HSLS Update

Rapid Deployment Continuing Education

Using Educational Technology to Improve Patient Safety

In 2001, the Institute on Medicine issued a report that called for reform of the U.S. healthcare system. The report, Crossing the quality chasm: a new health system for the 21st century, mandates that existing gaps in patient safety and quality of care be filled. In response, Rapid Deployment Continuing Education (RDCE®) <cme.health.pitt.edu> has been developed to help overcome these gaps by using educational technology to improve patient safety.

A project of the Pittsburgh IAIMS Program, RDCE® was developed by the Center for Continuing Education in the Health Sciences, in conjunction with the Center for Biomedical Informatics and the Health Sciences Library System. First released in the fall of 2002, RDCE® consists of a series of educational modules covering different health related topics. These learning modules are composed of a variety of electronic resources, including journal articles, guidelines, aggregated patient care and outcomes data, and patient education materials. Content de-velopment time is relatively short (1-2 weeks) because, where possible, existing resources are used, and the courseware functionality supports quick assembly of content into modules. In addition, open-ended, reflective questions are used, reducing the effort required to formulate traditional multiple-choice tests. Reflective questions also require the learner to think about how the information relates to practice and what barriers might affect implementation of the recommendations. Responses are posted to a public discussion list that can be reviewed and commented upon by other members of the learning community, as well as the performance improvement team. Evaluation questions address relevance of the educational materials to the learner’s practice, perceived knowledge change, and intent to improve practice. Users who complete the module receive up to one hour of continuing education credit. To date, ten RDCE® modules have been created (listed at end of article) and the application has over 900 users.

Traditional continuing educational approaches, such as attending meetings, knowledge-based quizzes, etc., are not always effective in changing physician behavior. As an alternative to traditional continuing education, the RDCE® platform provides an elegant way for performance improvement teams to educate large and small populations of health care workers with specific educational needs. Authors of modules geared towards performance improvement can combine already available general resources with those the authors have developed. In this way authors can create a module that focuses on the defined needs of the population.

Most recently, the University of Pittsburgh Medical Center (UPMC) has created several modules designed to address specific performance improvement issues. The modules are a mandatory activity for all employed physicians at UPMC. Thus far these modules, Hand Hygiene Training and Central Line Associated Blood Stream Infections (CLABS), have been accessed by 532 and 307 users respectively. Both modules consist of a mix of CDC guidelines and materials created by the UPMC Institute for Performance Improvement. Users are asked to answer three reflective questions:

1. What are some of the factors that prevent physicians from consistently using all five barriers (gloves, gown, mask, cap, and drape) when inserting a central line?
2. What strategies could be undertaken to improve physician documentation of central line placement?
3. What can be done to create a hospital environment in which nurses and other hospital staff feel comfortable telling physicians and house staff that they are not using all five barriers (gloves, gown, mask, cap and drape) during central line insertion?

These questions are designed to provide useful feedback for the performance improvement team as well as to directly involve the user in the performance improvement effort. The questions force users to think about the information they have just reviewed in relation to their own practices and then make suggestions based on their conclusions. As the numbers of responses grow, themes become apparent. These themes can be helpful to define further performance improvement efforts as well as environmental changes that can be put into effect to help improve patient safety.

This type of educational intervention has been well received by the users. The modules do not take a long time to complete, are easy to use, are relevant to the users practice, and enhance the users’ knowledge of the subject area. In addition, the modules can be accessed from anywhere and the user receives continuing education credits upon completion. All of these features combine to make up a positive user experience.

Overall, RDCE® is an effective way to provide targeted education to a specific population. Because of this, RDCE® is an excellent way to incorporate education into a performance improvement effort.

Rapid Deployment Continuing Education: Currently Available Modules

• Appropriate Use of Influenza Vaccine
• Appropriate Use of Meperidine
• Central Line Associated Blood Stream Infections (CLABs)
• Current Controversies of Hormone Replacement Therapy
• Disclosure - How to Talk with Patients and their Families when Unfavorable Events Occur
• Hand Hygiene Technique
• Informed Consent - Corporate Insurance, Risk Management and Patient Safety
• Severe Acute Respiratory Syndrome
• Smallpox Immunization
• West Nile Virus

--Stephanie Lunsford, Center for Biomedical Informatics

--Barbara Barnes MD, Associate Dean for Continuing Education, Center for Continuing Education in the Health Sciences