204 - Outcomes of A Pediatric Resident-focused Interprofessional Departmental Patient Safety Rounds: When you don’t ask, you don’t know.

Publication Number: 3196.204

Carol Lynn O'Dea, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Joel M.. Bradley, Dartmouth Health, Norwich, VT, United States; Samantha House, Dartmouth Health Children's, Lebanon, NH, United States

Background: Safety huddles are proactive opportunities to address quality and safety (QS) gaps in clinical care. While leadership-focused huddles are widespread, few models prioritize engagement of residents, who observe clinical quality as direct care providers across multiple settings within a department and health system.

Objective: Implement a trainee-focused interprofessional departmental safety rounds at our rural academic medical center in 2023 and assess an 8-month pilot of this new curricular structure to describe 1) QS gaps raised in this forum, and 2) pediatric resident learning outcomes.

Design/Methods: Pediatric Patient Safety Rounds (PPSR) was integrated in July 2023 during the first 15-minutes of an existing weekly departmental case conference led by residents, and attended by students, residents, multidisciplinary and interprofessional faculty. PPSR structure is described in Table 1. Leaders tracked and categorized all QS events, resolving disagreements. Patient safety events were reviewed according to institutional standards; follow-up for other event types was assigned during PPSR and updates were brought by leaders to subsequent sessions. To understand the impact of PPSR on pediatric resident clinical practice and learning outcomes, we administered a one-time anonymous survey in RedCap at pilot conclusion in February 2023.

Results: 47 unique QS gaps arose in 26 huddles over the 8-month pilot. 70% (33/47) were initiated by residents; 34% (16/47) had not been reported. Table 2 describes categories of QS gaps, representative examples, and improvement actions. 71% of pediatric residents (15/21) completed the survey (4 R1, 5 R2, 6 R3); all had attended >6 sessions and reported >1 event. 53% of residents (8/15) reported known system changes in response to PPSR; 93% (14/15) reported changes to their own clinical practice, including practices for order review, interprofessional collaboration, medication reconciliation, lab follow-up, and patient instructions. 73% (11/15) felt PPSR changed how they use safety event reporting into clinical practice, and 33% (5/15) reported improved understanding of interprofessional safety event analysis. Figure 1 further describes qualitative data from the resident survey.

Conclusion(s): PPSR identified diverse QS issues, many of which had not been reported elsewhere. Residents identified changes to their own clinical and safety reporting practices, and observed systems improvements. Further interprofessional engagement and resident involvement in tracking QS gaps and improving care is needed.

Table 1. GME-focused Departmental Pediatric Patient Safety Rounds Structure
PPSR Abstract Table 1.pdf

Table 2: Quality and Safety Gaps discussed in Pediatric Patient Safety Rounds
PPSR Abstract Table 2.pdf

Figure 1: Qualitative learning themes across the spectrum of responding to safety events
PPSR Abstract Figure 1.pdf