Residency Emphasizes Patient Safety Tracking

Urology residents are encouraged to report patient safety events, to discuss them in departmental meetings, and to lead initiatives to address them.

The Washington University urologic residency is at the forefront of ensuring that residents leave the program proficient in a skill critical to success in today’s health-care environment: tracking and addressing patient safety issues.

Supporting that priority, when Erica Traxel, MD, became residency program director two years ago, one of her goals was to improve discussions of patient care complications during the division’s monthly Urology Morbidity and Mortality (M&M) Conferences, during which faculty and residents discuss reported events and together try to devise ways to improve safety and address complications.

“I felt that many times, we were not reaching conclusions on what we individually should do differently to prevent future similar complications,” says Traxel.

Traxel now encourages residents to begin reporting patient safety events themselves in the Washington University Event Reporting System (ERS), whether the patient was affected or not. And instead of faculty reporting on those events at the conference and calling on residents to comment on the spot, Traxel now assigns residents in advance to present instead, giving them time to process details ahead of time.

Traxel also reviews patient safety events weekly with Sam Bhayani, MD, chief medical officer of Washington University Physicians, and Urology Director of Clinical Operations Vicky Peck, RN, BSN, MHS, CURN.

In addition to presenting cases in the M&M conference, residents lead patient safety initiatives on events they have reported. One such effort grew from the experience of Chief Resident Jennifer Robles, MD, in treating a patient who needed a nasogastric tube, a device placed through the nose into the stomach, usually for providing nourishment. But the patient had undergone a previous nasopharyngeal surgery that made tube placement difficult. Several other services were consulted before the tube was placed 24 hours later. Robles took the extra step of meeting with representatives of the other services and developing a hospital-wide protocol for nasogastric tube placement in patients with aberrant anatomy.

Robles will continue her focus on patient safety and minimally invasive surgery in a fellowship at Vanderbilt University that encompasses both areas.


Sam Bhayani, MD

Sam Bhayani, MD, was appointed chief medical officer of the Faculty Practice Plan at Washington University School of Medicine in September 2015. As CMO, he works with the school’s clinical departments to ensure that clinical services and programs are “best in class” in terms of clinical quality, patient outcomes, patient safety and patient satisfaction. Partnering with the non-profit organization BJC HealthCare, he also is helping to implement a new, unified electronic patient medical record system. He continues his practice and role as chief of surgery at Barnes-Jewish West County Hospital.

Washington University urologists completed a clinical trial of vascular-targeted photodynamic therapy in the treatment of small prostate cancers. The therapy combines a drug and laser energy to block blood flow to tumors, killing tumor tissue. The Food and Drug Administration is reviewing trial data.

Urologic residents, under the mentorship of Division Chief Gerald Andriole, MD, have made contributions to the study of magnetic resonance imaging (MRI)-targeted prostate biopsies, which use MRI to visualize tumors for needle biopsy in place of the current method of random needle biopsy. Resident Eric Kim, MD, found that MRI-targeted biopsies detected cancer in 76 percent of patients, compared with 56 percent using the traditional method in the same patients. Resident Niraj Badhiwala, MD, presented a study of infection rates with MRI-targeted biopsies at an American Urological Association meeting, and, with Andriole, developed a protocol that reduced infection rates from 10 percent to almost zero.