Improved clinical outcomes combining house staff self-assessment with an audit-based quality improvement program

Area of Science:

• Medical Education
• Quality Improvement
• Patient Safety

Background:

• Integrating quality improvement (QI) with medical education is crucial for advancing healthcare competencies.
• Focus on enhancing patient care through educational initiatives and structured reviews.

Purpose of the Study:

• To evaluate the impact of patient audits and focused Morbidity and Mortality (M&M) conferences on unexpected intensive care unit (ICU) admissions.
• To determine if a self-assessment tool and M&M conference improve patient care in the ICU.

Main Methods:

• Multidisciplinary team reviewed charts of patients transferred from general medical floors (GMF) to the medical ICU.
• Implemented physician and nursing self-assessment tools and monthly M&M conferences for root cause analysis.
• Audited 194 patient transfers over a 10-month period.

Main Results:

• Initiated new policies for vital signs and house staff escalation of care.
• Increased medical emergency response team/critical care consult calls from 53% to 73%.
• Improved nurse notification (65% to 100%) and documentation (65% to 90%) of patient condition changes.
• Reduced cardiac arrests on GMF (3.1 to 0.6/1,000 discharges) and Medicine Service deaths (34 to 24/1,000 discharges).

Conclusions:

• An audit-based program involving nurses, house staff, self-assessment, and M&M conferences can drive significant policy changes.
• The program facilitated more rapid assessment of unstable patients.
• Improved hospital outcomes were achieved through this QI initiative.