Christiana Care Health System, Newark-Wilmington, DEDeveloping a Resident Quality & Safety Council: Integrating Reporting and Improvement Science into Daily Work

Background: Christiana Care, a major teaching hospital, provides the clinical learning environment for more than 270 residents/fellows in 13 residency programs. Our vision is that all residents will demonstrate that patient safety is a part of their profession. However, we found that although many residents observe safety events, few personally report them ( Methods: The Resident Quality & Safety Council consists of faculty-resident dyads for all of our residency programs that were nominated by chairs and program directors. The council serves as a vehicle for enhancing communication between hospital committees and clinical departments and provides a forum for teaching safety concepts, discussing/disseminating specific system efforts, developing new initiatives, collaborating across departments, participating in safety activities, reviewing data, and providing feedback and solutions for system-level concerns. The council meets monthly for 1.5 hours with the assignment of between-session activities. Each session typically includes didactics, discussion of events/event reporting, reports of dyad-driven quality and safety activities/findings, and advice or consultation on system-level initiatives. The council reports activities to the system9s GMEC and Safety Committee. Key measures of effectiveness included reporting climate data, resident participation in committees/councils, and percent change in self-reported attitudes about patient safety. Results: In the quarter when the AIAMC NI IV project began (October 1, 2013–December 13, 2013), we had 56 resident-submitted Safety First Learning Reports (SFLRs). In the first quarter of 2014, the number increased to 76 resident-submitted SFLRs. The number of resident-submitted SFLRs dipped to 59 in the second quarter of 2014, but rose to 71 and 82 in the third and fourth quarters of 2014, respectively. The GME log of resident participation in health system forums showed a 75% increase in the number of residents participating in root cause analyses (RCAs) and debriefs in June 2014–February 2015 compared to the June 2013–February 2014 time period. According to the risk management event reporting system, the number of resident-submitted events increased 167% from the first measure of January 2013–December 2013 to the second measure of January 2014–December 2014. Safety attitudes remained relatively the same. Conclusions: During our study period, we were able to demonstrate more than a 2-fold increase in the total number of resident-submitted SFLRs. Faculty-resident dyad participation not only enabled effective dissemination of quality and safety initiatives within and between programs but also strengthened mentoring relationships.

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