Development and Implementation of an Escalation Protocol for Internal Medicine Trainees.

Area of Science:

• Medical Education
• Patient Safety
• Healthcare Management

Background:

• Physicians in training have reduced direct supervision overnight.
• This necessitates effective patient assessment and escalation by trainees.
• Failure to escalate can lead to adverse patient safety events.

Purpose of the Study:

• Standardize overnight patient deterioration evaluation for internal medicine residents.
• Enhance communication between residents and supervising physicians.
• Improve patient safety perceptions in a tertiary academic medical center.

Main Methods:

• Developed and implemented an overnight escalation-of-care protocol.
• Utilized badge buddies and an educational campaign for residents, supervising physicians, and nursing staff.
• Conducted anonymous surveys pre- and post-intervention to assess protocol use, communication, and safety perceptions.

Main Results:

• 82% of residents reported using the protocol post-implementation.
• No significant change in the frequency of resident-supervising physician communication.
• Improved resident-perceived patient safety (47% early, 72% delayed post-intervention; P=0.02).
• Interns reported decreased fear of contacting supervising physicians.

Conclusions:

• A multimodal approach successfully implemented an escalation-of-care protocol.
• The protocol standardized overnight resident escalation.
• Improved resident-perceived patient safety and intern comfort with escalation.