Teaching Tools to Enhance Patient Safety in Ambulatory Care Practice

Presenter: S. Muret-Wagstaff, PhD, MPA

Institution: Childrens Hospital Boston

Context: Identified gaps in quality and evolving evidence about patient safety factors in ambulatory care create new opportunities to translate research into practice through resident training.

Objective: Increase pediatric residents' knowledge and skills in reducing errors and improving care in all settings, including ambulatory primary care and the home.

Design, Setting, Participants: Single group study of a quality of care and patient safety curriculum segment for 33 senior pediatric residents in 2002-03.

Intervention: Four groups of 8 to 9 residents participated in a required, 3-month rotation that includes 6 hours of seminars/week, with 20% focused on the Institute of Medicine's 6 aims to make care safe, effective, patient-centered, timely, efficient, and equitable. Interactive approaches include case-based learning; resident interviews of patients, nurses, and physicians; and exercises such as creation of evidence-based messages for families to reduce medication errors. Residents use tools adapted from rapid cycle improvement, Six Sigma, and Baldrige methodologies.

Outcome Measures: Residents' anonymous self-assessments of confidence in their ability to participate in improving quality of care at individual, team, and organizational levels before and after the rotation, using 3-point Likert scales; residents' anonymous assessments of the rotation overall (A, B, C, D, F; 4 to 0 point scale).

Results: Among 33 participants, 29 (88%) completed surveys. Most residents (59%) were "not confident" of their ability to participate in patient safety and quality improvement efforts prior to the rotation, 38% were "somewhat confident," and 3% were "very confident." Results following the rotation improved to 0% "not confident," 90% "somewhat confident," and 10% "very confident." Mean score for quality of the rotation overall was 3.7 (A-).

Conclusion: Using tools from quality methodologies in interactive seminars can rapidly increase residents' confidence in applying skills to improve ambulatory patient safety. Further opportunities remain to advance training, evaluation, and resident performance in this critical area.