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Michele M. Nypaver, MD Associate Professor William G. Barsan Dept. of EM Research Forum April 27 , 2016

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Page 1: Presentation by Michele Nypaver

Michele M. Nypaver, MDAssociate Professor

William G. BarsanDept. of EM Research Forum

April 27, 2016

Page 2: Presentation by Michele Nypaver

A Less Conventional Research Journey

We’re gonna be program directors!

Survival Guide for PD’s

Curriculum Development for Dummies

Learning 101

A girls guide to simulators

FINDING COLLABORATORS!

•AAP/Section on EM Program Directors Subcommittee•UM Educators (MERG),

Residents and PEM Fellow

Page 3: Presentation by Michele Nypaver

Nypaver 101

• Clinical (Educator) Track•Associate Professor

•Scholarly Interests•Education

•Simulation•Assessment

•Quality Improvement•Children with Cancer & Fever

Page 4: Presentation by Michele Nypaver

How do we evaluate (and measure) performance?Build your own or steal someone else’s tools!

What are we trying to assess?Formative?Summative?Cognitive?Technical?

What tools are available to measure the learner?

Are they valid?Are they reliable?Are the evaluators trained to use

the tool?Will the tool discriminate levels of learners?

OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILLS (OSATS)

GLOBAL RATING SCALE OF PERFORMANCE: Pediatric Emergency Endotracheal Intubation

Please circle the number corresponding to the candidate's performance in each category.

Time/Situational awareness

1 2 3 4 5 Does not know

Dependent on instruction Independent with

minor error(s) Independent and efficient

with no errors Preparation

1 2 3 4 5 Does not know

Dependent on instruction Independent with

minor error(s) Independent and efficient

with no errors

Medication 1 2 3 4 5 Does not know

Dependent on instruction Independent with

minor error(s) Independent and efficient

with no errors Pre- Intubation Processes 1 2 3 4 5 Does not know

Dependent on instruction Independent with

minor error(s) Independent and efficient

with no errors Intubation Technique 1 2 3 4 5 Does not know

Dependant on instruction Independent with

minor error(s) Independent and efficient

with no errors ETT Placement 1 2 3 4 5 Does not know

Dependent on instruction >90 seconds Between 60 and 90

seconds Between 60 and

30 seconds <30 seconds

Confirmation of Tube Place

1 2 3 4 5 Does not know

Dependent on instruction Independent with

minor error(s) Independent and efficient

with no errors

Recognizes Complication: Right main stem ☐ Not applicable

1 2 3 4 5 Does not know

Dependent on instruction Recognize and correct

>2 min Recognize and correct <2 min,

but >1 min

Recognize and correct <1 min

Would you let this Trainee perform this procedure on your next patient unsupervised?: YES NO

OVERALL PERFORMANCE

1 2 3 4 5 Very poor Competent Clearly superior

Page 6: Presentation by Michele Nypaver

Cloutier RL, Walthall JD, Mull CC, Nypaver MM, Baren JM: Best educational practices in pediatric emergency medicine during emergency medicine residency training: guiding principles and expert recommendations. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 17 Suppl 2: S104-13, 2010. PM21199076

House JB, Dooley-Hash S, Kowalenko T, Sikavitsas A, Seeyave DM, Younger JG, Hamstra SJ, NypaverMM: Prospective comparison of live evaluation and video review in the evaluation of operator performance in a pediatric emergency airway simulation. Journal of graduate medical education 4(3): 312-6, 2012.

Eppich WJ, Nypaver MM, Mahajan P, Denmark KT, Kennedy C, Joseph MM, Kim I: The Role of High-Fidelity Simulation in Training Pediatric Emergency Medicine Fellows in the United States and Canada. Pediatric emergency care 29(1): 1-7, 2013. PM23283253

Iyer MS, Santen SA, Nypaver M, Warrier K, Bradin S, Chapman R, McAllister J, Vredeveld J, House JB: Assessing the validity evidence of an objective structured assessment tool of technical skills for neonatal lumbar punctures. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 20(3): 321-4, 2013.

House J, Iyer M, Santen S, Warrier K, Bradin S, Chapman R, Vredeveld J, Nypaver, M: OSATS Assessment Instrument for Neonatal Lumbar Puncture. MedEdPortal www.mededportal.org/publication/9758, 2014.

House, J, Nypaver M, Dooley Hash S, Hamstra S.: OSATS Tool for Pediatric Rapid Sequence Intubation AAMC MedEdPORTAL Feb 2014

Doughty, Cara; Kessler, David; Zuckerbraun, Noel; Stone, Kimberly; Reid, Jennifer; Kennedy, Chris; Nypaver, Michele; Auerbach, Marc: Simulation in Pediatric Emergency Medicine Fellowships Pediatrics 136(1): 152-158, 2015. 26055850

House J, Santen SA, Carney M, Nypaver M, Fischer JP, Hopson LR.: Implementation of an Education Value Unit (EVU) System to Recognize Faculty Contributions Western Journal of Emergency Medicine16(6): 952-6, 2015. 26594298

Perry M, Hopson L, House JB, Fischer JP, Dooley-Hash S, Hauff S, Wolff MS, Sozener C, Nypaver M, Moll J, Losman ED, Carney M, Santen SA.: Model for Developing Educational Research Productivity Western Journal of Emergency Medicine 16(6): 457-451, 2015. 26594297

Hsu D, Nypaver M, Fein DM, McAneney C, Santen S, Nagler J, Zuckerbraun N, Roskind C, Reynolds S,Zaveri P, Stankovic C, House J, Langhan M, Titus MO, Dahl-Grove D, Klasner A, Ramirez J, Chang TP, Jacobs E, Chapman J, Lumba-Brown A, Thompson T, Mittiga M, Eldridge C, Heffner V, Herman B, Kennedy C, Madhok M, and Kou M on behalf of the PEM Fellowship Directors' Writing Group: Essentialsof PEM Fellowship Part 2: The Profession in EPAs Pediatric Emergency Care Journal accepted Feb 2016

Page 7: Presentation by Michele Nypaver

The Pediatric Emergency Medicine Milestone Project

A Joint Initiative of The Accreditation Council for Graduate Medical Education,

The American Board of Pediatrics, and,

The American Board of Emergency Medicine

July 2015Emergency Medicine Advisory Group Wallace Carter, MD Deborah Hsu, MD, MEd Maybelle Kou, MD Michele Nypaver, MD Earl Reisdorff, MD

Page 8: Presentation by Michele Nypaver

Thou Shalt:Learn & Teach Quality Improvement to residents & fellows

Thou Shalt:Participate in QI for Maintenance of Certification for your board.

ACGME

ABP

ABEM

2010Pediatric EmergencyMedicine LeadershipConferenceEnhancing Leadership to Improve Qualityof Care in Emergency Settings for ChildrenSponsored by the American Academy of Pediatricsand the AAP Section on Emergency Medicine

Page 9: Presentation by Michele Nypaver

Benner C, Nypaver, M, Mora E, Mueller E, Seagull FJ, Walkovich K, Johnson K, Halverson S, Rothman E, Hucks G, Younger JG.: Making improvements in the ED: Does ED busyness affect time to antibiotics in febrile pediatric oncology patients presenting to the emergency department? Pediatric Emergency CareJournal (accepted for publication 11/2015).

Improving clinical processes (and publishing)

Page 10: Presentation by Michele Nypaver

Successful emergency department interventions that reduce time to antibiotics in febrile pediatric cancer patients.

Michele M. Nypaver MD1 , Sandra Spencer MD2, Katherine Hebert MD3, Christopher Benner MD4,5, Rachel Stanley MD, MHSA1,2, Daniel M. Cohen MD2, Alexander Rogers MD1, Jason Goldstick PhD, MA1, & Prashant Mahajan MD, MPH, MBA3

Page 11: Presentation by Michele Nypaver

  Center 1 Center 2 Center 3Education Interventions       1. Patient/Family information for ED experience during fever with neutropenia (FN) episodes

X X X

2. Staff/faculty on consensus guidelines for FN care (Time to Antibiotic goal < 60 minutes and Antibiotic type)

X X X

3. Staff/faculty initial education & update on project progress X X X

4. Standardized RN central line education/training   X X       Process Change       5. Topical anesthetic to central line site in triage X X X 6. Rapid rooming for all cancer patients with fever X X X 7. Ill appearing or severe triage category placed in resuscitation room X X X

8. Central line equipment more accessible X X X 9. Antibiotic delivery prior to absolute neutrophil count (ANC) result X X X

10. Rapid ANC testing   X**   11. Electronic order entry modifications/order set development   X X

12. Pharmacy assistance for antibiotic readiness/availability X   X13. MD notified upon patient arrival X X  14.Direct phone communication (Oncology MD to Emergency MD) of incoming patient prior to arrival (when possible)

   X

15. All febrile cancer pts triage level 1(highest acuity) X           

TEAM Composition      

Emergency Physicians X X X

Emergency Nurses X X X

Pharmacy Representative X X X

Oncology Physicians X X X

Computer Order Entry Representative   X X

Infectious Disease Physician   X X

Quality Improvement Representative   X X

       

Table 2: Quality Improvement Project Interventions & Team Composition** Bold type = Interventions adopted at all sites**Rapid ANC testing at Site 2 was abandoned during the project period

Page 12: Presentation by Michele Nypaver

ED Improvement is for kids too!Keith Kocher, MD Director

Michele Nypaver, MD Co Director Pediatrics

Joining general & pediatric ED provider data to improve pediatric emergency practice

Pediatric Initiatives:CT use in minor traumatic brain injury (adult & children)

CXR utilization in asthma, croup and bronchiolitisMEDIC-Program for alternatives to hospitalization (adult & children)