Get access

Residents contributing to inpatient quality: Blending learning and improvement

Authors

  • Kristofer L. Smith MD, MPP,

    Corresponding author
    1. Division of General Internal Medicine, The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York
    2. Division of Hospital Medicine, The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York
    • Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1216, New York, NY 10029
    Search for more papers by this author
    • Telephone: 212-241-4141; Fax: 212-426-5108

  • Sarah Ashburn BA,

    1. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
    Search for more papers by this author
  • Erin Rule MD,

    1. Division of Hospital Medicine, The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York
    Search for more papers by this author
  • Ramiro Jervis MD

    1. Division of Hospital Medicine, The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, New York
    Search for more papers by this author

  • Related paper presentation: Poster Presentation at the Society for Hospital Medicine Annual Meeting, Washington, DC, April 2010.

  • Disclosure: Nothing to report.

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

Get access to the full text of this article

Ancillary