Resounding Residencies: Trainees speak up for better patient care
By Bruce Coleman
When recent data from the intensive care unit indicated a spike in catheter-associated urinary tract infections, a potential solution to preventing this type of infection for patients at the University of Mississippi Medical Center came from a once-overlooked source.
The suggestion by resident physicians was pretty direct: place a bladder scanner in the ICU. But having hospital administrators consider residents’ advice hasn’t always been as straightforward.
With an increasing focus on the quality of patient care by health-care organizations nationwide, academic medical institutions are recognizing the inherent value that residents have in quality improvement efforts.
It’s a welcome trend, according to Dr. Shirley Schlessinger, professor of medicine and associate dean for graduate medical education (GME).
“It’s very clear in academic medical centers that, unless you actively engage the trainees in quality initiatives and how to solve problems, you’re probably not going to be as effective as you want to be,” she said. “Our residents in general tend to be the first line of physical contact with patients in our hospitals and clinics. They are who the nurses call first when there are problems with patients.
“They are in a unique position to identify problems with systems and to provide solutions that can make a difference in the long-term outcome of the quality of care for our patients.”
Indeed, a study published in the July 2012 issue of the Joint Commission Journal on Quality and Patient Safety suggests that a house staff quality council that engages residents in quality improvement efforts can boost patient safety significantly.
To that end, a Resident Quality Council has been working to carve out its place at UMMC.
Following the example of a leading health-care organization, Schlessinger sought to emulate its program at UMMC.
She consulted with Dr. Michael H. Baumann, an expert in quality care, and Dr. William H. Cleland, then head of risk management, and found residents who were receptive to the concept.
“I didn’t give them any clear-cut guidelines,” Schlessinger recalled. “The volunteer members wanted to take an active part in quality measures at the hospital. I wanted them to think from their own perspective what could make the biggest difference, have the greatest impact on how they could improve quality care.”
The committee is made up of 12 residents, each of whom serves on other hospital committees. They give reports of committee actions to the council. The council’s chair, Dr. Jason Stacy, house officer in the Department of Neurosurgery, and co-chair, Dr. Rishi Roy, house officer in the Department of Surgery, report the council’s findings to the Hospital Quality Board.
The first thing the committee addressed was the variation in the level of faculty engagement in patient care. The residents suggested an enhanced faculty evaluation tool because, as Schlessinger puts it, “helping our faculty be good supervisors and teachers is important to quality care.”
Next, council members suggested ways the Access Center could improve the transmission of critical patient information to make certain it had arrived at the unit by the time the patient had been transferred.
“If we see a change that needs to be made at the ground level, as residents we now have a mechanism to address that change,” Stacy said.
”The hospital is really the focus of these quality improvement efforts by the Resident Quality Council,” Baumann said. “It really points to the need for having GME and the hospital working hand-in-hand for the quality care of our patients.”
But what makes the Medical Center’s Resident Quality Council unique among its contemporaries at other academic medical centers is its peer-review efforts, Baumann said.
The Resident Quality Review Committee, also made up of resident volunteers, is tasked with helping individual residents who may be struggling with their responsibilities or may have trouble communicating with other members of the health-care team.
This “innovative next step,” as Baumann describes it, doesn’t work like a traditional hospital review committee, because it doesn’t have the power to mete out plans of improvement. But it can have its findings brought to the attention of the appropriate GME director.
“It’s not about finding fault – it’s not a ‘gotcha’ kind of thing – but they talk about how they can properly remediate resident challenges,” Baumann said.
Schlessinger said the peer review group should have a lasting impact on quality.
“While the quality council is focused on patient care and trying to have systems checks in place to make sure we can provide the best quality care, the peer review council is more of an educational process for our physicians,” she said. “It’s about helping each of us be the best doctor we can possibly be. … “
Baumann said both groups provide a great opportunity for house staff to make their mark on the health-care team at the Medical Center.
“Physicians, nurses and residents all have their own peer review process now,” he said. “This is really a great opportunity to engage the residents and get the most mileage out of their knowledge, background and frontline experiences with our patients.”