Request for Funding
Medical Student Research Fellowship for Summer 2002
Mentor: Yvonne Coyle, M.D.
Department: Internal Medicine
Room Number: K1.200
Mail Code: 9103
Phone Number: 8-2992
E-mail: yvonne.coyle@utsouthwestern.edu
Project Title: The Use of Graduate Medical Education in the Prevention of
Medical Errors and Reduction of Patient Risk
Human subjects IRB approved project number (where applicable): Pending
Animal subjects IRB approved project number (where applicable): NA
Project Type: Patient-based research
Brief Description of Project:
Purpose: Past case studies have shown that inadequate educational preparation has the potential for causing significant harm to the patient. Very little research has focused on preventable medical events outside of hospitals, such as office practices or ambulatory care clinics. The major hypothesis guiding the project is that educating graduate medical trainees about types and causes of medical errors heighten awareness and will reduce the potential for harm in their patients. The primary aim of this project is to develop a medical event identification and prevention educational program for family practice residents and their support staff in the ambulatory care setting. The
Specific Aims for the project are to:
1. Develop a medical event reporting system and a training program for its use
in the ambulatory care setting
2. Provide medical event reporting training (Specific Aim #1) to the project's
participants
3. Develop and implement an educational feedback intervention based on medical
event reports
4. Test the effectiveness of the educational feedback intervention (Specific
Aim # 3) for changing medical event types and reducing medical event risk for:
a. Family practice residents
b. Ambulatory care clinic staff
Concise Summary of Project: The design for the project's study is the
one group pre- and post-test study. The proposed project will be conducted in
collaboration with the Parkland Family Practice Clinic (public health care),
which is managed by the UT Southwestern Family Practice and Community Medicine
Department, and the St. Paul Harvest Hill Clinic (private health care) over
1 year.
During month 1 of the project, the investigation team will develop the event
coding system to use in an anonymous general medical event version of Medical
Event Reporting System for Transfusion Medicine (MERS-TM), or MERS-Med, and
the core graduate medical trainee educational program for the recognition, identification
and prevention of general medical errors. The PI for the project is the PI for
a NIH funded project (R01-HL53772) at UT Southwestern whose purpose is to develop,
implement, and evaluate MERS-TM in collaboration with Columbia University. MERS-TM
is a confidential reporting system, whose primary strengths of this system include:
(1) the inclusion of the entire spectrum of events, near misses through sentinel
events, (2) a standardized reporting format that uses a combination of event
codes and narrative tags for event description, (3) a tool for risk assessment
based on actual or potential severity to the patient and probability of recurrence
for selection of events for root cause analysis, and (4) a domain-independent
classification system for the root causes of events. The MERS-TM training package
includes an introduction to general human error research as well as specific
training on the use of event and causal codes, the process of conducting a root
cause analysis, and how to analyze and use the information collected.
Project data collection instruments will be developed during months 1-2. In
month 3, all of the family practice residents (assigned to the Parkland Family
Practice Clinic or the St. Paul Harvest Hill Clinic), and all of the clinic
staff at the St. Paul Harvest Hill Clinic will be instructed on how to use the
medical event reporting form. At least 90% of the graduate medical trainees
and 90% of the ambulatory care site personnel at the St. Paul Harvest Hill Clinic
will be trained to use the medical event reporting forms at all times. We will
evaluate the effectiveness of the medical error reporting system with regards
to achieving sufficient reporting levels during months 3-4. This evaluation
will be based on comparing the number of reports with the number of patient
encounters and previously published levels of adverse events. During months
5-11, we will collect medication error data that includes medical event number,
type, and severity. The primary educational intervention will be conducted during
months 5-10 of the project (Specific Aim #3). The intervention will consist
of providing the clinic residents and personnel feedback about types of medical
events reported, their causes and recoveries in the form of a monthly 1-hour
conference. Only those events that have a risk assessment score of > 0.50
and are determined by the clinic faculty and investigators to have teaching
value will be undergo root cause analysis using 'modelling'. 'Modelling' uses
the collective experiences of the graduate medical trainees to describe how
a particular type of event can happen in a particular environment. The goal
is to model the production of events. The added benefit of 'modelling' is that
two dimensions are used to reduce the probability for such events to occur in
the future. The first is the identification of factors that are productive of
events. The second dimension is the identification of 'recovery-promoting factors'
that can subsequently be strengthened in the system. During these conferences
the clinic residents and faculty will collectively discuss how particular types
of events can occur in a particular type of environment, referred to above as
event 'modelling', as well as possible mechanisms to either minimize patient
harm as the result of these events or prevent these events from recurring. The
medical event analysis will determine if there were changes over time (baseline
at month 4 as compared with month 10) in the number of reports made, the risk
associated with those events, the event types and root causes determined by
event 'modelling' (Specific Aim #3). Data analysis for the project will be performed
during months 11-12 of the project.
Previous Research Activities or Publications with Medical Students:
As the Director of the Health Services and Outcomes Research Center, I have worked with medical students (MS-0 and MS-1), graduate students (has included the public health, psychology, and anthropology disciplines), medical and surgical residents, and research fellows. In addition, our research center also works closely with UT School of Public Health epidemiologists and biostatisticians.
Currently, the center has 4 major projects funded by Federal and Non-Federal grants that are ongoing and collaborates with other health services researchers and epidemiologists at Columbia University, UT School of Public Health, UT Medical Branch at Galveston, and Baylor University Medical Center at Dallas.
Publications, Posters, and Theses of Past Medical and Graduate Students (name underlined below) associated with the Center's Research Faculty:
1. Coyle YM, Land K, Hynan LS. Developing tools to assess and improve the quality
of care: acute asthma care as an example (submitted to the Archives of Internal
Medicine in December 2001).
2. Ko J. Analysis of the acute asthma care process in the emergency room to
identify opportunities for patient asthma education. The University of Texas
Southwestern Medical Center at Dallas 39th Medical Student Research Forum, Dallas,
January 23, 2001.
3. Battles JB, Kaplan HS, Mercer SQ. Automated blood testing in the United Kingdom.
A case study of three blood centers. American Association of Blood Banks 53rd
Annual Meeting, Washington, DC, November 2000.
4. Kraynick YG. Poster: Cultural impacts on asthma aeatment autcomes for Mexicans
and Mexican Americans. Agency for Health Services Research Conference, Chicago,
IL, June 27, 1999.
5. Coyle YM, Gruchalla RS, Kraynick YK, Hynan LS. Risk factors for asthma among
inner-city adults. American Public Health Association 127th Annual Meeting,
Chicago, November 7-11, 1999.
6. Kraynick YG. Effect of personal characteristics of Mexicans and Mexican Americans
with asthma on emergency room treatment outcomes. Ph.D. dissertation, University
of Texas Southwestern Medical Center; 1998.
7. Mercer SQ, Battles JB, Kaplan HS, Whitaker BI. The use of "smart paper"
technology in event reporting systems. Fourth World Conference on Injury Prevention
and Control, Amsterdam, May 17-20, 1998.
8. Kaplan HS, Battles JB, van der Schaaf TW, Shea CE, Mercer SQ. Identification
and classification of events in transfusion medicine. Transfusion. 1998;38:1071-1081.
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