Updates In Patient Safety for C-L Psychiatrists

Abstract: Organizations providing services that are both complex and high-risk at the same time—e.g., hospital systems—require that every individual who is involved in its operations also participates in a strong culture of safety. Physicians have historically lagged behind other professional disciplines in this regard. Meanwhile, adverse events related to behavioral health conditions can and do occur in hospital systems, and responding to such events is an activity that CL psychiatrists should be prepared to lead. CL psychiatrists often bring a perspective that is unique among interdisciplinary teams, and their expertise can be especially useful in cases of suicide, violence, non-medical substance use, and other behavioral emergencies. In this workshop, quality and safety leaders in CL psychiatry will share their expertise in this area. First, they will define what it means to have a functioning safety culture and outline the role of CL psychiatrists in leading that culture, and then they will provide a template for responding to adverse events when they arise. This will lead to an immersive role-playing experience, in which participants will participate in a series of mock case reviews and have an opportunity to practice these skills together.

Agenda:

1. Why CL psychiatrists should be involved in patient safety activities [10 min]

2. Describe the safety culture frameworks that are used in hospital systems [10 min]

3. Explain how patient safety activities can be structured to meet regulatory and educational requirements [10 min]

4. Mock case review: straightforward case, more scripted guidance from panel [Panel, 15 min]

5. Mock Morbidity and Mortality conference: less scripted guidance, weighted toward audience participation [Panel, 25 min]

6. Q&A [5 min]



References:

1. Pang S, Warraich HJ. Humanizing the morbidity and mortality conference. Acad Med 2021;96:668-70.

2. Kroll DS, Shellman AD, Gitlin DF. The Psychiatry Morbidity and Mortality Incident Reporting Tool Increases Psychiatrist Participation in Reporting Adverse Events. J Patient Saf 2018;14:e51-55.

3. Chathampally Y, Cooper B, Wood DB, et al. Evolving from morbidity and mortality to a case-based error reduction conference: evidence-based best practices from the council of emergency medicine residency directors. West J Emerg Med 2020;21:231-41.