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CLER Program. Next Accreditation System ( NAS). Annual Data Collected and Reviewed Annual ADS Update - Streamlined Program Attrition Program Characteristics – Structure and Resources Scholarly Activity Board Pass Rate – Rolling Rates Clinical Experience (Case L ogs)

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CLER Program

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next accreditation system nas
Next Accreditation System (NAS)

Annual Data Collected and Reviewed

  • Annual ADS Update - Streamlined
    • Program Attrition
    • Program Characteristics – Structure and Resources
    • Scholarly Activity
  • Board Pass Rate – Rolling Rates
  • Clinical Experience (Case Logs)
  • Resident Survey
  • Faculty Survey – Core Faculty
  • Semi-Annual Resident Evaluation and Feedback
    • Milestones
    • Clinical Competency Committees
  • CLER site visits
cler clinical learning environment review
CLER:Clinical Learning Environment Review
  • Emphasizes the responsibility of the SI for the quality and safety of the environment for learning and patient care
  • Also emphasizes addressing health care disparities
  • Intent to improve quality and safety goals after graduation
cler site visit areas of focus
CLER Site Visit: Areas of Focus
  • Key institutional policies affecting residents:
    • Transitions of care (patient handoffs)
    • Supervision
    • Duty hours, fatigue management & mitigation
    • Professionalism
  • Integration of residents into projects:
    • Patient Safety
    • Quality Improvement (Including health care disparities)
cler site visit goals
CLER Site Visit: Goals
  • Support national efforts addressing patient safety, quality improvement, and reduction in health care disparities.
  • Increase resident knowledge of and participation in safety activities and quality improvement.
  • Monitor Sponsoring Institution maintenance of a clinical learning environment that promotes the six goals.
  • Initially, not for accreditation decisions
    • Set expectations for the 6 focus areas and provide institutions with formative feedback
  • CLER Evaluation Committee charged to set expectations for the 6 focus areas
  • First cycle (18 months): information shared with ACGME/RCs will be de-identified and/or reported in aggregate.
  • Second cycle: CLER Evaluation Committee will share relevant information from the CLER site visits with the IRC and RCs
cler site visit agenda
CLER Site Visit: Agenda
  • Senior leadership initial and exit meetings: CEOs, DIO/GMEC Chair, Resident Member of GMEC
  • Quality & Safety Leadership: Chief Safety Officer and Chief Quality Officer
  • Residents/Fellows
  • Core Faculty
  • Program Director
  • Walk-arounds
cler site visit materials
CLER Site Visit Materials
  • Organizational charts
  • Supervision policy
  • Duty hour policy
  • Care transitions policy
  • Patient safety protocol/strategy (approved by Board)
  • Quality strategy (approved by Board)
  • Quality & Safety Committee membership rosters (identifying resident members)
  • DIO’s most recent annual report to SI governance
example beta test visit uw
Example/”beta” test visit UW
  • Patient Safety: relatively little resident reporting in PSN and viewed as a “black hole”; many didn’t know Patients are First goals
  • Quality Improvement: Data from hospitals not readily available for QI projects; need to brand Housestaff Quality and Safety Council (HQSC); no strategy on health care disparities
  • Transitions in Care: CORES is a best practice but could be more effectively used; observed a handoff without supervision
  • Supervision: Policy template is a best practice; need to make policies and approved procedures available to nurses/care team
  • Duty Hours/Fatigue: No significant duty hour concerns; insufficient fatigue training for faculty; need to improve fatigue monitoring
  • Professionalism: Very strong education; residents know how to report concerns (too many avenues to report?)
what to do now
What to Do Now?
  • Include residents in real, meaningful experiences
    • Root cause analysis
    • Protocol development
    • LEAN/RPIW teams
    • Patient safety reporting
  • Obtain clinical effectiveness data
  • Work with SI leadership, including safety and quality officers
    • One should be on GMEC
what to do now1
What to Do Now?
  • Implement meaningful policies for supervision and duty hours
  • Develop transitions of care protocols
  • Provide fatigue management/mitigation training
  • Develop monitored standards for professionalism
  • Include residents in SI initiatives in patient safety, quality improvement, and addressing health care disparities