Interventions to improve resident reporting of patient safety events: a quality improvement initiative.
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ABSTRACT: Background
Patient safety events (PSE) are opportunities to improve patient care but physicians rarely report them. In a previous study, residents identified knowledge regarding what constitutes a PSE, perceived lack of time, complexity of the reporting process, lack of feedback, and perceived failure to resolve the issue despite reporting to be barriers limiting their PSE reporting. The residency programs and system patient safety and quality improvement departments created targeted interventions to address identified barriers.Objective
Assess effectiveness of targeted interventions on improving PSE reporting rates amongst residents.Methods
As part of a multi-residency patient safety project, interventions were created to focus on the removal of barriers to reporting PSE identified previously. Post-interventions, an identical cross-sectional survey of the residents at the same two community teaching hospitals was conducted from Sept to Dec 2018 through an online questionnaire tool.Results
78 out of 149 residents (52.3%) completed the survey. We found a significant improvement in the number of residents who endorsed reporting a PSE in the past 1 year (51.2% vs 23.5%, p = 0.001), as well as during the course of their training (52.6% vs 26.5%, P = 0.001). There was also a significant decrease in the number of residents who were unsure of how to report a PSE (p = 0.031) as well as those who viewed medical error as a sign of incompetence (p = 0.036).Conclusion
Our study demonstrates that simplifying the PSE reporting process, improving knowledge and acceptance of patient safety/quality improvement principles and promotion of a just culture improves resident PSE reporting.
SUBMITTER: Singal M
PROVIDER: S-EPMC7671725 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionResidents play a key role in patient care at academic medical centers and have unique insights into safety improvement opportunities. At our institution, <1% of safety events were reported by resident trainees. The primary objective of this quality improvement (QI) initiative was to increase the monthly incidence of event reporting by pediatric residents by 20% from baseline within 12 months.MethodsA QI team used the model for improvement to identify barriers to submitting safety event reports. The team used multiple intervention cycles to increase knowledge and promote engagement in event reporting. Interventions included educational tip sheets, a hospital-wide Morbidity and Mortality (M&M) conference, peer recognition and acknowledgment by senior leadership for report submission, and an interactive reporting activity. The outcome measure was monthly number of reports filed by residents. The process measure was the number of unique residents submitting a report each month. Time to complete a report was a balancing measure.ResultsThe number of reports placed by residents increased significantly, with a centerline shift from 15 to 29 reports per month (statistical process control chart-Fig. 3). The number of unique residents submitting reports increased from 10 to 22 per month. The time to complete a report was unchanged.ConclusionsEngaging residents in patient safety initiatives through education, experiential learning, and recognition can increase safety event reporting by residents. Future planned interventions include enhancing safety event reporting technology, developing patient safety faculty and resident champions, and increasing transparency regarding outcomes of safety event reports.
| S-EPMC8782116 | biostudies-literature
Project description:BackgroundDespite the Clinical Learning Environment Review's recommendations of their use, patient safety event reporting systems are underutilized by residents.ObjectiveWe aimed to identify perceived barriers to event reporting amongst internal medicine residents and implement a targeted quality improvement initiative to address the identified barriers and increase overall resident event report rates.MethodsA total of 94 Internal Medicine (IM) residents participated in the educational intervention in 2018. We measured residents' perception of barriers to event reporting and employed the results of the questionnaire to create a skill-based educational workshop. We conducted the plan-do-study-act model to test a structured educational intervention and its effectiveness on pre-post IM residents' event report rates and compared it to report rates of Non-Internal Medicine (Non-IM) residents. Additionally, we assessed pre-post intervention knowledge, skills, and attitudes in event reporting.Results94/94 (100%) of IM residents had a significantly higher median percent of patient safety event reporting when compared to pre-intervention (23.6% compared to 5.88%, p-value = 0.0030) and when compared to Non-IM residents (23.6% compared to 5.31%, p-value = 0.0002). Residents performed better on the post-test compared to the pre-test (90% compared to 30%, p-value = 0.0001) for knowledge. 100% of the critical action items were completed and 90% of participants reported their perception of the event reporting process improved.ConclusionsBy elucidating common reasons why residents are not reporting patient safety events, a specific intervention can be created to target the identified impediments and improve resident event reporting.AbbreviationsIM: Internal Medicine IM; Non-IM: Non-Internal Medicine; IOM: Institute of Medicine I; ACGME CLER: Accreditation Council for Graduate Medical Education Clinical Learning Environment Review; GME: Graduate Medical Education; IRB: Institutional Review Board; PDSA: Plan, Do, Study, Act.
| S-EPMC7425618 | biostudies-literature
Project description:IntroductionPatient safety and quality improvement are essential components of modern medicine. The traditional model of graduate medical education does not lend itself well to learning these disciplines. This curriculum encompasses these disciplines across multiple modalities and extends throughout residency.MethodsThe curriculum includes introductory presentations suitable for naive audiences. Following these is a structured rotation that provides the opportunity both to experience in-depth self-directed learning and to practice skills involved in quality and safety. This rotation includes existing online courses published elsewhere, reflective writing exercises based on self-directed learning, and practice cases. Finally, residents lead a morbidity, mortality, and improvement conference where adverse events are identified and reviewed, specific interventions and outcome objectives are selected, and action teams are identified.ResultsAfter two presentations on system issues and individual issues, responses to the prompt "This talk will aid in my professional development" were 4.75 and 4.59 out of 5, respectively. Eighty-three percent of residents agreed they had a better understanding of the concepts of patient safety and/or quality improvement than they did before the rotation. Audience members for the resident-led morbidity, mortality, and improvement conference agreed it would lead to a change in their own practice.DiscussionThe contents of this longitudinal curriculum have been incorporated into the core requirements of our general pediatrics residency program and could reasonably be imported into any residency requiring a robust longitudinal experience in quality improvement and patient safety.
| S-EPMC6338155 | biostudies-literature
Project description:BackgroundResident participation in quality improvement and patient safety (QIPS) programs is an essential training experience and Accreditation Council for Graduate Medical Education requirement. However, the most effective approach to achieve this is unclear.ObjectiveWe developed an experiential Quality Improvement and Patient Safety Curriculum and Resident Experience (QIPS CURE) program, which provides internal medicine (IM) residents with foundational QIPS knowledge, and evaluated its effectiveness.MethodsAfter reviewing IM residency QIPS curricula and obtaining input from institutional stakeholders in 2013-2014, we launched a longitudinal QIPS curriculum for all 66 postgraduate year 1-3 IM residents in July 2014. The QIPS CURE included 2 major elements: didactics, delivered through a variety of sources, including online modules and workshops, and hands-on projects. We delivered this curriculum annually from 2014 to 2018. We used project completion and an attitude survey of participants to evaluate it.ResultsSix projects were completed in 2014-2015, and 10 projects completed yearly for the next 3 academic years. Residents presented all projects at regional meetings. Surveyed residents reported improvement in understanding (M = 5.71, SD = 1.07 pre- to M = 6.38, SD = 0.49 post-curriculum, P = .013) and competence (M = 3.31, SD = 1.18 pre- to M = 6.08, SD = 0.77, post-curriculum, P < .001) when comparing graduates of the curriculum with incoming interns. Qualitative analysis revealed perceived acquisition of skills needed to carry out successful QIPS projects.ConclusionsThis QIPS program was sustainable over 4 years and generally well-received by residents, with many projects completed each year.
| S-EPMC7450742 | biostudies-literature
Project description:BackgroundPhysicians and physicists are expected to contribute to patient safety and quality improvement (QI) in Radiation Oncology (RO), but prior studies suggest that training for this may be inadequate. RO and medical physics (MP) program directors (PDs) were surveyed to better understand the current patient safety/QI training in their residency programs.MethodsPDs were surveyed via email in January 2017. Survey questions inquired about current training, curriculum elements, and barriers to development and/or improvement of safety and QI training.ResultsEighty-nine RO PDs and 84 MP PDs were surveyed, and 21 RO PDs (28%) and 31 MP PDs (37%) responded. Both RO and MP PDs had favorable opinions of current safety and QI training, and used a range of resources for program development, especially safety and QI publications. Various curriculum elements were reported. Curriculum elements used by RO and MP PDs were similar, except RO were more likely than MP PDs to implement morbidity and mortality (M&M) conference (72% vs. 45%, p < 0.05). RO and MP PDs similarly cited various barriers, but RO PDs were more likely to cite lack of experience than MP PDs (40% vs. 16%, p < 0.05). PDs responded similarly independent of whether they reported using a departmental incident learning system (ILS) or not.ConclusionsPDs view patient safety/QI as an important part of resident education. Most PDs agreed that residents are adequately exposed to patient safety/QI and prepared to meet the patient safety/QI expectations of clinical practice. This conflicts with other independent studies that indicate a majority of residents feel their patient safety/QI training is inadequate and lacks formal exposure to QI tools.
| S-EPMC6154943 | biostudies-literature
Project description:BackgroundGiven persistent gaps in coordination of care for medically complex primary care patients, efficient strategies are needed to promote better care coordination.ObjectiveThe Coordination Toolkit and Coaching project compared two toolkit-based strategies of differing intensity to improve care coordination at VA primary care clinics.DesignMulti-site, cluster-randomized QI initiative.ParticipantsTwelve VA primary care clinics matched in 6 pairs.InterventionsWe used a computer-generated allocation sequence to randomize clinics within each pair to two implementation strategies. Active control clinics received an online toolkit with evidence-based tools and QI coaching manual. Intervention clinics received the online toolkit plus weekly assistance from a distance coach for 12 months.Main measuresWe quantified patient experience of general care coordination using the Health Care System Hassles Scale (primary outcome) mailed at baseline and 12-month follow-up to serial cross-sectional patient samples. We measured the difference-in-difference (DiD) in clinic-level-predicted mean counts of hassles between coached and non-coached clinics, adjusting for clustering and patient characteristics using zero-inflated negative binomial regression and bootstrapping to obtain 95% confidence intervals. Other measures included care coordination QI projects attempted, tools adopted, and patient-reported exposure to projects.Key resultsN = 2,484 (49%) patients completed baseline surveys and 2,481 (48%) completed follow-ups. Six coached clinics versus five non-coached clinics attempted QI projects. All coached clinics versus two non-coached clinics attempted more than one project or projects that were multifaceted (i.e., involving multiple components addressing a common goal). Five coached versus three non-coached clinics used 1-2 toolkit tools. Both the coached and non-coached clinics experienced pre-post reductions in hassle counts over the study period (- 0.42 (- 0.76, - 0.08) non-coached; - 0.40 (- 0.75, - 0.06) coached). However, the DiD (0.02 (- 0.47, 0.50)) was not statistically significant; coaching did not improve patient experience of care coordination relative to the toolkit alone.ConclusionAlthough coached clinics attempted more or more complex QI projects and used more tools than non-coached clinics, coaching provided no additional benefit versus the online toolkit alone in patient-reported outcomes.Trial registrationClinicalTrials.gov identifier: NCT03063294.
| S-EPMC8739408 | biostudies-literature
Project description:OBJECTIVES:Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN:Quality improvement before-after unblinded trial. SETTING:430-bed Canadian community teaching hospital. PARTICIPANTS:All admitted adult medical-surgical patients in a before-after 12-month interventional study. INTERVENTION:Locally validated checklist (Modified Early Warning Score+urinary?catheter in situ+nurse?concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED). RESULTS:Following deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24?hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95%?CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04?hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged. CONCLUSIONS:ER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.
| S-EPMC6303585 | biostudies-literature
Project description:Initiatives to improve hypertension control within academic medical centers and closed health systems have been extensively studied, but large community-wide quality improvement (QI) initiatives have been both less common and less successful in the United States. The authors examined a community-wide QI initiative across 226 843 patients from 198 practices in nine counties across upstate New York to improve hypertension control and reduce disparities. The QI initiative focused on (a) providing population and practice-level comparative data, (b) community engagement, especially in underserved communities, and (c) practice-level quality improvement assistance, but was not designed to examine causality of specific components. Across the nine counties, hypertension control rates improved from 61.9% in 2011 to 69.5% in 2016. Improvements were greatest among whites (73.7%-81.5%) and more modest among black patients (58.8%-64.7%). The authors noted a considerable improvement in BP within the group of patients with the highest risk (defined as a BP ≥ 160/100) and a decrease in disparities within this group. The quality collaborative identified five key lessons to help guide future community initiatives: (a) anticipate a plateauing of response; (b) distinguish the needs of disparate populations and create subpopulation-specific strategies to address and reduce disparities; (c) recognize the variation across low SES practices; (d) remain open to the refinement of outcome measures; and (e) continually seek best practices and barriers to success. Overall, a large community-wide QI initiative, involving multiple different stakeholders, was associated with improvements in BP control and modest reductions in some targeted disparities.
| S-EPMC8030610 | biostudies-literature
Project description:ObjectiveDespite the increasing numbers of published trials of quality improvement (QI) interventions in diabetes, little is known about the risk of bias in this literature.DesignSecondary analysis of a systematic review.Data sourcesMedline, the Cochrane Effective Practice and Organisation of Care (EPOC) database (from inception to July 2010) and references of included studies.Eligibility criteriaRandomised trials assessing 11 predefined QI strategies or financial incentives targeting health systems, healthcare professionals or patients to improve the management of adult outpatients with diabetes.AnalysisRisk of bias (low, unclear or high) was assessed for the 142 trials in the review across nine domains using the EPOC version of the Cochrane Risk of Bias Tool. We used Cochran-Armitage tests for trends to evaluate the improvement over time.ResultsThere was no significant improvement over time in any of the risk of bias domains. Attrition bias (loss to follow-up) was the most common source of bias, with 24 trials (17%) having high risk of bias due to incomplete outcome data. Overall, 69 trials (49%) had at least one domain with high risk of bias. Inadequate reporting frequently hampered the risk of bias assessment: allocation sequence was unclear in 82 trials (58%) and allocation concealment was unclear in 78 trials (55%). There were significant reductions neither in the proportions of studies at high risk of bias over time nor in the adequacy of reporting of risk of bias domains.ConclusionsNearly half of the included QI trials in this review were judged to have high risk of bias. Such trials have serious limitations that put the findings in question and therefore inhibit evidence-based QI. There is a need to limit the potential for bias when conducting QI trials and improve the quality of reporting of QI trials so that stakeholders have adequate evidence for implementation.
| S-EPMC3641459 | biostudies-literature
Project description:INTRODUCTION: Failure to schedule timely follow-up appointments may impair continuity and quality of care, especially for patients with low health literacy and unstable living situations. Resident continuity clinics face particular challenges in scheduling patient follow-up because of residents' complex schedules and limited time in clinic. METHODS: As part of a structured quality-improvement curriculum, residents initiated discussions with clinical supervisors and clerical staff to evaluate and improve scheduling practices in an urban continuity clinic. The problem-solving process emphasized feasibility (rapid implementation/evaluation cycle, low time/resource burden) and measurable outcomes. These discussions led to design of a new scheduling form. We evaluated the short-term impact of awareness raising by comparing scheduling rates before (month 1) versus after (months 2-3) implementation, and of the form itself by randomly selecting 2 afternoon clinics to implement the new form, with a third serving as control. RESULTS: We analyzed all patient encounters over a 3-month period (n = 910), excluding patients with a recommended follow-up interval of greater than 4 months. The proportion of appointments "never scheduled" (at 1 month after provider-requested follow-up date) declined from 18.8% (95% confidence interval [CI], 14.5%-23.9%) in month 1 to 11.4% (CI, 8.1%-15.5%) in month 3. This proportion was significantly higher before than after implementation of the form (multivariable relative risk, 1.49; 95% CI, 1.08-2.03; P = .02), both in clinics that used and did not use the form (P = .93 for difference). CONCLUSIONS: We describe a model resident-led, team-based intervention that addressed core competencies in graduate medical education while improving outpatient scheduling practices.
| S-EPMC3184901 | biostudies-other