Background: Graduate medical education (GME) comprises residents and fellows being trained at a hospital but also providing essential patient care. At academic hospitals, residents and fellows are often the front-line physicians and an integral part of the interprofessional team. The Accreditation Council for GME (ACGME) requires annual participation by residents and fellows in quality improvement but this is often conducted at the program level and separate from the primary Quality and Safety operations of the health system.
Purpose: To engage residents in quality and safety work that satisfies both their educational needs, the ACGME requirement, and the health system’s patient care improvement needs, an annual, GME-wide incentive program was started. The goal of this program was to engage front-line physicians in meaningful quality and safety work.
Description: The hospital provides an incentive of $500 per resident per year for participating in a quality improvement project. The projects are done at a residency training program level. The area of focus for each project is approved by the Quality and Safety department. The program has been in place for 7 years and over the past 3 years has focused on increasingly specific health system-defined metrics such as mobility improvement, harm reduction (CAUTI, CLABSI, etc.), and patient throughput.
Conclusions: The program has been well received by the health system and training programs with excellent engagement of resident and fellows in their QI projects. Each year the program has enrolled up to 30 different residency or fellowship programs with up to 550 participating residents. Projects have improved a broad range of outcomes. A project reducing overnight neuro-checks in stroke patients reduced length of stay in this group by 0.6 days and incidence of delirium by 13%. One program improved 10am discharge orders from 29.3% to 55.8%. Another project reduced central venous line (CVL) days from 0.58 to 0.33 CVL days/patient days, with a long-term goal of reducing CLABSI. An incentive program can be an important tool to engage an influential workforce within academic hospitals. Although this program spanned medical and surgical disciplines, it is an innovative and replicable example of engaging residents and fellows in meaningful quality and safety work.