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Patient Safety Committee


Administration: Cheryl Skinner
Chair: Jeff Young, M.D.


The Patient Safety Committee is an interdisciplinary committee charged with identifying patient safety risks and hazards within the Medical Center, ensuring appropriate mitigation of those risks, and overseeing the appropriate response to serious preventable harm events. The Patient Safety Committee evaluates and determines appropriate actions to improve patient safety throughout the Medical Center.

Membership: Operational and Clinical Chiefs, leadership from Clinical Staff, Pharmacy, Health Information Technology Services, Resuscitation, and  Physician representation from Medicine, Surgery, Anesthesia, Radiology, and GME.

Meetings: The Patient Safety Committee shall meet weekly or as otherwise deemed necessary by the Chair, but not less than monthly.

Duties and Responsibilities:

  • Reviews the findings from the analyses of significantly adverse outcomes to approve or recommend actions designed to mitigate re-occurrence.
  • Reviews the findings from the analyses of deaths following local, departmental and Patient Safety Office review and recommends or approves response to learnings.
  • Charges Root Cause Analyses when indicated, and approves and monitors corrective action plans.
  • Reviews analysis of aggregated, trended data related to patient safety and recommends and monitors actions.
  • Refers physician practice issues to existing peer review processes, including M&M conferences, and monitors corrective action plans.
  • Provides oversight for Be Safe Events system which serves as the mechanism for all staff and physicians to report patient safety concerns.
  • Administers bi-annual Patient Safety Culture Survey to identify opportunities for improvement to strengthen patient safety across the organization.
  • Recognizes and celebrates positive staff actions impacting patient safety.
  • Provides quarterly summary of sentinel event analysis findings to Quality Subcommittee of the Medical Center Operating Board.
  • Provides annual report of activities to Clinical Staff Executive Committee

Current Members

 Members Specialty 
Jeff Young, MD, Chair Chief Patient Safety Officer, Surgery
Jim Amato Chief, Ancillary Services
Kevin Greer, MD Housestaff Council Co-President
Bo Cofield, DrPH AVP for Hospital & Clinic Operations
Stacy Crowell Director, Quality and Performance Improvement
Alex Michaels, MD Housestaff Council Co-President
John Dent, MD Medical Specialties Rep
Lorna Facteau, RN, DNsc Chief Nursing Officer
Chris Ghaemmaghami, MD CMO, Emergency Medicine
Robert Gibson, MD President, Clinical Staff, Cardiology
Mark Golub, MD Radiology & Medical Imaging, Quality Officer
Rebecca Hill, SLP Patient Safety & Risk Management 
Tracey Hoke, MD Chief, Quality & Performance Improvement; Pediatrics
Rachael Holmes, RN, MSN Patient Safety & Risk Management
Jamie Hughes, RN Epic, HSTS
Jackie Loach, RN Patient Safety & Risk Management 
Fred Jung, RN, PhD Administrator, Performance & Quality Improvement
Susan Kirk, MD DIO and Associate Dean for GME
Luke Kohan, MD Cardiology Fellow
Gabrielle Marzani-Nissen, MD Office of the CMO
Beth Mehring, RN Emergency Management, LSLC
Justin Rizer, MD Emergency Medicine Resident
Rafael Saenz, PharmD Pharmacy
Ellen Smith, RN Patient Safety
Robert Thiele, MD Anesthesiology
Deb Wilmoth, RN Patient Safety & Risk Management 
Erin Talman, MD Resident, Emergency Medicine
Heather Columbano, MD Resident, Anesthesiology
Lily Johnston, MD Resident, Surgery