A HYPOTENSION GROUP OBSERVED STANDARDIZED CLINICAL ENCOUNTER: ESTABLISHING A CULTURE OF PATIENT SAFETY FOR NEW INTERNS

Ian Fagan, MD1, Lynn Buckvar-Keltz, MD2, Kinga Eliasz, PhD2, Adina Kalet, MD, MPH2, Alexandra Mack, MSAP3, Thomas Riles, MD2, Sondra Zabar, MD2, 1NYU Langone Medical Center / Bellevue Hospital, New York, NY; 2New York University Langone Medical Center; 3New York Simulation Center for the Health Sciences

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: 55

Categories: Education, Hospital Medicine 2018, Research

Keywords: , ,

Background: Incoming interns must understand the specific culture of safety at their new institution as well as processes that they are expected to know on day 1 of residency. As part of an immersive half-day simulation program for incoming interns called First Night On Call (FNOC), we developed a hypotension Group Observed Standardized Clinical Encounter (GOSCE) to educate interns about resources available to them during emergent clinical situations. By the end of the hypotension GOSCE, interns will have an opportunity to identify and evaluate an acute issue (hypotension), collaborate with nursing, escalate to a supervisor, and call the rapid response team.

Methods: 145 incoming interns from 56 schools and 7 departments participated in the hypotension GOSCE, and all were asked to complete a Wise OnCall educational online module on hypotension prior to it. The hypotension GOSCE case is an immersive simulation during which groups of 4 incoming interns are asked to answer a call from a standardized Nurse (SN) and subsequently evaluate a standardized patient (SP) with a fever, obtaining clinical data from both the SN and the SP. During the simulation, the SN reports that the SP develops hypotension and altered mental status, which prompts a repeat evaluation and activation of the Rapid Response Team (RRT). A faculty member observes the case and subsequently debriefs the group. Learners completed a pre-simulation assessment, which included an assessment of the hypotension module, and a retrospective pre-post assessment. The SP and SN complete behavioral anchored checklists.

Results: Prior to the GOSCE, incoming interns (n=133) felt most comfortable (4 or 5 on Scale 1-5) speaking to a supervisor (56%) and escalating a situation (38%). Only a few (21%) had reported escalating a situation prior to the simulation. In the post GOSCE survey, the interns (n = 133) reported their comfort improved (4 or 5 on Scale 1-5) to escalate a situation (96%) and to involve an attending/supervisor (94%). 63% of groups (n=46) called a rapid response team for the hypotensive patient and only 22% contacted the senior resident without prompting prior to initiating a new medication. Interns were asked to write down what they would do in the future and the most prevalent response was “Ask for Help/Escalate care” (83%). 123 of the interns (85%) completed the Wise OnCall hypotension module and 95% reported it increased their level of readiness for internship (4 or 5 on Scale 1-5).

Conclusions: A patient safety simulation is an innovative and acceptable approach to educate learners and improve comfort managing emergent situations. Assigning online resources increase reported learner readiness. Lasting impact will be evaluated by follow-up assessments measuring rates of rapid response team activation at our affiliated institutions.

To cite this abstract:

Fagan, I; Buckvar-Keltz, L; Eliasz, K; Kalet, A; Mack, A; Riles, T; Zabar, S. A HYPOTENSION GROUP OBSERVED STANDARDIZED CLINICAL ENCOUNTER: ESTABLISHING A CULTURE OF PATIENT SAFETY FOR NEW INTERNS. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract 55. https://www.shmabstracts.com/abstract/a-hypotension-group-observed-standardized-clinical-encounter-establishing-a-culture-of-patient-safety-for-new-interns/. Accessed September 19, 2019.

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