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首页> 外文期刊>The Journal of Graduate Medical Education >Get a “CLEW”: Using Clinical Learning Environment Walks (CLEWs) to Optimize Clinical Learning Environments
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Get a “CLEW”: Using Clinical Learning Environment Walks (CLEWs) to Optimize Clinical Learning Environments

机译：获得“CLEW”：使用临床学习环境走路（CLEWS）以优化临床学习环境

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Setting and Problem Leadership rounding, or “gemba walks,” are well described in the safety literature as an effective means to communicate the importance of the hospital's improvement agenda, to gain clearer understanding of safety issues, and to build rapport with frontline caregivers. Talking with caregivers at the bedside has long been an important part of environmental assessments performed by agencies, such as The Joint Commission and, more recently, the Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) site visitors. Designated institutional officials, program directors, and others in graduate medical education (GME) leadership have a significant stake in the health of the “actual” culture in which residents engage. GME leaders have historically relied on resident surveys, patient safety reports, other inquiries (eg, risk management), and more recently CLER survey reports, to inform their perspective on the learning environment.;Intervention The clinical learning environment walks (CLEWs) are built on the concept of gemba walks, but focus more explicitly on assessing the 6 focus areas in the CLER Pathways to Excellence: patient safety, health care quality, care transitions, supervision, duty hours/fatigue management and mitigation, and professionalism. CLEWs consist of unannounced visits to hospital units, using a questionnaire to guide discussions with residents and nursing staff. Over the last 2 years, the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) developed a CLEW questionnaire utilizing specific and open-ended questions to get a sense of the culture of resident engagement within these working environments (provided as online supplemental material). The designated institutional official, assistant dean of quality improvement and patient safety, and program directors conduct monthly CLEWs in tandem or alone. A hospital unit is selected for a CLEW to assess or to better understand issues identified via an institutional survey, the ACGME CLER report, or reported patient safety events. CLEWs are also used to assess implementation and impact of improvement initiatives. The GME office maintains a spreadsheet to track dates of hospital unit CLEWs, issues identified, and, if warranted, action plans to address concerns.;Outcomes to Date All who have conducted CLEWs have reported they are well received on the units. Each visit (including completion of a CLER-focused questionnaire) takes approximately 30 minutes. More than 20 CLEWs have been conducted to verify successful and unsuccessful implementation of GME-focused patient safety initiatives within the hospital, as shown in 2 examples. First, after an adverse event, a CLEW by the SAUSHEC Supervision Subcommittee verified successful implementation and nursing understanding of a new resident procedural verification policy. Second, a colored badge system distinguishing medical students, residents, and faculty, resulting from a GME/hospital collaborative, was highly praised during The Joint Commission visit. However, several CLEWs demonstrated that nursing staff often were not fully aware of the badge system. This led to a meeting between GME and nursing leadership to develop a systematic process to ensure better communication of all GME-centered patient safety initiatives moving forward. CLEW findings have also resulted in resident-led quality improvement projects, improved interdisciplinary rounding, and enhanced adverse event reporting. After the CLEW concept was presented at a national meeting of GME institutional leaders, a significant proportion of the participants reported the process would be “very useful” (35%) or “useful” (38%) at their institution. The University of Texas Health Science Center at San Antonio subsequently implemented CLEWs successfully in a setting where the sponsoring institution does not own the participating site. The University of Texas Health Science Center at San Ant
机译：环境和问题领导圆形或“Gemba散步”在安全文献中详细描述为传达医院改善议程的重要性的有效手段，以更清楚地了解安全问题，并与前线护理人员建立融洽关系。与床边的护理人员谈话长期以来一直是各机构的环境评估的重要组成部分，如联合委员会，最近，学习医学教育（ACGME）临床学习环境评估（CLER）网站访客的认证委员会。指定机构官员，方案董事和研究生医学教育（GME）领导的其他人在居民参与的“实际”文化的健康方面具有重要股份。 GME领导人历史依赖于居民调查，患者安全报告，其他询问（例如，风险管理），更新的询问调查报告，以告知其对学习环境的看法。;干预临床学习环境走路（CLEWS）是建立的论Gemba Walks的概念，但更明确地专注于评估牧师途径的6个重点领域，以卓越：患者安全，医疗保健品质，护理过渡，监督，税率/疲劳管理和减缓，以及专业性。 CLEWS使用调查问卷来指导与居民和护理人员的讨论来指导医院单位的未经认证访问。在过去的2年中，圣安东尼奥制服的服务健康教育财团（Saushec）利用具体和开放的问题制定了CLEW调查问卷，以获得这些工作环境中的居民婚姻文化感（作为在线补充材料）。指定的机构官员，质量改进和患者安全的助理院长，方案董事在串联或单独进行月度线索。选择一个CLEW的医院单元，以评估或更好地了解通过机构调查，ACGME CLER报告或报告的患者安全事件确定的问题。 CLEWS还用于评估改进举措的实施和影响。 GME办公室维护了一个电子表格，以跟踪医院单位线索的日期，确定的问题，如果有保证，行动计划应对疑虑。;迄今为止的成果据报道，他们在单位上很好地接受了他们。每次访问（包括完成忠诚调查问卷）需要大约30分钟。已经进行了20多个以上的线索，以验证医院内的GME集中患者安全举措的成功和不成功的实施，如2例示例所示。首先，经过一个不良事件，由Saushec监督小组委员会的CLEW验证了对新居民程序验证政策的成功实施和护理理解。其次，彩色徽章系统区分医学生，居民和教师，由GME /医院协作产生的，在联合委员会访问期间受到高度称赞。然而，几个线索表明护理人员往往没有完全了解徽章系统。这导致GME和护理领导之间的会议开发系统的过程，以确保更好地沟通所有GME集中的患者安全举措前进。 CLEW调查结果也导致居民LED质量改进项目，改善跨学科舍入，并增强不良事件报告。在国民GME机构领导人的国家会议上提出了CLEW概念之后，一部分参与者报告的进程将是其机构的“非常有用”（35％）或“有用的”（38％）。德克萨斯州大学圣安东尼奥的健康科学中心随后在赞助机构不拥有参与网站的环境中成功实施了线索。德克萨斯大学圣蚂蚁的健康科学中心

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