Background: There has been a national push over the last few decades to integrate patient safety within clinical care delivery. Despite an increased focus by educators and accrediting bodies, successful involvement of learners in high fidelity event review resulting in systems-level improvement lags behind expectations. Specific areas for improvement include faculty skillset development, involving interprofessional teams, and meaningfully capitalizing on proposed action plans.1
Purpose: Harnessing the momentum of the Accreditation Council for Graduate Medical Education (ACGME) Safety Leaders collaborative, the division of hospital medicine (HM) in an academic medical center fused its safety event process with the internal medicine (IM) residency’s novel intern safety event analysis curriculum.2 The goals of this partnership were to generate actionable change, guide a large number of learners through a patient safety curriculum, engage faculty in patient safety education, and increase faculty and learner involvement in high level patient safety-related systems improvement.
Description: Near-miss or low harm HM safety events were identified for review through the online event reporting system or by direct referral. Six events were selected in total, and each event was assigned to an interprofessional team for review within 45 days of the event. Each team consisted of 1 HM faculty facilitator, 4-8 interns, and 1-3 allied health professionals. A total of 36 interns, 6 HM faculty, and 8 allied health partners participated in the reviews over a 12-week period. Each review occurred over a two-week block during protected resident education time, in a standardized format. Key findings were presented at HM division conferences for discussion and further action planning. Action plans were escalated by HM leadership for prioritization and collaboration with stakeholders. Each review resulted in alterations to relevant patient care policies and procedures (Table 1). Every team received feedback regarding final outcomes within three months of the presentation. Following the reviews, we conducted debriefing sessions with faculty and learners. Themes reported from HM faculty include a sense of an enhanced patient safety skillset, importance of interprofessional teams and action plan loop closure in the event review process, and increased general interest in patient safety. Of the 19 interns who completed the post-course assessment, all learners agreed working in an interprofessional group enhanced their learning. When prompted to identify safety-related behavioral changes, 73% of responding PGY1s identified at least one change they would make after this course, and 93% of this group were motivated to make the change. A total of 35 safety-related behavioral changes were identified.
Conclusions: The integration of the HM division with a residency patient safety curriculum facilitated tangible systems improvement, highlighting the productive synergy of clinical leadership and the IM residency. Identified keys to success for our group include a designated faculty leader responsible for action plan implementation and engagement of interprofessional collaboration. Ultimately, the partnership between the HM division and the IM training program in patient safety event analysis successfully achieved both educational and clinical improvement outcomes.