Information about past and present fellows
Dr. Lisa Calder Selected as the 2009 EMPSF/SAEM Emergency Medicine Patient Safety Fellow
The Emergency Medicine Patient Safety Foundation (EMPSF) and the Society for Academic Emergency Medicine (SAEM) selected Dr. Lisa Calder as their 2009 Emergency Medicine Patient Safety Fellow. Dr. Calder will receive $75,000 to conduct research in the area of patient safety.
Dr. Calder leads emergency medicine patient safety research at the Ottawa Hospital Research Institute in Ottawa, Ontario. The focus of her research is decision making processes around high acuity emergency patients. Some of her previous studies have specifically examined adverse events among high acuity emergency patients. Dr. Calder’s research has been supported by the Canadian Association of Emergency Physicians and local funding bodies. ED physicians rarely make errors in diagnosis and management decisions; however, when they do make an error it can have very important consequences to the patient. Dr. Calder’s previous research has shown that such errors lead to adverse events in 4% of patients sent home from the ED. It is not known how to reduce the chances of these errors occurring. While much has been written about the cognitive theory behind decision making as it relates to patient safety in the ED, there is sparse data on how emergency physicians make “real time” decisions and what factors into these decisions. By understanding the factors physicians use to base their clinical decisions, it might be possible to understand why errors are made and more importantly how to devise interventions to enhance the safety of disposition decision making. Dr. Calder’s current project examines the process of disposition decision making for high acuity areas in the emergency department. The goal is to be able to better describe diagnostic and disposition errors.
Dr. Calder is an Associate Scientist in the Clinical Epidemiology Program at the Ottawa Hospital Research Institute and an Assistant Professor at the University of Ottawa Faculty of Medicine. She is also an active Attending Staff Physician at the Ottawa Hospital. Dr. Calder received her master of science degree in Epidemiology at the University of Ottawa.
The EMPSF/SAEM Patient Safety Research Training
Fellowship Grant: Plain and simple, this fellowship is the catalyst to training a new generation of investigators in emergency medicine patient safety!
Daniel Patterson, PhD, MPH
There are a limited number of emergency medicine researchers with knowledge and expertise in patient safety. The reasons for this include limited funding for training, limited research describing the problem of safety in emergency medicine – thus little awareness, – and limited mentors who are experienced, qualified, and willing to train motivated individuals. To put it plainly, “thank goodness for the EMPSF/SAEM Patient Safety Fellowship!” If not for this fellowship, and the people who support it, the road to improving patient safety in the emergency setting would be even more challenging than it is. In only its second year, this fellowship has had a 100% success rate in catapulting fellows on the road to independent investigator status with federal and non-profit research funding. In the paragraphs below, I describe my experiences as a fellow from July 2008 to June 2009.
The EMPSF/SAEM Fellowship program was created to develop emergency medicine practitioners with an interest in research into patient safety investigators who are focused on safety in the emergency care setting. The fellowship provides 12 months of support in the amount of $75,000 to be used towards protecting the trainee’s time. The protected time is to be used for education and training in patient safety. In addition, the fellowship provides financial support for the trainee to take part in the Health Research & Educational Trust (HRET) / National Patient Safety Foundation Program for Leadership Development in Patient Safety an investment worth an additional $21,000.
The HRET component provides a class-like structure to advance education in patient safety and research development. Throughout the year, HRET trainees meet as a group. At these meetings, national experts in patient safety lecture on the issues relevant to patient safety. These lectures are designed to educate, and fill gaps in knowledge. The HRET program includes a project component, which for the EMPSF/SAEM fellow, involves working towards completion of a project that targets an emergency medicine patient safety problem.
In looking back on my HRET experience, I can say without hesitation that it was a valuable, educational experience that permitted the forming of new friendships and collegial relationships with individuals that share the same goal: improving patient safety. Trainees included nurse unit leaders, quality officers, surgeons, emergency medicine department directors, critical care nurses, and hospital administrators. The structured meetings, team building exercises, and group learning activities were important towards solidifying my commitment to improving patient safety in emergency medicine and important towards broadening my perspective.
While the HRET program was an important and valuable component of the fellowship experience, the protected time provided by the EMPSF/SAEM funding was invaluable. Too often junior investigators are bombarded with the need to serve on multiple projects, committees, etc. It is difficult to secure the time to sit, think, read and learn. The EMPSF/SAEM fellowship provided me with the time I needed to do these very activities, which in the long run, were instrumental in my constructing fundable grants focused on continuing the work of the fellowship.
I valued my protected time and worked diligently to fulfill my training, education, and research project goals. From day one, I surrounded myself with relevant literature, read numerous texts, seminal documents, and the latest research. In a relatively short period of time, my knowledge of patient safety grew. I was able to identify important, and previously unnoticed, gaps in patient safety research that existed in emergency medicine.
As part of my education, I visited and was mentored by one of my mentors, Dr. Barrett Caldwell, a human factors researcher and associate professor of industrial engineering at Purdue University. Dr. Caldwell provided guidance and instruction on relevant literature that dovetailed with my interest and project aims. He was an invaluable mentor and colleague. I also received one-on-one mentorship from Donald Yealy, MD – Chair and Professor of Emergency Medicine at the University of Pittsburgh, and Nicholas Castle, PhD, of the Graduate School of Public Health at the University of Pittsburgh.
In parallel with my education, I pursued an ambitious research project. My project focused on what Cook, Woods, and Miller (1998) refer to in their theoretical framework as the “blunt end” of patient safety. One could also classify my project in terms of James Reason’s “swiss cheese model,” as a project that addressed organizational, professional, and team latent factors --- the factors that both theoretical models and empirical evidence show set the stage for accidents and error to occur. My project aimed to 1) develop and evaluate a tool to longitudinally measure crew configuration in Emergency Medical Services (EMS); 2) Develop and evaluate a tool to measure adverse events in ground-based EMS agencies; and 3) Apply Social Network Analysis (SNA) methods towards evaluating the impact of EMS employee turnover and crew configuration on select measures of patient safety (e.g. safety culture).
We have accomplished much. Specifically, we have presented our research on safety culture at the SAEM annual meeting (poster), we have one publication in press, and we have one abstract accepted to the National Association of EMS Physicians annual meeting in 2010. The data needed to address all aims have been collected and we are now in the process of conducting our analyses. The final project and results will be described in detail in an article which will be shared with all EMPSF members.
Other accomplishments associated with the grant include my applying for and receiving funding from the American Society for Healthcare Risk Management (ASHRM) and Pittsburgh Emergency Medicine Foundation (PEMF) to study communication patterns in the Emergency Department (ED).
Most importantly, the EMPSF/SAEM Patient Safety Fellowship was instrumental in my applying for and receiving career development funding as part of the Clinical Research Scholars Program (CRSP) KL2 program at the University of Pittsburgh, funded by the National Institutes of Health (NIH). (see: http://www.icre.pitt.edu/crsp/about.html). The CRSP KL2 award will allow me to continue the work started by the EMPSF/SAEM fellowship.
In summary, I am grateful to the EMPSF and SAEM for the opportunity and trust in my capabilities and potential. The fellowship was a wonderfully educational and rewarding experience which allowed me to grow both personally and professionally. It is a program that I believe will continue to build emergency medicine’s capacity to advance patient safety science for emergency medicine.