703 - Leveling Up Supervision: A Quality Improvement Initiative to Strengthen PEM Fellows’ Role in Overseeing Patient Care
Sunday, April 26, 2026
9:30am - 11:30am ET
Publication Number: 3680.703
Barron Frazier, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Daisy Ciener, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Jessica Hayes, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Peyton Bennett, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Meredith Montgomery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Abigail Gauthier, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Amanda Seibert, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Amelia Wong, Vanderbilt University School of Medicine, Nashville, TN, United States; Viraj Mithani, Vanderbilt University School of Medicine, Nashville, TN, United States; Taylor Anderson, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Elizabeth Ebbens, University of Chicago, Oak Forest, IL, United States; Rachel E. Quinn, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
Pediatric Emergency Medicine Fellow Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Tennessee, United States
Background: Pediatric emergency medicine (PEM) fellows develop the skillset of supervising residents as they prepare for their attending careers. Some PEM fellowships achieve this objective when third year fellows function as attendings, but not all PEM fellowships are structured this way. More commonly, fellows carry dual roles on shift, seeing patients independently while also overseeing resident-managed patients. Fellow supervision of residents in patient management builds clinical teaching and decision-making skills, regardless of fellowship structure. Objective: We aimed to increase the percentage of fellow-supervised patients from 23% to 40% by June 2025. Our global aim was to enhance resident education, improve fellow autonomy, and develop fellow supervision skills within the pediatric emergency department. Design/Methods: Nine pediatric emergency fellows from July 2024 to June 2025 participated in this study. All fellows participated in creating a key driver diagram and performing a failure mode effect analysis to understand barriers to supervising residents (Figure 1). Retrospective baseline data was obtained from Epic generated reports between January 1 to June 30, 2024. Real time data was subsequently collected weekly from July 1, 2024, to June 30, 2025. Mental health encounters were excluded. Statistical process control charts, specifically p-charts, were used to analyze data. The primary outcome was percentage of patients seen collaboratively by residents and fellows. Results: 14,167 encounters were analyzed with baseline data comprising of 4049 encounters with a supervision rate of 23.1%. Following the implementation of this QI initiative with fellow led interventions, special cause variation was achieved with a center-line shift to a mean of 34.7% that was sustained for six months (Figure 2). Notable interventions included the reassignment of the fellow’s medical student education role, notifying pediatric and emergency medicine residency leadership of the initiative, providing monthly fellow supervision rate feedback, and reviewing the fellow role with residents at the start of shifts.
Conclusion(s): Our study demonstrates an increase in the percentage of patients seen collaboratively by PEM fellows and residents working in the pediatric emergency department. This study offers insight into tangible actions that improve fellows' supervision opportunities, contributing to the fellows' professional growth as independent, competent, and confident physicians.
