The Sullivan Group's e-Learning Newsletter
February 2014 - In This Issue
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Thank you for reviewing INSIGHT, a newsletter outlining news and events at The Sullivan Group and providing valuable advice and tips from the esteemed members of our Advisory Board.
Dan Sullivan, MD, JD, FACEP
President & CEO
SAVING LIVES. REDUCING RISK.
Leveraging Continuing Education for Nurses & Physicians to bring about meaningful change.
The Sullivan Group offers a series of scalable, comprehensive loss prevention and patient safety programs, specifically targeted at reducing medical errors and malpractice claims across the care continuum. The RSQ® Solutions (Risk-Safety-Quality) programs are tailored for a variety of medical and nursing specialties and based on a proven cyclical model of continuous quality improvement that drives change, strengthens clinical performance, and reduces risk exposure. Contact us to learn more.
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Captive Online Risk Education
Engage your Insureds
The Sullivan Group (TSG) has designed an affordable, immediate continuing education solution to meet the loss prevention goals of captives and risk retention groups. This program is easy to implement and access, and the entry point can be customized with your company's logo and color schematic. Authored by TSG's RSQ® Advisory Board, a group of clinical experts/champions, these relatable courses will help you to better engage your insureds and enable you to stay in front of them with current medical malpractice issues. Contact us to learn more.
Value-Based Purchasing Educational Program
TSG has designed a comprehensive educational program designed to change behavior to increase the quality and efficiency of care for front line staff.
With the increased access to care afforded under the Patient Protection and Affordable Care Act (PPACA), we anticipate an adjustment period whereby hospitals will note a decrease in the quality of care provided to patients as a function of volume. To get ahead of this anticipated trend, we recommend a comprehensive program for the entire healthcare team to outline how they can make little changes in their approach that have great returns on the whole.
TSG has outlined a specific curriculum for quality improvement through risk mitigation and increased patient safety awareness. Contact us to learn more.
The Sullivan Group solutions go well beyond education. We develop tools to help providers proactively manage risk and improve the care provided to patients (RSQ® Modules for EMRs) and provide methods to allow organizations to anticipate and respond to latent needs (RSQ® Assessment). The RSQ® Assessment helps clients:
- Uncover gaps in practice and currently employed proactive risk education initiatives
- Conduct a thorough audit of: Documentation, Skill, Teamwork, Communication, Patient Management, Supervision, and Policy
- Provide the C-Suite with a data-driven perspective on clinical risk management leading to investment in practice solutions
- Assign online courses to address the professional practice gaps in high-risk areas of clinical practice
As with all TSG services, reassessment, recommendations, and ongoing support are provided. Contact us to review a sample assessment report and to discuss how this program can benefit your organization.
We are attending and/or exhibiting at the following conferences. We hope to see you there!
- HIMSS - 2/23-27 in Orlando, FL
- AONE - 3/12-15 in Orlando, FL
- UCAOA Conference - 3/17-20 in Las Vegas
- Medical Insurance Conference (Crittenden Conferences) - 3/30-4/1 in San Diego, CA
- PLUS Medical Liability Conference - 4/23-24 in Atlanta, GA
- RIMS Annual Conference - 4/27-30 in Denver
Faculty Speaking Engagements
Arnie Mackles is still on the road! Please contact Arnie if you are interested in learning more about his presentations or to check availability.
- Feb 7th - Bayonne, NJ
- Feb 26th - 34th Annual Respiratory Conference at the Slopes, Champion, PA
- Feb 27th - Windbur, PA
- March 7th - Grand Junction, CO
Shelley Cohen, RN, MSN, CEN will be presenting at the following conferences:
New Jersey Emergency Nurses Association
Atlantic City, New Jersey
2014 Emergency Care Conference
March 19-21, 2014
Emergency Nurses Association
March 5-9, 2014
Pitfalls & Liability Risks in Labor (see Dr. Lerner's section for details)
Pitfalls & Liability Risks in Prenatal Care (see Dr. Lerner's section for details)
The first 5 Fetal Heart Monitoring Vignettes are live and available to learners. They are available as a package or separately.
- FHM Vignette #01: A 32-Year-Old G2P1 at 40½ Weeks
- FHM Vignette #02: An 18-Year-Old Primigravida in Labor at 37 Weeks
- FHM Vignette #03: 39-Year-Old Obese Diabetic
- FHM Vignette #04: 42-Year-Old G1P0 With IVF Pregnancy
- FHM Vignette #05: 29-Year-Old With Mild Gestational Hypertension
Pediatric Testicular Torsion
For a variety of reasons, the diagnosis and management of testicular torsion is particularly troublesome. Failure to diagnose and manage testicular torsion is among the most common causes of malpractice lawsuits in pediatrics. In fact, for adolescent males (aged 12-17 years), this is the third most common diagnosis involved in malpractice claims. This is a key risk area in emergency, urgent care, and pediatric medicine. When a pediatric patient with a complaint of scrotal or lower abdominal pain enters the healthcare system, he needs to be promptly evaluated for the possibility of testicular torsion.
In this activity, we focus on errors in the diagnosis and management of testicular torsion in young patients, using cases where the condition was allegedly missed or treatment delayed. After completing this activity, practitioners should be able to: recognize both typical and atypical presentations of testicular torsion in pediatric patients; identify the difficulties in diagnosing testicular torsion by history and physical exam alone; and manage testicular torsion expeditiously to prevent necrosis of the testicle.
Disclosure & Apology Just-In-Time
This activity is a short video introduction on empathy training; it will show you how to handle post-event discussions with patients and families. It is helpful to watch after an adverse event has just happened and you have to give bad news to a patient or family. It will also help you, your patient and your patient's family get through the difficult moments ahead.
This activity begins with a 6-minute introduction video that outlines 10 tips that will prepare you to begin to rebuild and preserve the relationship with your patients and their families post-event. This is followed by two brief 2-minute videos that show you how to handle two different scenarios. The first scenario is an example of disclosure and empathy; the second also shows disclosure and empathy, but with a combative family member who is too angry to listen.
Disclosure & Apology: Fundamentals
Errors in the practice of medicine occur despite everyone's best efforts and intentions. When adverse events happen, clinicians and consumers typically struggle in their communications, and relationships become damaged or even broken. Trust can be diminished or lost. Angry patients and families may pursue litigation as well as share their stories with state regulators, the media, and social media. At one end of the disclosure spectrum, healthcare providers communicate little or nothing, and instead opt for secrecy. This habit of non-disclosure is driven by customary practices learned during medical education along with the fear of malpractice liability. The other end of the spectrum is disclosure and apology, which has only recently begun to take root among healthcare, insurance, and legal professionals. This new practice of disclosure addresses patients' issues of anger and their belief in a cover-up that fuels most malpractice litigation. Many defense and plaintiff's attorneys report that disclosure literally "takes the wind out of the case."
In this activity, we use the literature and case studies to explore disclosure and apology (D&A), a method of communicating "bad news" to patients who experience unanticipated adverse outcomes as a result of a medical error, as well as disclosure, apology and offer (DA&O), which includes an offer of compensation. After completing this activity, practitioners should be able to: use the phrase "I'm sorry" in the appropriate context following an unanticipated patient outcome; apply the guidelines for post-event review, resolution, and apology; and classify the potential barriers to implementation of a disclosure and apology (D&A) or disclosure, apology and offer (DA&O) program.
CME Courses in Development
The TSG faculty and staff are currently working on the following courses. We will keep you posted on our progress, but please do not hesitate to contact us to learn more about what we have planned for each topic.
- Workplace Violence, Disruptive Behavior & Hostile Environment in Healthcare
- 7 Simple Strategies to Reduce Readmissions
- Information [Cyber] Security Tips for Healthcare Professionals
We are pleased to announce the release of evidence-based updates to the following courses:
- Myocardial Infarction, Part 1
- Myocardial Infarction, Part 2
- Pulmonary Embolism, Part 1
- Thoracic Aortic Dissection
- Stroke Literature Review: Acute Stroke Management with Thrombolysis
- Stroke Part 1
**Significant Updates! The latest evidence-based medicine best practices were added to each of the courses listed above. As such, we recommend reassignment of the material.**
"We couldn't be more pleased with our relationship with The Sullivan Group. Their risk education has been a hit with our practitioners and combined with the clinical risk assessment tool, we have been able to provide a comprehensive and very focused loss prevention program for our EDs. Now with a decade of claims data across 160 facilities, the data show a strong correlation between success in the program and our approximately 60% reduction in claims frequency."
Joseph Haase, CPHRM, President, HCI, Inc. (Hospital Corporation of America's insurance entity)
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RSQ® Advisory Board Spotlight
|We appreciate this month's contributions from the following members of The Sullivan Group RSQ® Advisory Board. For more information about the Board, please click here.|
Today's risk managers face a myriad of challenges associated with the increased emphasis on patient satisfaction, experience, and expectations of care with healthcare's value-based purchasing (VBP). This is an enterprise risk that impacts clinical, strategic, regulatory, and financial domains.
On January 16, 2014, Dr. Finefrock presented a webinar for ASHRM titled, "Implementing Programs to Improve the Patient Experience and HCAHPS in the Era of Value-Based Purchasing." (It is available as a recording through the ASHRM website.)
The webinar provided participants with an overview of the importance of addressing patient experience and satisfaction with the changes to the VBP domain percentages in regard to improving HCAHPS scores. He reviewed best practices and shared new tactics to successfully engage front-line staff and obtain leadership buy-in. Dr. Finefrock recommends organizations utilize checklists systematically applied during each patient encounter as one method to impact the patient experience, as well as educational programs that feature role-playing in the healthcare setting to better engage the healthcare professional in the process. PatientSET™ is the program Dr. Finefrock developed with The Sullivan Group to provide education, tools and resources to front-line staffs to positively impact the patient experience ratings - an increasingly important reimbursement criterion for hospitals.
Follow this topic: PatientSET
- PatientSET™: Introduction for All Healthcare Providers
- PatientSET™: Hospital Best Practice High-Risk Videos
- PatientSET™: Office Best Practice High-Risk Videos
- PatientSET™: Introduction for Nurses
- PatientSET™: HCAHPS Videos for Nurses
- PatientSET™: Healthcare Customer Service Videos for Nurses
- PatientSET™: Healthcare Customer Service (for non-licensed professionals)
Shelley Cohen, RN, MSN, CEN
Managing Patient Volume in the ED
Are you prepared for surges in your ED patient volumes?
As we head into the peak of flu season, many facilities are already feeling the effects of increased volumes, such as:
- Longer waiting times
- Staff exposed to more airborne illnesses resulting in increased sick time
- A shift in perceptions of care resulting in lower patient satisfaction scores
In addition, the Patient Protection and Affordable Care Act (ACA) is expected to result in a surge in patient volume, and there is no way to determine those numbers. Millions of people are expected to enroll in a health insurance plan, many for the first time. Most healthcare professionals anticipate an increased demand on triage, as some of these individuals will assume the "magic" insurance card will cover ED visits for every health issue.
The unpredictable impact on and future of ED/Urgent Care Services as a result of ACA will inevitably place a burden on organizations that are already striving for improved door to physician times to affect better outcomes and patient satisfaction ratings; the increased patient flow has the potential to derail the advances made to date.
The Journal of Health Affairs estimates that more than 30% of physicians will be unwilling to accept the 17 million new Medicare patients, leaving these patients no choice but to access care through the ED or urgent care. The ObamaCare Survival Guide even refers to the ED setting as "back up" for both the newly insured as well as those uninsured by choice.
Given these factors, we recommend you assess your current triage practices and consider the following:
- When was the last time you validated triage competency in the nursing staff?
- Do you have a surge plan in writing that is supported by the administrative team?
- Where are the gaps in triage education, particularly those related to orientation?
- Are staff trained in rapid triage?
- Are your standing orders for triage in compliance with CMS regulations?
Healthcare professionals need to be realistic and base patient volume surge predictions on historical data about how patients seek emergency care. Despite the fact that the newly insured patients will have access to community health centers and primary care services, it is inevitable that many of them - millions of them - will seek care in emergency departments or urgent care settings.
A proactive stance will mitigate the challenges - prepare for increasing volumes by providing triage staff with the tools, resources and education required to meet the predicted shift in patient demographics and increased volume.
Cohen, Shelley. Triage Trainer Update. Hohenwald, TN. Health Resources Unlimited. 2013.
Marco, Catherine, et al. The Ethics of Health Care Reform. Impact on Emergency Medicine. AEM. 19 94;, pages 461-466. 2012.
Tate, Nick. ObamaCare Survival Guide. West Palm Beach. Humanix Books. 2012.
Follow this topic: RSQ_TriageSTAT
- Triage Fundamentals: A comprehensive suite of eleven (11) courses (ranging in length from one to two hours) targeting risk issues in triage nursing, and covering topics such as The Risky Business of Triage, practice standards, assessment and documentation, etc.
Arnie Mackles, MD, MBA, LHRM
Risk Management & Patient Safety
NEW YEAR! ... NEW HEALTHCARE REFORMS! ... NEW PATIENT SAFETY CHALLENGES!
Healthcare reform as created by the Patient Protection and Affordable Care Act (ACA) and the Hospital Readmissions Reduction Program (HRRP) has presented the need for innovative strategies to protect both providers and patients. Hospitals are currently being penalized for 30-day readmission rates that exceed national standards for the following conditions: Heart Failure, Pneumonia, and Acute Myocardial Infarction.
Beginning in 2015, three additional conditions will be added to the list: Chronic Obstructive Pulmonary Disease, Elective Hip Arthroplasty, and Elective Knee Arthroplasty. It is therefore imperative that healthcare organizations implement techniques and policies that have been proven to SAFELY reduce unplanned readmissions. In response to the growing need for targeted solutions, The Sullivan Group is offering the following CME/ CE activities:
- Handoffs, Transitions & Discharges: Key Moments in Patient Care
- 7 Simple Strategies to Reduce Readmissions - coming soon
- Communication Strategies to Improve Patient Safety in High-Risk Situations
- 11 Simple Strategies to Prevent Medication Errors
- Technology Revolution: Improving Patient Safety, Reducing Liability
- Essentials of Patient Safety
- Prevention of Medical Errors
**These courses and others are now a part of TSG's Value-Based Purchasing program, a curriculum designed to impact the behaviors and areas of clinical care that most frequently result in readmissions.**
Follow this topic: RSQ_Education
SorryWorks! Disclosure & Apology
We are proud to announce the recent launch of two new courses for front-line clinicians and managers:
Just-in-Time/Introductory is a 12-minute video based course which quickly provides the basics of disclosure and empathy along with two scenarios. This short course is a must for all existing and new staff, and should be part of your on-boarding process. The course is also a quick refresher for staff and managers who must disclose to patients and families.
Disclosure Fundamentals is an in depth, CME-accredited* course covering why disclosure is important to patients and families to how disclosure works, including how to empathize and stay connected post-event without prematurely admitting fault. The course provides check lists, dos and don'ts, video segments & video commentary, case scenarios, and test questions. This is the complete course to help your staff truly embrace disclosure.
We will be holding preview webinars for these two new on-line disclosure learning courses on the following dates & times:
- Thursday, February 6th: Noon-1 pm CST
- Tuesday, February 18th: Noon-1 pm CST
- Disclosure & Apology: Fundamentals
- Disclosure & Apology: Just-In-Time Trainer
Clinical Integration: As a function of ACOs or through mergers and acquisitions, risk managers are feeling pressure to indoctrinate new groups. TSG offers convenient and standardized solutions to assist this effort. The online courses may be used to create a baseline of knowledge across a disparate organization and can be rapidly deployed to hundreds or thousands of clinicians.
HIPAA: Despite the overall-wait-and see approach, the noise on this topic is increasing, especially on the heels of the security issues with the rollout of the Healthcare.gov website. The Department of Health and Human Services has publicly criticized the Office of Civil Rights (enforcement of HIPAA) for lax monitoring and inconsistent investigation. In response, the OCR has outlined the permanent monitoring program and promised increased diligence in monitoring, auditing and penalizing covered entities and business associates. TSG predicts that OCR will be looking to set a few examples to the detriment of those who experience a breach in the first or second quarter of 2014. TSG is putting the finishing touches on a Just-in-Time online course to assist organizations in generating awareness of risky behaviors. The course outlines hypothetical situations based on actual OCR investigations.
Workplace Violence/De-Escalation Techniques: The unfortunate and terrifying trend of violence in public settings continues to plague the U.S. These situations can be paralyzing in the moment. TSG is in the process of completing a course on Workplace Violence that includes recommendations for de-escalating violent and/or emotionally charged individuals. The course is authored by Dr. Leslie Zun. Dr. Zun's research interests include healthcare administration, violence prevention and behavioral emergencies.
Please contact us to discuss adding the aforementioned courses to your TSG library.
New Obstetrics Courses!
Dr. Lerner has just completed the finishing touches on Pitfalls & Liability Risks in Labor and Pitfalls & Liability Risks in Prenatal Care. Please contact us to add these programs to your TSG course library.
Pitfalls & Liability Risks in Labor
While pregnancies, labors, and deliveries usually go smoothly, all obstetrical providers know that this is not always the case. As obstetricians, midwives, family practitioners, and others caring for pregnant women from gestation through birth, it is important to strike the right balance between anticipation of disaster and normalization of the birthing process. It is only through the review of previously learned information and the acquisition of new knowledge that all who care for women during pregnancy can afford their patients the highest level of care and clinical acumen.
In this activity, we get down to basics; for example, the way even basic issues such as pelvic shape, uterine contractions, and assessment of labor curves can challenge the practitioner in his or her attempts to provide optimal care. We discuss breech and other malpresentations, pelvimetry and cephalopelvic disproportion, diagnosis of labor, use of oxytocin, labor protraction and arrest disorders, diagnosing ruptured membranes, delivery of the placenta, episiotomies, and areas of controversy related to labor. We examine a number of cases to highlight some of the common pitfalls and liability risks in labor. After completing this activity, practitioners should be able to: employ techniques to diagnose breech and other malpresentations in order to anticipate and prevent the associated complications; integrate awareness of the consequences of the inappropriate diagnosis of labor into clinical practice in order to improve patient safety and decrease the risk of exposure to medical malpractice; and assess the benefits and risks associated with the use of oxytocin during labor in order to improve patient safety and decrease the risk of exposure to medical malpractice.
Pitfalls & Liability Risks in Prenatal Care
Prepregnancy care has many facets. Hereditary or genetic conditions, medical illnesses, or harmful habits a woman might have at the time of conception significantly increase the risk of suboptimal outcomes for her and her baby. Since most women do not know they are pregnant until four to six weeks after conception and since much embryologic development occurs during this period, opportunities for preventing harmful fetal exposures are often missed. It is only through the review of previously learned information and the acquisition of new knowledge that all who care for women during pregnancy can afford their patients the highest level of care and clinical acumen.
In this activity, we cover prepregnancy counseling and prenatal care. We examine a number of cases to highlight some of the common pitfalls and liability risks in prenatal care (e.g., the issues involved in conducting relevant and comprehensive prepregnancy and pregnancy counseling, correctly identifying and managing prenatal risk factors, and performing ongoing pregnancy risk assessment). After completing this activity, practitioners should be able to: outline the obligations an obstetrician has to inform his/her patient regarding the interaction of pregnancy with an accompanying medical condition; choose the appropriate steps to take when a high-risk problem is identified during the initial obstetric history in order to improve patient safety and decrease the risk of exposure to medical malpractice; and interpret the signs and symptoms that may occur during routine prenatal care that indicate potential problems with the pregnant patient and her fetus in order to improve patient safety and decrease the risk of exposure to medical malpractice.
Follow this topic: RSQ_OB
- Neonatal Emergencies
- Postpartum Hemorrhage
- Neonatal Asphyxia
- Ectopic Pregnancy in Obstetrics & Gynecology
- Pitfalls & Liability Risks in Labor
- Pitfalls & Liability Risks in Prenatal Care
- Shoulder Dystocia
- Anatomy of a Medical Negligence Lawsuit in Obstetrics & Gynecology
The Sullivan Group is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Some continuing education activities were approved by the Emergency Nurses Association, an accredited approver of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
The details of the CME and/or CE for all TSG activities can be found here