I often hear people say that we should apply what we know from #QI to the #COVID19 response -- the concerns around COVID testing and trying to increase our testing capacity serve as a good example where knowledge of systems can be helpful. A thread. I often teach #QI with @kgshojania.

He uses this analogy of a Rube Goldberg machine to describe complex systems in healthcare.

Rube Goldberg machines are intentionally designed to perform a simple task in an indirect and overly complicated way

E.g., a pencil sharpener

I have set my clock to 10:30 AM to get @jkwan_md's amazingly informative updates on Ontario's #COVID19 situation.

Want to take this opportunity to thank her immensely, but also reflect on 4 #COVID19 curves that really worry me. The first is the fact that we have no known Epi-link for 50% of our new cases -- @IrfanDhalla points this out repeatedly as a major barrier to properly #TestTraceIsolate

The inaugural @NEJMres360 resident #QI challenge was launched this year. Received 90 submissions.

Of these, 59 invited to prepare and post a poster -- can view them here: resident360.nejm.org/groups/qi-chal…

I'm thrilled that FOURTEEN posters are from @uoftmedicine cc @UofTMedDean @UofTPGME Would like to highlight these amazing #QI posters from resident programs in medicine (@UofT_DoM), pediatrics (@SickKidsNews) and family medicine (@UofTFamilyMed)

cc @UofTPGME @SalSpadafora1 @UofTDoMChair @LennoxHuang @ronald_cohn @CQuIPS @tara_kiran @kgshojania

Today, as the Director of the Centre for Quality Improvement & Patient Safety (@CQuIPS) at the University of Toronto (@uoftmedicine) sent a message to all of our members -- a call to action to mobilize now to support health system efforts to respond to #COVID19 "Our focus at @CQuIPS will be to mobilize as many of our members, graduates and current students and direct them towards their local QI efforts to respond to the #COVID19 pandemic."

Are you an academic clinician or trainee with a career focus in #QI?

Are you interested in implementing QI initiatives in an academic teaching hospital/clinic settings?

Apply for EQUIP - QI certificate program offered by @CQuIPS
(Deadline Mar 27, ‘20)

cpd.utoronto.ca/equip Program format:

1) Two 3-day in-person sessions in Toronto, Canada
2) Longitudinal #QI project
3) Webinars for participants to receive feedback on their projects
4) Personalized coaching from expert program faculty

We are now accepting applications for EQUIP for 2020-21, our #QI certificate course at @CQuIPS that prepares faculty & senior trainees to lead QI in academic environments. Pls retweet & encourage others to apply. Deadline for applications is March 27, 2020 cpd.utoronto.ca/equip @CQuIPS Hoping my 🇺🇸QI friends can help spread the word:
@boedudley @karynbaum @CincyIM @drjensmyers @ChrisMoriates @FutureDocs @dbtady @DrDWP @LisaDHowley @ReshmaGuptaMD @KCaverzagie @DrDanSchumacher @gogrinc @anneghena @JOylerMD @HyungChoMD @Pahwa

An important thread for how we as GIM/hospitalists can communicate more effectively with our primary care colleagues at the time of discharge — @AM_Cressman we should send to our trainees on CTU right now. #MedEd

https://twitter.com/DrJamesOwen/status/1199766531602894851

My 2 major takeaways:

1) I need to spend as much or more effort confirming the patient’s primary care provider (who likely sees patient regularly) as I do figuring out who their specialists are (who might only see patient 1-2 times per year)...

Capping off our yearlong @CQuIPS #QI certificate course. Our course director Olivia Ostrow from @SickKidsNews looking back at the year that was and reminding everyone of the numerous opportunities that lie ahead My favourite part of the morning is our keynote presentation featuring 3 past participants reflecting on their path after completing the @CQuIPS #QI certificate course #CQuIPS2019

Excited to launch #CWCSTARS leadership summit with @ChooseWiselyCA chair Wendy Levinson and patient and public advisor Amy Ma welcoming the next 34 students representing all 17 medical schools in Canada 🇨🇦 Amy Ma tells our students “You are the stewards of patients and families’ trust” #CWCSTARS @ChooseWiselyCA

Spots still available (~12) for EQUIP certificate course for academic clinicians interested in #QI -- course that combines deep dive in #QI methodologies with academic skills building. Starts July 2019 cpd.utoronto.ca/equip Participants spend 3 full days in Toronto July 10-12, 2019, go back to their organizations where one of our expert faculty provide 1-on-1 coaching by distance, and then return to Toronto May 7-8, 2020

It’s go time! @Sunnybrook interprofessional #QI teams pitching their projects to our Quality Quest Judges — @kgshojania @RuTaggar Steffanye and Vivian. Good luck to all the teams! On the line (in addition to Quality Quest bragging rights), teams are vying for project funding courtesy of @Sunnybrook Practice-Based Research & Innovation and Dept of Quality & Patient Safety, priority data access via Decision Support and #QI project coaching from @CQuIPS

One day later I am still filled with emotion — sad with the thought that our system fails patients but hopeful that it will improve — so thankful to Greg’s family for sharing his story with the next generation of doctors so that we can make care safer @gregswings @uoftmedicine

https://twitter.com/Brian_M_Wong/status/1060589611360141312

Brought out important reflections by our @uoftmedicine students — the risks of a “no news is good news” approach to test follow-up for example

The #ICRE2018 debate on the #BawaGarba case tightly links issues of #MedEd and #ptsafety — in the first 10 mins, have already heard about just culture, safe supervision, learning from mistakes, diagnostic uncertainty, systems failures & 2nd victim Here are some more #MedEd #ptsafety topics being discussed at #ICRE2018 plenary:

Speaking up
Teamwork vs teaming
Handoffs
Fatigue and its impact on clinical performance
Psychological safety

Now up -- @eddeestyle leading a discussion on how to introduce discussions on human factors in residency education at #ASPIRE #ICRE2018 #ptsafety For some, the term human factors may not be familiar. Here's a common definition:

"Human factors is the study of the interrelationship between humans, the tools and equipment they use in the workplace, and the environment in which they work."

who.int/patientsafety/…

#ICRE2018

We start with discussion of #ptsafety culture and how to introduce discussions in #MedEd. Stacy Ackroyd uses this powerful video from @MedStarHealth to trigger reflection and discussion on ones organizational safety culture #ICRE2018 #ASPIRE One of the major challenges facing #ptsafety is a culture of disrespect. Revisiting 2012 paper by Lucien Leape in @AcadMedJournal -- highly relevant for #ICRE2018 and its focus on the learning environment this year journals.lww.com/academicmedici…

Back to school!! @kgshojania kicking off the 6th cohort of the @CQuIPS Certificate Course in QI & Patient Safety with 30 interprofessional learners. Cautioning them in coming #QI pitfalls to avoid... Pitfall #1 - Rushing to a solution @kgshojania @CQuIPS — need to make sure you understand the problem and pick a solution that matches it.

Morning report #ChoosingWisely tracker featuring @zacfeilchenfeld leading #AMreport at @Sunnybrook. Let’s see what teaching points he makes...#MedEd Patients with atrial fibrillation do not benefit from treatment with rhythm control meds like amiodarone over rate control meds alone from stroke prevention standpoint. See AFFIRM trial nejm.org/doi/full/10.10…

I was BLOWN AWAY by the caliber of #QI work presented today. Clear impact demonstrated by our resident leaders! #ICRE2017

https://twitter.com/pmoore99/status/921391676278521856

One project by Justin Hall @UofTPGME used patient-reported outcomes to measure improved quality of ED discharge communication #ICRE2017