Engaging Pediatric Resident Physicians in Quality Improvement Through Resident-Led Morbidity and Mortality Conferences

摘要

Background: Increasingly, medical disciplines have used morbidity and mortality conferences (MMCs) to address quality improvement and patient safety (QI/PS), as well as teach systems-based improvement to graduate trainees. The goal of this educational intervention was to establish a pediatric resident physician-led MMC that not only focused on QI/PS principles but also engaged resident physicians in QI/PS endeavors in their clinical learning environments. Methods: Following a needs assessment, pediatric resident physicians at the Stanford University School of Medicine (Stanford, California) established a new MMC model in February 2010 as part of a required QI rotation. Cases were identified, explored, analyzed, and presented by resident physicians using the Johns Hopkins Learning from Defects tool. Discussions during the MMCs were resident physician-directed and systems-based, and resulted in projects to address care delivery. Faculty advisors assessed resident physician comprehension of QI/PS. Conferences were evaluated through the end of the 2012-2013 academic year and outcomes tracked through the 2013-2014 academic year to determine trainee involvement in systems change resulting from the MMCs. Results: The MMC was well received and the number of MMCs increased over time. By the end of the 2013-2014 academic year, resident physicians were involved in addressing 14 systems-based issues resulting from 25 MMCs. Examples of the resident physician-initiated improvement work included increasing use of the rapid response team, institution of a gastrostomy (g)-tube order set, and establishing a face-to-face provider handoff for pediatric ICU-to-acute-care-floor transfers. Conclusion: A resident physician-run MMC exposes resident physicians to QI/PS concepts and principles, enables direct faculty assessment of QI/PS knowledge, and can propel resident physicians into real-time engagement in the culture of safety in a complex hospital environment.