Assessing the impact of the implementation of a remediation and teaching tool on error rate

Effective Quality Assurance/Improvement (QA/QI) remediates and educates physicians, aiming to address past adverse events and guard against similar errors. Limiting future error requires understanding how different educational methods work. The objective of this study was to assess the impact of QI discussion and teaching slides during Morbidity and Mortality (M&M) rounds on subsequent error.

This was a retrospective study of all QA-reviewed cases between 2015 and 2022 at a tertiary-care, academic ED. Starting in 2019, QI slides addressing recent errors were presented and discussed during weekly M&Ms. To assess education efficacy, errors from 2015 to 2018 (no slides) were compared to those from 2019 to 2022 (teaching slides). Cases with an error were reviewed to determine if the error was primarily attributable to the attending or resident and then classified and compared by five categories: not acquiring necessary information, not acting on data acquired, knowledge gaps, communication gaps, and systems issues.

There was no significant difference in overall error rate by attending or resident after the implementation of QI slides (attending: 2.5% pre vs 2.1% post; risk difference: -0.4% [95% CI: -1.0%-0.1%, p = 0.107], resident: 0.9% pre vs 1.2% post; risk difference: 0.2% [95% CI: -0.1%-0.6%, p = 0.229]). When evaluating by specific error category, there was a decrease in "not acquiring necessary information" by attendings only (0.6% pre vs 0.3% post; risk difference: -0.3% [95% CI: -0.5%, -0.1%, p = 0.006]).

Implementing QI teaching slides did not significantly impact the total number of errors by attendings or residents but may lower the risk of attendings not acquiring certain key information. Future studies on directed feedback for attending and resident errors may elucidate their full educational impact.