Peter J. Pronovost, MD, PhD; Myron L. Weisfeldt, MD
Acknowledgment: The authors thank Christine G. Holzmueller, BLA, for her assistance in editing the manuscript.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2717.
Requests for Single Reprints: Peter J. Pronovost, MD, PhD, 1909 Thames Street, 2nd Floor, Baltimore, MD 21231; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Pronovost: 1909 Thames Street, 2nd Floor, Baltimore, MD 21231.
Dr. Weisfeldt: 1830 East Monument Street, Suite 9026, Baltimore, MD 21287.
Author Contributions: Conception and design: P.J. Pronovost, M.L. Weisfeldt.
Drafting of the article: P.J. Pronovost, M.L. Weisfeldt.
Critical revision of the article for important intellectual content: P.J. Pronovost, M.L. Weisfeldt.
Final approval of the article: P.J. Pronovost, M.L. Weisfeldt.
Administrative, technical, or logistic support: P.J. Pronovost.
Pronovost P., Weisfeldt M.; Science-Based Training in Patient Safety and Quality. Ann Intern Med. 2012;157:141-143. doi: 10.7326/0003-4819-157-2-201207170-00457
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Published: Ann Intern Med. 2012;157(2):141-143.
The American public has benefited tremendously from its investments in biomedical research. The increase in life expectancy is a testament to this benefit (1). Patients with AIDS grow old; most children with cancer survive; patients undergoing dialysis receive kidney transplants; patients with orthopedic conditions have hip replacement and can play tennis again; patients with lung cancer receive chemotherapy targeted to their unique genes; and patients with heart failure live longer, more active lives with carefully titrated drug therapies.
Consider the Marfan syndrome. This genetic disease dilates the aorta until it ruptures. Twenty years ago, we lacked methods to diagnose and treat this condition, and patients uniformly died before their 30th birthday, often leaving a young family behind. Now, we can diagnose and treat this syndrome. Patients are screened for the disease, imaging studies allow physicians to monitor the size of the aorta, new drugs slow aortic dilatation, and once-fatal aortic replacement surgery is now successfully performed (2, 3).
Douglas Paull, Bradley V. Watts, MD, MPH, Robin R. Hemphill, MD, MPH
VA National Center for Patient Safety, Ann Arbor
September 18, 2012
Science-based training in patient safety and quality
We read the article by Pronovost and Weisfeldt (1) with interest. We are happy to report that the Veterans Health Administration (VHA) has heeded their ‘call to arms’ to include patient safety and quality improvement in graduate medical education. The VHA Office of Academic Affiliations (OAA) and the National Center for Patient Safety (NCPS) have offered an Advanced Fellowship in Patient Safety since 2005. The graduates of this inter-professional Fellowship have included 16 with master degrees in public health or hospital administration, 15 physicians, 6 nurses, 4 with doctoral degrees (anthropology, sociology, computer science, organizational psychology), 3 pharmacists, and 1 clinical psychologist. The Fellowship is a one year program, in residence, at one of 7 university-affiliated VHA Medical Centers across the country, with the VHA NCPS serving as the academic hub. The curriculum includes a weekly two-way-interactive-video (TWIV) hosted by NCPS Faculty, face-to-face meetings, and local patient safety and quality improvement projects and activities mentored by local Faculty. Curricular domains include high reliability organizations; systems theory and understanding error; patient safety culture; teamwork and communication; reporting and disclosure of medical errors; change models; transformational leadership; information technology; medication errors, infection, and suicide prevention; and simulation-based teaching.Fellows have completed over 200 patient safety and quality improvement projects and published 58 articles in peer-reviewed journals. Graduates have gone on to positions in research, education, and quality and safety both within the VHA and in other healthcare organizations.Building on the success of the Patient Safety Fellowship, VHA NCPS and OAA have collaborated with The Dartmouth Institute in developing a “Chief Resident in Quality and Safety” (CRQS) Program. The Program currently includes 20 Residency Sites at university-affiliated VHA Medical Centers with positions in Medicine and Surgery. The Program will be expanding next year both in number of sites and breadth of specialties. The VHA Patient Safety Fellowship and the CRQS Program are a start in fulfilling the vision shared by Pronovost and Weisfeldt that “health care needs appropriately trained young clinicians and researchers to lead the way toward improving patient safety . . .” (1).
1. Pronovost, P.J., Weisfeldt, M.L. Science-based training in patient safety and quality. Ann Int Med 2012;157:141-143. [PMID 22688840]
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