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BACKGROUND: Lean concepts, including Daily Management Systems (DMS), have been adopted by health systems to prioritize high-quality and efficient care. Since 2018, our residency program has utilized a daily readiness huddle (key component of DMS) to prepare inpatient residents for their workday. This is a time when residents can raise administrative and/or clinical patient safety concerns. Concerns unable to be immediately resolved locally are designated as Quick Hits (QH) and escalated through residency and hospital leadership with resolutions cascaded back to frontline providers. With <10% of residents on inpatient services each month, a gap in overall resident awareness of findings from resolved QH exists, posing potential patient safety risks. OBJECTIVE/AIM: We aimed to improve the weekly percentage of findings from resolved QH communicated to every resident (rather than only those in attendance at the daily readiness huddle) from 0% to >95% within 6 months. METHODS: A core team was created consisting of residency program leadership (DIO, Program Directors, Chief Residents). Root causes were identified and guided interventions. Outcome measure was percentage of weekly QH communicated to all residents. Process measure was weekly QH identified for escalation. Findings of resolved QH were shared at bi-weekly residency program meetings/minutes. Plan-Do-Study-Act Cycles included: 1) Standardizing process of identifying QH requiring report-back to all residents, and 2) Audit and feedback to program leadership regarding transmission of resolved QH with adjustment in standard work when needed. Due to rarity of patient safety events, these were unable to be tracked. Run charts assessed improvement over time. RESULTS: Over 20 weeks, 83 QH were identified with 45 requiring escalation beyond residency program leadership for resolution including to physician safety officer and CEO huddles. Outcome measure showed sustained, special-cause improvement from 0% to 100% by Week 15 following Cycle #2 (Fig 1). Process measure remained unchanged at 4.2 QH averaged per week. CONCLUSIONS: Using improvement methodology, we were able to achieve sustained improvement above our goal of communicating findings of resolved QH to all residents. Audit and feedback appeared to have the greatest impact on our outcome measure. Further study is needed, but this closed-loop communication process may also provide beneficial impacts to patient safety.


Medical Education


Presented at the Association of Pediatric Program Directors 2022 Spring Meeting, San Diego, CA, May 16-19, 2022.

Improvement in Follow-up Communication for Resident-Identified Patient Safety and Hospital Process Issues