Residents contributing to inpatient quality: Blending learning and improvement

Abstract

BACKGROUND:Quality improvement (QI) initiatives reduce medical errors and are an important aspect of resident physician training. Many institutions have limited funding and few QI experts, making it essential to develop effective programs that require only modest resources. We describe a resident‐led, hospitalist‐facilitated limited root cause analysis (RCA) QI program developed to meet training needs and institutional constraints.METHODS:We initiated a monthly quality improvement conference (QIC) at the Mount Sinai Hospital in New York City, New York. Before each conference, a third‐year resident investigated a patient care issue and completed a limited RCA. At the QIC, the findings were presented to the Internal Medicine residents, followed by a chief resident and hospitalist‐facilitated group discussion. All proposed interventions were recorded, and selected interventions were later implemented. The success of these interventions in achieving permanent system‐wide change or resident behavior change was tracked. Residents' views on the conferences were solicited via an anonymous questionnaire.RESULTS:Twenty conferences were held over the first 22 months of the program. Twenty‐five (54%) of the 46 suggested interventions were initiated. Eighteen (72%) attempted interventions resulted in system‐wide change or resident behavior change. Fifty‐three residents evaluated the quality of the conferences. The majority believed the conferences were high quality (98%) and led to patient care improvements (96%).CONCLUSIONS:Resident‐led modified RCAs are an effective method of integrating QI efforts into resident training. As front line providers, residents are uniquely positioned to identify and implement system changes that benefit patients. Conferences were implemented without overburdening facilitators or participants. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

Meeting American Geriatrics Society Competencies: Are Residents Meeting Expectations for Quality Care of Older Adults?

“…The ACGME has long emphasized the importance of developing skills in systems‐based practice and quality improvement to promote consistent excellent care. Harnessing this emphasis may be one strategy to support geriatrics curricula and translate knowledge into practice . A recent study demonstrated that specific educational interventions improved not only resident knowledge of the hazards of hospitalization in acutely ill older adults, but also their behavior, as reflected in their documentation, lending support to the thought that quality care for hospitalized elderly adults can be taught and outcomes potentially improved …”

“…Harnessing this emphasis may be one strategy to support geriatrics curricula and translate knowledge into practice. [13][14][15] A recent study demonstrated that specific educational interventions improved not only resident knowledge of the hazards of hospitalization in acutely ill older adults, but also their behavior, as reflected in their documentation, lending support to the thought that quality care for hospitalized elderly adults can be taught and outcomes potentially improved. 16 In addition to the need for resident education is the need for continued faculty training in the care of older adults.…”

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“…A few promising studies have led to persistent organizational changes (Kirkpatrick Level 4) . Examples of such organizational changes are the frequency of red‐flag symptoms identified in back pain presentations in a general practice, all patient receiving a physical examination within 6 hours of admission to a mental health unit, and implementation and use of central line kits and team and completion of discharge summaries before discharge from the institution.…”

Risk management – learning from the mistakes of others

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