Using resident focus groups to improve subspecialty consultations in a pediatric urgent care setting

In a pediatric urgent care center, patients requiring management by subspecialty consultants have average waiting times of two hours. Pediatric resident input was sought in order to identify problems and propose urgently needed solutions.

1) To define the dimensions on which residents measure quality of consultations; 2) To generate solutions for perceived problems.

Mixed methods, including focus groups, survey questionnaires and an intervention, were used. Focus groups and questionnaires involved pediatric residents from a large public hospital that provides care to medically underserved African-American and Latino patients.

Residents defined four dimensions of quality: waiting time, teaching, courtesy and overall quality of care. An intervention made with the service having the poorest ratings on the questionnaire consisted of a detailed discussion of focus group findings and recommendations. The overall effectiveness of the intervention was evaluated by analyzing pre- and postprogram measures. Postintervention ratings showed significant improvement of ratings along three of the four dimensions of concern.

At minimal-to-no cost to an institution, focus groups composed of residents can generate viable solutions to observed problems. This form of feedback could be beneficially incorporated into an institution's continuous quality improvement processes.