no relevant financial relationships with commercial interests to disclose

Ildiko Agoston, MD, FACCAssociate Professor of MedicineDivision of CardiologyMedical Director MARC Cardiology ClinicMedical Director Women’s Comprehensive Health InstituteUT Health Science Center San AntonioFinancial Disclosure: Dr. Agoston has no relevant financial relationships with commercial interests to disclose

Joe R. Becker, MDClinical Assistant ProfessorDivision of EndocrinologyDepartment of Medicine UT Health Science Center San Antonio Financial Disclosure: Dr. Becker has no relevant financial relationships with commercial interests to disclose

Jan M. Bruder, MD Chief Division of EndocrinologyProgram Director, Endocrinology, Diabetes and Metabolism Training ProgramProfessorDepartment of MedicineUT Health Science Center San Antonio

Financial Disclosure: Dr. Bruder has no relevant financial relationships with commercial interests to disclose

John Calhoon, MD ChairDepartment of Cardiothoracic Surgery UT Health Science Center San Antonio Financial Disclosure: Dr. Calhoon has no relevant financial relationships with commercial interests to disclose

Virginia Isabel Calley, BSResearch Associate Department of Orthopaedics UT Health Science Center San Antonio Financial Disclosure: Ms. Calley has no relevant financial relationships with commercial interests to disclose

Davin Cordell, MDResidentDepartment of OrthopaedicsUT Health Science Center San Antonio Financial Disclosure: Dr. Cordell has no relevant financial relationships with commercial interests to disclose

Kelly DixonClinic ManagerCancer Therapy Research CenterFinancial Disclosure: Ms. Dixon has no relevant financial relationships with commercial interests to disclose

Belinda Flores, RN, BSDirectorSouth Coastal Area Health Education Center (AHEC)UT Health Science Center San Antonio Financial Disclosure: Ms. Flores has no relevant financial relationships with commercial interests to disclose

Jennifer Healy, DOAssistant Professor MedicineAssociate DirectorHospice and Palliative Medicine FellowshipDirector UHS Palliative Care Educational ServicesDirector UHS Lifelong Intensive Family Emotional (LIFE) Care/Palliative Medicine Clinic

UT Health Science Center San Antonio Financial Disclosure: Dr. Healy has no relevant financial relationships with commercial interests to disclose

Karla J. Hudson, R.T.(R)(M)(CT)(QM)(ARRT)CT Technologist IIIUniversity Health SystemFinancial Disclosure: Ms. Hudson has no relevant financial relationships with commercial interests to disclose

Darrel Hughes, PharmDClinical Pharmacist Department of Emergency Medicine UT Health Science Center San AntonioPERCInpatient PharmacyUniversity Health System Financial Disclosure: Dr. Hughes has no relevant financial relationships with commercial interests to disclose

Myra Joseph, RNUT Health Science Center San Antonio Financial Disclosure: Ms. Joseph has no relevant financial relationships with commercial interests to disclose

Patty McCarroll, MBASenior DirectorFinance & AdministrationDepartment of MedicineUT Health Science Center San Antonio Financial Disclosure: Ms. McCarroll has no relevant financial relationships with commercial interests to disclose

Tom Methvin, MHAProject ManagerSchool of Medicine Deans OfficeUT Health Science Center San Antonio Financial Disclosure: Mr. Methvin has no relevant financial relationships with commercial interests to disclose

Luke A. Newton, MD Assistant ProfessorDepartment of Obstetrics & Gynecology UT Health Science Center San Antonio Financial Disclosure: Dr. Newton has no relevant financial relationships with commercial interests to disclose

Jennifer Peel, PhDAssistant Dean of Education/GME ProfessorDepartment of Anesthesiology UT Health Science Center San Antonio Financial Disclosure: Dr. Peel has no relevant financial relationships with commercial interests to disclose

Linda Phillips, RNNurse Supervisor Cancer Therapy Research CenterDepartment of Radiation Oncology UT Health Science Center San Antonio Financial Disclosure: Ms. Phillips has no relevant financial relationships with commercial interests to disclose

Salim Rezaie, MDAssistant ProfessorDepartment of Emergency Medicine UT Health Science Center San Antonio Financial Disclosure: Dr. Rezaie has no relevant financial relationships with commercial interests to disclose

Raquel Lozano Romero, MD, MPH Faculty AssociateDepartment of Family Community and Medicine UT Health Science Center San Antonio Financial Disclosure: Dr. Romero has no relevant financial relationships with commercial interests to disclose

Erin SidleAdvanced Care Planning CoordinatorLIFE Care/Palliative MedicineUniversity Health System Financial Disclosure: Ms. Sidle has no relevant financial relationships with commercial interests to disclose

Kelly D. Sutton Senior DirectorClinic Operations Cancer Therapy Research Center UT Health Science Center San Antonio Financial Disclosure: Ms. Sutton has no relevant financial relationships with commercial interests to disclose

Class of Cohort 13Project Overview

Maximal benefits from the course would be achieved if the project chosen is designed in a judicious manner, concentrating on a definite objective which can later be disseminated to other areas institution-wide.

Recommended projects:Patient Safety (ex: Decreasing overuse of medical interventions, improving outcomes by improving patient selection for outpatient antibiotic therapy)

Patient flow (ex: To reduce the time of routine blood administration from the “MD to give” order to the “nurse hang time” on, reduce patient “wait item” in outpatient clinic)

Teamwork (ex: Develop strategic teams, facilitate hand-off interaction between healthcare team workers, better communication between Rapid Response, Code teams)

Patient population based: (ex: Increasing pneumococcal vaccination, patient satisfaction, timely communication)

Florence Wall, PA-CSpecialistDepartment of Orthopaedics UT Health Science Center San Antonio Financial Disclosure: Ms. Wall has no relevant financial relationships with commercial interests to discloseBrent Wagner, MDDirector TDI Nephrology Continuity ClinicDirectorTexas Diabetes Institute Outpatient Nephrology Continuity Clinic UT Health Science Center San Antonio Financial Disclosure: Dr. Wagner has no relevant financial relationships with commercial interests to disclose

Ahmad Wehbe, MDAssistant ProfessorCancer Therapy Research Center UT Health Science Center San Antonio Financial Disclosure: Dr. Wehbe has no relevant financial relationships with commercial interests to disclose

Paula Winkler, M.Ed.Director South Coastal Area Health Education Center (AHEC)UT Health Science Center San Antonio Financial Disclosure: Dr. Winkler has no relevant financial relationships with commercial interests to disclose

Elly Xenakis, MDProfessorDepartment of Obstetrics & Gynecology UT Health Science Center San Antonio Financial Disclosure: Dr. Xenakis has no relevant financial relationships with commercial interests to disclose

Cohort 13 Clinical Safety & Effectiveness Program

9:30 am: BREAKFAST 9:30 am - 9:45 amIntroductionsJan E. Patterson, MD, MS, CCMEPAssociate DeanQuality and Lifelong LearningDirectorCenter for Patient Safety & Health PolicyUT Health Science Center San AntonioSpecial Guest SpeakerLois L. Bready, MDVice Dean for Graduate Medical EducationProfessor (with Tenure)Department of Anesthesiology UT Health Science Center San Antonio 9:45 am – 10:05 am Group 1Elly Xenakis, MD, Luke A. Newton, MD and Jennifer Peel, PhDProject: Transition of Patient CareAim Statement: To improve the quantitative sign-out score by 25% during sign out (transition of care) of OB patients between resident shifts by December 1, 2013. 10:05 am – 10:25 am Group 2Adewale Ajumobi, MD, MBA and Patty McCarroll, MBAProject: Development of Gastrointestinal Endoscopic Quality Improvement Program, Quality Metrics & Reporting Tools(EQUIPMENT) Aim Statement: Increase the availability of reports on colonoscopy metrics (clinical performance) at University Health System from 0% to 100% by January 2014. 10:25 am – 10:45 am Group 3Salim Rezaie, MD and Darrel Hughes, PharmDProject: Decreasing Door to Balloon TimeAim Statement: Decrease Total Door to Ballon Time by 10% by January 2014.

10:45 am – 11:05 am Group 4Brent Wagner, MDProject: : Improving hepatitis B vaccination rate in the Chronic Kidney Disease (CKD) patient population being treated at the Texas Diabetes Institute Aim Statement: The aim of the project is to improve the number of chronic kidney disease patients vaccinated (starting series 1) for hepatitis B at the Texas Diabetes Institute (TDI) Friday Renal Clinic from the current rate of 10.5% to 80% by January 10, 2014. 11:05 am – 11:25 am Group 5Jennifer Healy, DO, Erin Sidle and Karen L. Aufdemorte, MHAProject: Improving Documentation Within an Interdisciplinary Care PlanAim Statement: To improve the Palliative Medicine Team’s Interdisciplinary Care Plan documentation in the Process of Care section from baseline of 46% to 75% by January 9, 2014 11:25 am – 11:35 am BREAK

11:35 am – 11:55 am Group 6Ildiko Agoston, MD, FACC and Myra Joseph, RNProject: Improving the INR/Coumadin Clinic at the MARCAim Statement: Increase Coumadin Anticoagulation tracking system flow in clinic by100% utilization at the MARC by 1/1/14 for Cardiology patients with arrhythmias’ and valve disease

11:55 am – 12:15 pm Group 7Davin Cordell, MD, Florence Wall, PA-C, Virginia Isabel Calley, BS and Karla J. Hudson, R.T.(R)(M)(CT)(QM)(ARRT)Project: : Preventing Missed Fractures in Trauma, Intubated Orthopedic Cases at UHSAim Statement: To improve initial assessment of intubated trauma patients with orthopedic consultation so that 100% of orthopedic diagnoses at 48 hours are the same as final diagnoses at discharge by January 7, 2014

12:15 pm – 12:35 pm Group 8John Calhoon, MD and David A. Abramson, MBAProject: Optimize Call Center Operations to Improve EfficiencyAim Statement: Place incoming referring physician calls and patient emergencies in the appropriate CT authority within 1 minute, 90% of the time, by January 2014 12:35 pm – 12:55 pm Group 9Paula Winkler, M.Ed., Raquel Lozano Romero, MD, MPH and Belinda Flores, RNProject: Utilizing the EMR to Guide QI Initiatives in Primary Care Settings in South TexasAim Statement: The aim of this project is to improve the process of documenting in the Immunization Section of the Outpatient EMR for patients age 60 and over at two South Texas clinics by January 10, 2014. Improvement goal target is 30% over baseline level of each site. The process begins when the patient reports for a clinic visit and ends when the documentation for that visit is entered in the EMR. This is important to improve because timely immunization of the targeted population is a major public health safety concern.

12:55 pm – 1:15 pm Group 10Linda Phillips, RN Project: High Dose Radiation Therapy Process Improvement Aim Statement: The aim of this project is to increase the efficiency and safety of delivering High Dose Radiation therapy to patients with gynecological cancers through increased accountability, standardized processes and an overall 10% reduction in the total appointment time per procedure per day 1:15 pm - 1:35 pm Group 11Ahmad Wehbe, MD, Kelly Dixon, Kelly D. Sutton and Tom Methvin, MHAProject: Clinical Wait Times – Cancer Therapy & Research Center (3rd Floor Medical Oncology)Aim Statement: To reduce mean patient cycle time (“door to doc”) by 25% or 15 minutes for the 3rd floor Medical Oncology patients by 1/13/14. 1:35 pm - 1:55 pm Group 12Jan M. Bruder, MD and Joe Becker, MDProject: Improve the multidisciplinary approach in the care of patients with thyroid cancerAim Statement: To decrease by 50% the amount of clinic time used to arrange admissions for I131 treatment for patients with thyroid cancer, by implementing an electronic order set and a web based scheduling tool accessible to ordering physicians, nuclear medicine, nursing, radiation safety and admissions by January 2013.

1:55 pm - CLOSING REMARKS/ LUNCH AND RECEPTION TO FOLLOW