Lost in translation: development and implementation of a metabolic monitoring protocol

Abstract

IntroductionQuality assurance (QA) interventions are part of the core competencies that psychiatric trainees need to acquire prior to graduation of residency. The process of developing, implementing and monitoring standards of care for patients on antipsychotic medications is a practical illustration of the teaching of QA methods to psychiatric residents.ObjectiveWe will describe the process used by the residents and faculty of the Outpatient Psychiatry Department of Temple University School of Medicine to create and introduce metabolic follow up protocols for patients on antipsychotic medication.AimsWe will present the challenges encountered in this process.MethodsWe will describe the process used to create a monitoring protocol that satisfies expert practice guidelines. In addition, we will examine the social, economic and organizational variables that are a part of our urban outpatient training clinic. We will present the trends of the monthly QA reviews (July 2010 to February 2011). We will introduce the process of identifying and solving obstacles. Finally, we will describe the feedback loops that inform clinicians and faculty about the effectiveness of the QA protocols.ResultsSome of the challenges met include: expert disagreement on the exact particulars of follow-up frequency, patient noncompliance, disparities in health literacy, trainees’ learning curve, changes in medication, and coordination of care among providers.ConclusionTeaching QA is a difficult experiential process that articulates many of the skills acquired by residents in their training, from evidence-based medicine to delivery of care and program evaluation.