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96. IMPLEMENTING AND MAINTAINING A PEDIATRIC NIGHT EDUCATION CURRICULUM
TAGEDENACADEMIC PEDIATRICS ambulatory charts) 2-General Pediatric attending consensus on note completion timeliness (same day for acute care visits, next day for well child visits) 3-Intermittent auditing and real time alerts by administrative staff for residents who failed to comply with the same day/next day clinic note completion timeline. MEASURES: Number of delinquent charts by pediatric residents according to the weekly graduate medical education deficiency notification system. RESULTS: Timely note completion improved significantly over the 13 months of the project. Program Director emails/pages to residents with deficient charts resulted in a reduction of a median 26 deficient charts/week to 12 deficient charts/week. Intermittent real time alerts to residents who failed to close charts within 24 hours of an acute care visit or 48 hours of a well child visit further reduced the median from 12 charts per week to 2 charts per week. CONCLUSIONS AND NEXT STEPS: Standard expectations for resident note completion in a general pediatric clinic coupled with real time feedback improved resident adherence to institutional expectations around timely note completion. While program director contact with residents who have delinquent charts demonstrated some improvement, this intervention alone was insufficient.
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ABSTRACTS
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providing more flexibility in teaching expectations led to a shift of the median to our goal of three times per week which has been sustained for 20 weeks. These changes in teaching expectations included the flexibility on who is present for teaching, the night it occurs, the time it occurs and the duration of teaching. Other interventions such as providing results of the survey and placing a calendar as a reminder did not result in a more reliable process. CONCLUSIONS AND NEXT STEPS: Simply creating night curriculum content does not ensure teaching occurs, especially when overnight workflows and workloads are variable and hectic. Implementing and sustaining a pediatric night education curriculum is possible using quality improvement methodology. Utilizing resident feedback for modifications to the curriculum and allowing more resident-ownership by testing different interventions increased the consistency at which resident-led night teaching was done at our institution.
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TAGEDFIUR TAGEDEN
TAGEDFIUR 97. RESIDENT NOON CONFERENCE FEEDBACK IN THE DIGITAL AGE: A QI PROJECT Christina M. Abrams, MD, Jessica Wilson, MD, Kristen Bettin, MD, Emilee Dobish, MD, University of Tennessee, Memphis, TN
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96. IMPLEMENTING AND MAINTAINING A PEDIATRIC NIGHT EDUCATION CURRICULUM McKenzie Vater, David Johnson, Alison Herndon, Whitney Browning, Vanderbilt University, Nashville, TN BACKGROUND: Resident work hour restrictions have led to increasing night float coverage, reducing the ability of residents to attend educational conferences. A night education curriculum could help fill this void. While sample curricula exist, few have evaluated factors leading to successful implementation. AIM STATEMENT: To increase resident-led formal teaching while on ward night shifts from zero occurrences per week to at least three times weekly by December 31, 2018. INTERVENTIONS: Resident-completed surveys provided information on educational needs and indicated formal nighttime teaching was exceedingly rare. Key drivers were developed to identify areas for intervention, including: flexibility on timing of teaching and who is present for teaching, resident understanding of survey results, comfort with teaching skills and content, and perception of adequate time to teach. MEASURES: Several plan, do, study and act cycles were instituted as changes were tested. Weekly data were analyzed using a run chart with six consecutive points on either side of the median line representing special cause variation indicating a shift. RESULTS: Nighttime teaching initially occurred zero times per week. Introduction of the curriculum with expectations to teach on Monday, Wednesday and Friday at 10 PM with the attending present increased teaching to a median of one session per week. Based on resident feedback and concerns, targeted interventions
BACKGROUND: Noon conference lectures are a valuable education tool for residency programs, but feedback is difficult to obtain with many methods unsuccessful. Our program used paper and audience polling systems without meaningful responses as the feedback consisted of a numerical rating without comments. Given the availability of smartphones, Quick Response (QR) codes may provide a sustainable method for feedback. AIM STATEMENT: By December 2018, we will increase feedback participation for noon conference lectures to 75% of residents in attendance utilizing QR codes and Google Forms. INTERVENTIONS: PDSA cycles were completed monthly to track changes in resident response rate. In cycle 1, chief residents asked residents to use the QR code to complete feedback. In cycle 2, feedback results were discussed during the monthly housestaff meeting. In cycle 3, faculty presenters displayed the QR code and asked residents to participate. In cycle 4, QR codes were placed in the conference hall. In cycle 5, QR codes were displayed Friday before conference. In cycle 6, faculty were provided education on the QR code process. MEASURES: Following the model for improvement, we reviewed prior attempts to obtain resident feedback and compiled baseline data. Surveys consisting of a 5 point rating scale and comment section were linked to a QR code. The primary outcome was the percent of residents in attendance providing feedback via the QR code. RESULTS: Over six months, we were unable to meet the goal of a 75% response rate. However, monthly median response rates increased from the baseline 27.9% to 34.2% at the end of cycle 6 indicating a 22.5% change from baseline in participation. The run chart indicates several runs of data, possibly indicating multiple data sets such as different response rates by residency class. CONCLUSIONS AND NEXT STEPS: Though we have not reached our goal, we have been able to get meaningful feedback from the residents for faculty. Using this feedback, we can guide topic
TAGEDPEN
ABSTRACTS
e43
providing more flexibility in teaching expectations led to a shift of the median to our goal of three times per week which has been sustained for 20 weeks. These changes in teaching expectations included the flexibility on who is present for teaching, the night it occurs, the time it occurs and the duration of teaching. Other interventions such as providing results of the survey and placing a calendar as a reminder did not result in a more reliable process. CONCLUSIONS AND NEXT STEPS: Simply creating night curriculum content does not ensure teaching occurs, especially when overnight workflows and workloads are variable and hectic. Implementing and sustaining a pediatric night education curriculum is possible using quality improvement methodology. Utilizing resident feedback for modifications to the curriculum and allowing more resident-ownership by testing different interventions increased the consistency at which resident-led night teaching was done at our institution.
TAGEDPEN
TAGEDFIUR TAGEDEN
TAGEDFIUR 97. RESIDENT NOON CONFERENCE FEEDBACK IN THE DIGITAL AGE: A QI PROJECT Christina M. Abrams, MD, Jessica Wilson, MD, Kristen Bettin, MD, Emilee Dobish, MD, University of Tennessee, Memphis, TN
TAGEDEN
96. IMPLEMENTING AND MAINTAINING A PEDIATRIC NIGHT EDUCATION CURRICULUM McKenzie Vater, David Johnson, Alison Herndon, Whitney Browning, Vanderbilt University, Nashville, TN BACKGROUND: Resident work hour restrictions have led to increasing night float coverage, reducing the ability of residents to attend educational conferences. A night education curriculum could help fill this void. While sample curricula exist, few have evaluated factors leading to successful implementation. AIM STATEMENT: To increase resident-led formal teaching while on ward night shifts from zero occurrences per week to at least three times weekly by December 31, 2018. INTERVENTIONS: Resident-completed surveys provided information on educational needs and indicated formal nighttime teaching was exceedingly rare. Key drivers were developed to identify areas for intervention, including: flexibility on timing of teaching and who is present for teaching, resident understanding of survey results, comfort with teaching skills and content, and perception of adequate time to teach. MEASURES: Several plan, do, study and act cycles were instituted as changes were tested. Weekly data were analyzed using a run chart with six consecutive points on either side of the median line representing special cause variation indicating a shift. RESULTS: Nighttime teaching initially occurred zero times per week. Introduction of the curriculum with expectations to teach on Monday, Wednesday and Friday at 10 PM with the attending present increased teaching to a median of one session per week. Based on resident feedback and concerns, targeted interventions
BACKGROUND: Noon conference lectures are a valuable education tool for residency programs, but feedback is difficult to obtain with many methods unsuccessful. Our program used paper and audience polling systems without meaningful responses as the feedback consisted of a numerical rating without comments. Given the availability of smartphones, Quick Response (QR) codes may provide a sustainable method for feedback. AIM STATEMENT: By December 2018, we will increase feedback participation for noon conference lectures to 75% of residents in attendance utilizing QR codes and Google Forms. INTERVENTIONS: PDSA cycles were completed monthly to track changes in resident response rate. In cycle 1, chief residents asked residents to use the QR code to complete feedback. In cycle 2, feedback results were discussed during the monthly housestaff meeting. In cycle 3, faculty presenters displayed the QR code and asked residents to participate. In cycle 4, QR codes were placed in the conference hall. In cycle 5, QR codes were displayed Friday before conference. In cycle 6, faculty were provided education on the QR code process. MEASURES: Following the model for improvement, we reviewed prior attempts to obtain resident feedback and compiled baseline data. Surveys consisting of a 5 point rating scale and comment section were linked to a QR code. The primary outcome was the percent of residents in attendance providing feedback via the QR code. RESULTS: Over six months, we were unable to meet the goal of a 75% response rate. However, monthly median response rates increased from the baseline 27.9% to 34.2% at the end of cycle 6 indicating a 22.5% change from baseline in participation. The run chart indicates several runs of data, possibly indicating multiple data sets such as different response rates by residency class. CONCLUSIONS AND NEXT STEPS: Though we have not reached our goal, we have been able to get meaningful feedback from the residents for faculty. Using this feedback, we can guide topic