INCREASING ADOPTION OF AIDET: A STUDENT-LED QUALITY IMPROVEMENT RESEARCH PROJECT

1. INCREASING ADOPTION OF AIDET: A STUDENT-LED QUALITY IMPROVEMENT RESEARCH PROJECT Research Club 1/23/18

2. Background • Many hospitalized patients do not understand their treatment and care plans1. • Prior research shows that better physician communication skills improve patient outcomes2. • Since these communication skills are teachable, many institutions implement a standardized communication tool for physicians and trainees3, 4, 5, 6. • The evidence-based Acknowledge, Introduce, Duration, Explanation, and Thank (AIDET) communication tool improves patient and provider interactions via a demonstrated increase in patient satisfaction scores in both institutional and national HCAHPS metrics7, 8, 9.

3. Study Questions • Aim Statement: In the next 6 months, we will increase the adoption of AIDET in observed patient interactions in Internal Medicine to > 85% in all categories. • Baseline data • UNM IM night accept team rounds

4. Study Questions • Intervention or methods • What statistical analysis did/will you perform? percentage analysis • Was this IRB approved? Yes • Intervention: resident and attending educational sessions • Post intervention measures: audits and real-time feedback

5. Pre-intervention data • 88.89% (24/27) • 92.60% (25/27) • 85.19% (23/27) • 92.60% (25/27) • 80.00% (20/25) 2 N/As • 33.33% (9/27) • 55.56% (15/27)

6. Post-intervention data • 96% (25/26) • 100% (26/26) • 100% (26/26) • 88% (23/26) • 88% (23/26) • 85% (22/26) • 96% (25/26)

7. Team and Roles • Melissa Martinez, MS4 • Christopher Bartlett, PGY3 • Christina DeShayes, SON • Greg Fahl, MS4 • Anna Jones, PGY3 • Gina Miller, MS4 • Katie Ogawa, MS4 • Aaron Stecker, PGY2 • Gina Stroud, MS4 • Dr. Eileen Barrett, supervising physician

8. Planning/Study Phase • Site visit • Literature review • Pre-intervention data • Intervention: education • Post-intervention data collection & comparison

9. Study Limitations • Only IM teams were surveyed • Not all teams within IM were surveyed • Interventions did not reach all subsequently surveyed

10. UNM QI and Patient Safety Goal • List which goal(s) your project falls under: 2016 Strategic Goals • Goal 1 – Develop Clinical Master Facility Plan  • Goal 2 – Increase Ambulatory access and throughput – Increase clinic volumes 4% – Complete centralized scheduling for adult clinics – Expand ambulatory capacity with new clinics – Implement the full scope of PCMH model  • Goal 3 – Increase Inpatient capacity – Decrease adult LOS (excluding OB) to 6.56 • Increase daily discharge by 3 • Decrease Adult LOS >15 days by 20% • Increase monthly adult discharges (excluding OB) by 2pm to 500/month • Home Health program • Post-Acute Care affiliations • Goal 4.1 – Improve tertiary referral transfer capabilities – Increase transfers from outside by 6 per month (72 annual)  • Goal 5 – Information Technology Implementation – EMR improvements – Population Health – Revenue Cycle – Consumer Access  • Goal 6.1 – Increase surgical volumes by 5%  • Goal 7 – Maintain accreditation deemed status  • Goal 8 – Improve National Patient Safety Goal, Core Measures and Mortality Index Outcomes • Goal 9 and 10 – Improve Patient satisfaction • Goal 11 – Foster strong community engagement, proactively address community concerns and meet community needs – Partner with Bernalillo County and Indian Health Services in the development of Behavioral Health Programs and Community based clinics • Goal 12 – Improve staff and faculty engagement and satisfaction – Turnover rates less than 15% – Improve staff satisfaction by 10% – Implement provider ease of practice programs – Conduct physician satisfaction survey  • Goal 13 – Develop shared governance for Magnet status

11. Next Steps • Share results with IM leadership • Present findings at SHM • Project sustainability

12. Barriers/Challenges • Language barriers. • Night accept team at capacity. • Hawthorne effect. • Time constraints.

13. What I would do with my project if I had unlimited resources • Expand audits hospital-wide • Regular audits hospital-wide • Correlating patient satisfaction with AIDET use. • Influence of AIDET use on HCAHPS data.

14. Questions?

15. Upcoming Deadlines • AAMC-Integrating Quality – usually in Spring • National Healthcare Coalition Preparedness Conference-June • Mountain West SGIM is usually in July • UNM Health Science Center Annual Education Day - August • NM ACP HVC, QI, research, clinical vignettes - September • NM SHM research and innovations abstracts - September • National SGIM – September • Western Regional Meeting of the American Federation of Medical Research​- Sept • SACME- October • APDIM- Academic Internal Medicine week- November • National ACP - November • American Geriatrics Society -December • National SHM – December

16. Sources: • O’leary K, Kulkarni N, Landler M, et al. Hospitalized patients’ understanding of their plan of care. Mayo Clinic Proceedings. 2010. • Studer Q. Keep your patients coming back. MGMA Connexion. 2008. • Braverman A, Kunkel E, Katz L, Katona A, et al. Do I Buy It? How AIDET Training Changes Residents' Values about Patient Care. Journal of Patient Experience. 2015. • Makoul G, Zick A, Green M. An Evidence-Based Perspective on Greetings in Medical Encounters. Arch Intern Med. 2007. • Kelley J, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient-clinician relationship on health care outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2014, • Rao J, Anderson L, Inui T, et al. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care 2007. • Allen T, Rieck T, Salsbury S. Patient perceptions of an AIDET and hourly rounding program in a community hospital: Results of a qualitative study. Patient Experience Journal. 2016. • Scott J. Utilizing AIDET and Other Tools to Increase Patient Satisfaction Scores. Radiology Management. 2012. • Zamora R. Influence of AIDET in the Improving Quality Metrics in a Small Community Hospital - before and after Analysis. Journal of Hospital Administration. 2015.