Patient Safety Curriculum

The Patient Safety Curriculum is designed to provide an overview of the key patient safety issues confronting the orthopaedic surgeon today. The curriculum is composed of seven learning modules which introduce critical concepts and terms related to patient safety, review the recent literature, outline tools and a template for utilizing the curriculum in Mortality and Morbidity Conferences, and provide an evidence-based discussion of common topics in orthopaedics that have direct impact on the safety of our patients. The specific topics covered correspond with sentinel events in orthopaedics as determined by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and based on the Agency for Healthcare Research and Quality's 2001 report, Making Healthcare Safer.

The new curriculum is modeled around the Accreditation Council for Graduate Medical Education’s six core competencies. Currently, these competencies are utilized to guide the education and assess the progress of residents and fellows. In the future, the process of certification and re-certification will be organized around these competencies. The Patient Safety Curriculum is especially valuable in helping to satisfy educational requirements in System-Based Practice and Practice-Based Learning for those in training and those in practice.

To access the curriculum click on the link for each module.

• The Basic Science of Patient Safety
  This module provides an overview of the curriculum and introduces the concepts, terms and literature so critical to understanding and addressing patient safety issues. It discusses perceptions, root cause analysis, human factors engineering, event reporting and barriers to improvement.

• Template for Morbidity and Mortality Conferences
  Newly acquired knowledge is put into practice through a change in the structure of Morbidity & Mortality (M&M) conferences. The recommended structure for these conferences emphasizes systems investigation through root cause analysis. Individual failure is recognized as a sign of deeper systems failings. Residents are provided a template to use when investigating and reporting adverse events or “close calls” at M&M conferences.

• Wrong Site Surgery
  Eliminating wrong site/patient/procedure surgery is no longer a JCAHO goal, it is a requirement. This module discusses the classes of wrong site surgery, the relative incidences and reasons for occurrence, the medical-legal consequences, and the appropriate responses. The AAOS sign your site program and its advisory statement are outlined and evidence of success is presented.

• Communications
  Communication deficiencies play important roles in the generation of medical errors. This module discusses physician-physician, physician-patient, and physician-staff communication and provides strategies for the recognition of difficulties and subsequent improvement. Pre-operative counseling includes a discussion with the patient of each component of the acronym PREPARED to allow for an informed decision regarding surgery. The need for full disclosure is discussed along with techniques to break “bad news.”

• Medication Errors
  Medication errors are perhaps the most common errors in medicine and in orthopaedics. This module reviews the potential sites of errors and the ways in which they may be addressed utilizing technologies like computerized medication order entry.

• Surgical Site Infection
  Nosocomial infection is the most common type of complication affecting the hospitalized patient. Surgical site infection (SSI) is a problem all orthopaedic surgeons encounter. Though SSI is most often not the result of a medical error, specific guidelines regarding choice, timing, route, and duration of antibiotic use have been developed to decrease the incidence. This module reviews these guidelines especially in regard to peri-operative antibiotic coverage for patients undergoing hip or knee arthroplasty.

• Venous Thromboembolism
  Venous thromboembolism is a relatively common occurrence in the orthopaedic patient, which may occur when we least expect it. This module reviews the risk factors, the incidence, and the strategies for protection, surveillance, detection, and treatment of venous thromboembolism. A government-based research/consensus process in which the AAOS is participating, is currently conducting an evidence-based search, which should be released sometime in 2006 and will be the basis for evidence-based recommendations in this module.