Wednesday, January 15, 2014

CPR, High Value Care, and MedPeds

What a whirlwind of a day today.  Lots of productive meetings, and some incredible learning along the way.  I have two “A-HA” learning moments from today.

The first was our Pediatrics Grand Rounds at Riley Hospital for Children.  Our PICU physicians set up a truly innovative Grand Rounds to have a discussion about the topic of “Do Everything?” regarding pediatric patients in the ICU.  It was co-hosted by a nurse researcher at our Ethics Center who has studied "Moral Distress", and a PICU nurse who provided an amazing perspective to the discussion.  It featured two role playing scenarios in how health care professionals speak with families of terminally ill children about CPR.  It was a great way to engage the audience to think about how families understand outcomes from CPR.  A critical learning point of this topic, common to many regarding patient-physician communication, is to avoid overly complex medical terminology, or jargon, when speaking with families.  In addition to talking about using language that matters, we discussed this paper from 1996, in which the authors evaluated the rate of successful CPR on television shows and compared it to the actual rate of survival in real patients.
This blog here is a recent update to that piece with a great infographic comparing the rates on specific shows.  The other great part was that this grand rounds was totally packed: not an open seat in the room!  For a CME person like myself, it is nice to see that so many participants were able to benefit from this presentation.  My tweets from today (1/15/14) convey much of the content of this educational session, for those with further interest on this topic.

Secondly, I am proud to announce that we piloted our first “High Value Care” curriculum to our MedPeds residents today.  The ABIM Foundation has been leading the charge on this, with the creation of the Choosing Wisely campaign.  Luckily, we did not have to reinvent the wheel, and were able to utilize this amazing high value care teaching resource from the ACP which was recently rolled out.  The residents were as engaged in this discussion as they have ever been.  I think this phrase captures their sentiments: “We want to be part of the solution to the costs of health care crisis and not just order tests indiscriminately”.  I couldn’t have been more proud!

For those interested in finding and using ready-made resources to teach cost-conscious care to residents or students, I can say that we were able to easily complete one of the five current modules with 8 formal multiple choice questions in less than one hour, with ample opportunity for robust in-depth discussion of some of the points.  We elaborated on clinical decision making in the context of cost conscious care.  Kudos to Dr. Daisy Smith of the ACP for creating these online modules that educators can use “off the shelf” right away in their training programs.  One does not even need to be an ACP member to gain access to these modules!

Looking back on these two topics noted above, I now see that they are a perfect example of the variety of training in MedPeds: both a Pediatric topic and an Internal Medicine topic in the same day!  Hooray for MedPeds!  I only hope that other days can be as “educationally productive and rewarding” as today was for me.