Murphy Martina, Duff Jennifer, Whitney Julie, Canales Benjamin, Markham Merry-Jennifer, Close Julia
Department of Medicine, Division of Hematology/Oncology, University of Florida and the North Florida/South Georgia Veterans Administration (NF/SGVA), Gainesville, Florida, USA.
North Florida/South Georgia Veterans Administration, Gainesville, Florida, USA.
BMJ Open Qual. 2017 Oct 31;6(2):e000096. doi: 10.1136/bmjoq-2017-000096. eCollection 2017.
The proposed revision to the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements includes participation in real or simulated patient safety activities, such as root cause analysis (RCA).1 Because exposure to RCA may occur with low frequency, a mock RCA was developed and piloted for feasibility with Hematology/Oncology fellows.
To improve trainee knowledge of the goals and application of RCA in patient safety and quality improvement through a simulated experience.
A mock RCA was implemented with Hematology/Oncology fellows over two subsequent years. In small groups, they reviewed a case involving an adverse event and identified sources of harm. Additional details, in the form of provider interviews, were available upon request. Trainees identified the root cause(s) and proposed measurable changes. Teams presented proposals to peers and a panel representing hospital leadership. Feedback was provided. Trainees completed evaluations and were surveyed regarding their perceptions.
Thirteen of 15 fellows completed the survey. Twelve of 13 (92%) fellows felt the mock RCA improved their comfort level for participation in a real RCA. Ten of 13 fellows (77%) reported increased awareness and likelihood of reporting near misses and/or adverse events following participation. More thorough patient care documentation following the session was reported by 8 of 13 (62%).
A pilot trial of a mock RCA with Hematology/Oncology fellows had high trainee satisfaction. Post-session surveys and informal interviews suggest trainees have reduced anxiety when faced with participation in a real RCA and have more interest in the process after participation.
研究生医学教育认证委员会（ACGME）对共同项目要求的拟议修订包括参与真实或模拟的患者安全活动，如根本原因分析（RCA）。1由于接触RCA的频率可能较低，因此开发了模拟RCA并在血液学/肿瘤学研究员中进行了可行性试点。
通过模拟体验提高学员对RCA在患者安全和质量改进方面的目标及应用的认识。
在随后的两年中，对血液学/肿瘤学研究员实施了模拟RCA。他们分组审查了一个涉及不良事件的案例，并确定了危害来源。如有需要，可提供以提供者访谈形式呈现的更多细节。学员们确定根本原因并提出可衡量的改进措施。各小组向同行和代表医院领导的小组展示提案，并获得反馈。学员完成评估并接受关于他们看法的调查。
15名研究员中有13名完成了调查。13名研究员中有12名（92%）认为模拟RCA提高了他们参与实际RCA的舒适度。13名研究员中有10名（77%）报告称，参与后对险些发生的失误和/或不良事件的报告意识和可能性有所提高。13名研究员中有8名（62%）报告称，会后患者护理记录更加详尽。
对血液学/肿瘤学研究员进行模拟RCA的试点试验获得了学员的高度满意度。会后调查和非正式访谈表明，学员在面对参与实际RCA时焦虑感降低，参与后对该过程更感兴趣。
