paperwork that went along with each visit — ACGME will visit once every 10 years to verify overall compliance and program improvement opportunities, barring any major concerns. Reviewers still have the flexibility to call for a site visit at any time, but programs won’t have to scramble to pre- pare the voluminous program informa- tion reports, or PIFs, they did in the past. So-called “focused” visits will address specific issues such as complaints or po- tential red flags raised in the annual re- porting. A “full” site visit might examine a broader range of program needs, like application for a new program or serious concerns identified by RRCs. Overall, Dr. Coburn says site visits will be less frequent and less burden- some, and the continuous accreditation process gives programs the chance to fix problems sooner, rather than waiting up to five years to erase a citation. ACGME also will implement a third type of site visit — known as a clinical learning environment review (CLER) — aimed specifically at addressing the quality and safety aspects of the resi- dents’ learning environment among the multiple teaching hospitals a single GME institution uses to support resident train- ing. Reviewers will conduct CLER visits every 18 months with an eye toward standardizing patient safety and supervi- sion protocols and will make recommen- dations for improvement in six areas:
• Patient safety, • Health care quality, • Care transitions, • Supervision, • Duty hours fatigue management and mitigation, and
• Professionalism. ACGME Senior Vice President for
Patient Safety and Institutional Review Kevin B. Weiss, MD, clarified that the CLER visits, at least initially, are not a required component of accreditation. “But we’ve seen a pretty large hole in patient safety in the learning envi- ronment, and we need to get that fixed pretty quickly, not just for residents as learners but for patient care. We recog- nize that good institutions are giving
good care, but residents by and large are not involved in patient safety,” Dr. Weiss said, adding that the visits may look at areas ripe for faculty development and education.
A learning curve Overall, Dr. Fiesinger expects the chang- es “will help — once we get all the tools in place.” Assuming the annual reporting
mechanisms are simple enough, the new system would replace regular site visits that he described as “huge disruptions that put everyone on hold for a few days, plus the six months it took to prepare, on top of everything else we have to do to maintain operations.” He also “like(s) the idea of knowing ever year where we are, that we’re on the right track, and that we can fix things more quickly.”
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April 2014 TEXAS MEDICINE 29
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