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CARe Implementation in the Ambulatory Setting

In June 2014, Atrius Health secured a two-year grant from CRICO to support implementation of the CARe program across the organization. We are now at the half way point of our grant. The first year focused on readying site leaders to assist with disclosure communication, officially launching the program organization-wide and educating front line clinicians on the CARe approach.

Disclosure coach training

On January 26, 2015, Site Medical Directors convened for training on how to coach clinicians on communication and apology conversations after adverse events. The training, led by the Institute for Professionalism and Ethical Practice, utilized actors to simulate real scenarios in which a patient was harmed due to a medical error. Participants were asked to observe and critique the interaction and also learn strategies for coaching their colleagues at their sites. The program was very well received and Atrius Health leadership has since called for an additional training to be held in the fall of 2015.

Atrius CARe Kickoff event

On March 31, 2015, Atrius Health hosted Mr. Richard Boothman, Executive Director of Clinical Safety at University of Michigan Health System, as our keynote speaker to officially launch our Communication, Apology and Resolution (CARe) program. Clinical and administrative leadership from across the organization attended and listened to Mr. Boothman share his success implementing a similar program at Michigan in 2006. After the keynote address, Mr. Boothman was joined by Dr. Rick Lopez, Atrius Chief Medical Officer, Kim Nelson, Atrius Chief Legal Officer and Elizabeth Cushing from CRICO in a panel discussion. CARe clinician education implementation

The first step to approaching a conversation with a patient/family after a safety event is to get help.  No matter how senior or experienced you may be, it may be helpful to talk through and practice what you plan to say with a disclosure coach. Such conversations are difficult and can be emotional. We have guidelines for communicating with patients and families after safety events. Since March, Dr. Beverly Loudin and Kerry Markert in the Department of Patient Safety and Risk Management have been presenting these guidelines at departmental meetings across Atrius. The presentations also give clinicians the opportunity to ask questions about the process and practice some skills through case vignettes.

Since the official program kickoff in March 2015, we have noticed a sustained increase in overall event reporting as well as an increase in the severity of the events reported. We are continuing to refine our root cause analysis process and fine tune our communications with CRICO regarding these cases. The greatest challenge in the ambulatory setting is in identifying when an event occurred. Safety events are often the result of coordination of care and it remains challenging to identify exactly what went wrong. We look forward to further refining our CARe processes and learning how best to share the quality improvement opportunities identified through our investigations. 


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