Practice Based Improvement Log - Stanford Medicine



Resident Practice Based Improvement Log

Department of Surgery

Stanford University School of Medicine

Instructions:

- Residents should complete the PBI form for each QI M&M they present

- Please submit to JoAnn Smithson at smithson@stanford.edu

- These entries can also be logged on MedHub in order for the GME to track our QI/PBI initiatives and will be discussed during your biannual meetings with your Program Director.

Case Information:

|Your Name: | |

|Date of QI M&M: | |

|Date of Surgery: | |

|Diagnosis: | |

|Operation: | |

|Complication: | |

|Readmission (Y/N): | |

Case Summary:

| |

Clavien-Dindo Classification (Select one):

|( |Grade I |Any deviation from the normal postoperative course without the need for pharmacological treatment or |

| | |surgical, endoscopic, and radiological interventions |

|( |Grade II |Requiring pharmacological treatment with drugs other than such allowed for grade I complications |

| | |(Blood transfusions and total parenteral nutrition are also included) |

|( |Grade IIIa |Requiring surgical, endoscopic, or radiological intervention – not under general anesthesia |

|( |Grade IIIb |Requiring surgical, endoscopic, or radiological intervention –under general anesthesia |

|( |Grade IVa |Life-threatening complication (including CNS complications) requiring ICU management – single organ |

| | |dysfunction (including dialysis) |

|( |Grade IVb |Life-threatening complication (including CNS complications) requiring ICU management – multiorgan |

| | |dysfunction |

|( |Grade V |Death of a patient |

Preventable:

|( |Preventable |( |Maybe Preventable |( |Not Preventable |

Complication Analysis (check all appropriate fields):

|Patient Factors |

|( |Comorbidities | | | | |

|Team Factors |

|( |Fatigue |( |Procedure Violation |( |Time Pressures |

|( |Performance Lapse |( |Poor Situational Awareness |( |Failure to Check Equip. |

|( |Lack of Knowledge |( |Lack of Skill |( |Lack of Judgement |

|Equipment |

|( |No Briefing |( |Poor Coordination of Care |( |Poor Communication |

|( |Understaffing |( |Inappropriate Help/Support |( |Unworkable Policy |

|Environment |

|( |Equipment Failure |( |Unfamiliar Equipment |( |Lack of Equipment |

What can the hospital do differently as a result of this experience?

| |

What would you do differently as a result of this experience?

| |

What self-improvement and learning goals have you set?

| |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download