Residency

Audits, self-assessments lead to quality improvement

Residency Program Insider, July 20, 2010

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Linking quality improvement and patient safety to medical education is a growing focus of regulatory and accrediting bodies. Internal medicine programs at implemented an audit system to determine why patients were unexpectedly admitted to the ICU.

A multidisciplinary team reviewed 194 charts of patients transferred from the medical ward to the ICU. Physicians, residents, and nursing staff members involved in those cases were given self-assessments regarding the cases, and the cases were discussed during monthly M&M conferences.

As a result, the hospitals initiated new policies regarding vital signs and house staff escalation of care. Other changes after the audit included:

  • The percentage of calls for patients who met medical emergency response team/critical care consult criteria increased from 53% to 73%
  • Nurse notification of a change in a patient's condition increased from 65% to 100%
  • Nursing documentation of the change in the patients condition and follow-up actions increased from 65% percent to a high of 90%
  • The number of cardiac arrests on a GMF decreased from 3.1 cardiac arrests per 1,000 patient discharges to 0.6/1,000 discharges
  • Deaths on the medicine service decreased from 34 deaths per 1,000 patient discharges to 24/1,000 discharges.


For more information, please see the June issue of the Journal of General Internal Medicine.
 



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