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Improving Communication in the Emergency Department: The 5 Cs Model of Consultation

Improving Communication in the Emergency Department: The 5 Cs Model of Consultation. Educational Soundbites CORD Academic Assembly 2011 San Diego , CA Chad Kessler, MD, MHPE Chad.Kessler@VA.gov. 15 Minute Plan of Attack. Identification of a problem

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Improving Communication in the Emergency Department: The 5 Cs Model of Consultation

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  1. Improving Communication in the Emergency Department: The 5 Cs Model of Consultation Educational Soundbites CORD Academic Assembly 2011 San Diego , CA Chad Kessler, MD, MHPE Chad.Kessler@VA.gov

  2. 15 Minute Plan of Attack • Identification of a problem • Communication and consultation background • What’s the big idea? • The 5 Cs of Consultation • Impact to the field • Questions and comments

  3. Identification of a Problem Lack of formal training in undergraduate or graduate medical education

  4. Background: Clinical Communication for safe patient care Medical errors Delays in treatment and care Hand-offs and consultations Lack of standardized process or model JCAHO. Sentinel Event Alert. Delays in treatment. http://www.jointcommission.org/assets/1/18/SEA_26.pdf. 2002; 26. Accessed Oct 1, 2010. Cheung DS, Kelly JJ, Beach C, et al. Improving handoffs in the emergency department. Ann Emerg Med. 2010 Feb; 55(2):171-80. Beach C, Croskerry P, Shapiro M. Profiles in Patient Safety: Emergency Care Transitions. Acad Emerg Med. 2003; 10(4):364-367.

  5. Education: ACGME Core Competencies ACGME: Outcome Project, General Competencies. http://www.acgme.org/outcome/comp/compmin.asp. Accessed Sep 15, 2010. Patient Care Medical Knowledge Practice-Based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-Based Practice

  6. What’s the Big Idea? • Qualitative analysis of consultation • Monster literature search Kessler C, Kutka B, Badillo C. Consultation in the Emergency Department: A Qualitative Analysis and Review of the Consultative Process. In Press. The Journal of Emergency Medicine.

  7. Data from Study: Skills for successful Consultation

  8. 5 Cs Checklist Assessment

  9. Reliability Inter-item reliability of GRS (Chronbach’s alpha) Rater 1 0.9 Rater 2 0.89 Rater 3 0.87 Inter-rater reliability for GRS 0.71 Inter-rater reliability for checklist 0.94 Correlation (pearson) between GRS and checklist (n=43, p<0.0001) Surgery cases r=0.59 Psychiatry cases r=0.71

  10. Main Results Intervention group had significantly higher GRS scores (4.1 vs. 3.5, F(1,39)=33.5, p<0.0001) and Checklist Scores (10.7 vs. 7.0, F(1,39)=196, p<0.0001). No natural progression in consulting skills with increasing PGY level

  11. Impact to the Field • An effective, standardized model of consultation; the 5 Cs • Assessment of difficult to measure/quantify ACGME core competencies • Wide-spread education for under-graduate and graduate medical learners

  12. Stepping it Up • From simulated setting to clinical setting • Demonstrate improvement in process measures and patient outcomes • Improve communication and relationships • Improve patient safety • Decrease resource utilization • Electronic Medical Records • Beyond Emergency Medicine

  13. Sug/quest/ments

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