Patient Safety, Quality Improvement, Supervision, and Accountability Policy
Radiation Oncology graduate medical education must occur in the context of a learning and working environment that emphasizes excellence in the safety and quality of care rendered to patients by trainees today as well as in their future practice.
The Radiation Oncology program, faculty, residents actively participate in patient safety systems and contribute to a culture of safety. We provide a structure that promotes safe, interprofessional, team-based care and offer formal educational activities that promote patient safety-related goals, tools, and techniques. Specifically, we provide training in incident reporting and encourage all faculty, staff, and trainees to employ the reporting system as deemed appropriate. Trainees also serve rotating terms on the QA and safety committee which meets monthly or more frequently as indicated based upon acuity of incoming incident reports.
Residents, faculty, and other clinical staff are trained in their responsibilities in reporting patient safety events; they learn how to report patient safety events (including near misses); and are provided with summary information of their clinical site’s patient safety reports. This information is both presented during a live session and provided on-line as a reference. Residents participate as team members in real interprofessional clinical patient safety activities via participation on the QA and Safety committee where they participate in root cause analyses and activities that include analysis, as well as formulation and implementation of actions. They report findings back to the resident group.
All residents receive training in how to disclose adverse events to patients and families via didactic sessions. They are encouraged to participate in ACGME Grand Rounds activities on disclosure. They have the opportunity to participate in the disclosure of patient safety events in the clinic. They are observed and given feedback with this activity as part of standard resident evaluations by faculty.
Radiation Oncology Residents will receive training and experience in quality improvement processes, including an understanding of health care disparities via the scheduled two-week quality improvement didactic block consisting of no fewer than 4 one hour lectures in quality improvement. In addition, residents participate in the annual GME sponsored quality improvement project.
Residents and faculty receive data on quality metrics and benchmarks related to their patient populations. Such data includes timeliness and completeness of clinical documentation. In addition, data on contouring proficiency is provided on each clinical service. Other data on patient referral and treatment timelines are provided to clinical directors and disseminated to faculty and residents.
Residents and fellows have the opportunity to participate in interprofessional quality improvement activities, which often include activities aimed at reducing health care disparities. Such activities include participation in Department Operations and Patient Experience subcommittees.
Supervision and Accountability:
The Radiation Oncology training program has a program- specific policy addressing supervision that is consistent with ACGME, UCSF GME policies as noted below. In addition, we have a communication/escalation policy that establishes guidelines for circumstances and events in which residents and fellows must communicate with appropriate supervising faculty, such as the transfer of a patient to an intensive care unit or end-of-life decisions.
Every patient must have an identifiable, appropriately-credentialed and privileged attending physician (or licensed independent practitioner as specified by the applicable ACGME Review Committee) who is responsible and accountable for that patient’s care. This information must be available to residents, faculty, other members of the health care team, and patients. Residents, fellows, and faculty must inform each patient of their respective roles in that patient’s care when providing direct patient care. As part of resident on-boarding, residents receive training on how to identify themselves and their role in the care team during initial and subsequent patient encounters.
Each training program must demonstrate that the appropriate level of supervision is in place for all residents and fellows based on each trainee’s level of training and ability as well as patient complexity and acuity. Expectations and roles are delineated in each service line goals and expectations document reviewed at the beginning of each clinical rotation, and which includes description of supervision, either being direct, indirect, or with oversight in a context dependent manner. In general, supervision may be exercised through a variety of methods as appropriate to the situation. Some activities require the physical presence of the supervising faculty member and are specified by departmental standard operating procedures. Some portions of care provided by the resident or fellow can be adequately supervised by immediate availability of the supervising faculty member or trainee, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of trainee-delivered care with feedback as to the appropriateness of that care.
The privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each resident is assigned by the program director and faculty. The program director with the help of the clinical competency committee evaluates each trainee’s abilities based on specific criteria guided by the Milestones. Faculty members functioning as supervising physicians must delegate portions of care to residents based on the needs of the patient and the skills of the trainees.
Each resident and fellow must know the limits of his/her scope of authority and the circumstances under which he/she is permitted to act with conditional independence. Initially, junior residents must be supervised either directly or indirectly with direct supervision immediately available as is directed by each service line’s goals and expectations documentation. Faculty supervision assignments must be of sufficient duration to assess the knowledge and skills of each trainee and delegate to him/her the appropriate level of patient care authority and responsibility.