Put Residents at the Center of Patient Safety With Housestaff Quality Councils

Julie McCoy , May 28, 2010

If trainees participate in the policymaking process and support it, they're also more likely to enforce it with their peers, Evans says.

Get the word out. "The hospital was having a hard time communicating patient safety and quality information to residents. They didn't have an outlet, and they weren't sure about the best way residents learn, so the HQC is also charged with communication," Evans explains.

Resident representatives to the HQC take information back to their programs.

"Every department communicates differently," Evans says. "I know how residents in my program like to have information delivered and what they will respond to, so we encourage residents to take the information back in the manner that will be best received."

For major, broad-sweeping patient safety programs, the HQC raises awareness for all healthcare providers with banners, e-mails, posters, dissemination of data, and an HQC newsletter, Fleischut says.

HQC structure and function
The HQC addresses patient safety and quality on two levels. First, the HQC adopts one or two large-scale initiatives each year that affects patient care throughout much of the hospital. Second, it is a forum where people working on specific quality improvement projects can come for resident input.

HQC leadership works with hospital administration, quality officers, and residents to identify an area for improvement for larger projects. At New York-Presbyterian, the HQC's large-scale projects have included developing an electronic solution that increased medication reconciliation compliance rates from 46% to 95% in one month. Another campaign to reduce Clostridium difficile rates led to a 50% reduction in most of the major units, Evans says.

Smaller quality projects are presented and discussed during the HQC's monthly meetings. For example, a vascular surgeon developing a new order set for pulmonary embolisms came to the HQC, presented the tool, and requested the residents' opinion on whether the tool was too complex, how he should advertise it, and whether it could be improved.

The HQC's input has been so valuable that there is a six-month wait to present at the meeting. "It's such a hot commodity within the institution," Kerr says.

The HQC concept is a model that can be easily replicated in other institutions. Kerr, Evans, and Fleischut are already working with other teaching hospitals around the country to implement HQCs in their institutions.

Julie McCoy is an associate editor with HCPro, Inc.'s Residency Department. For more residency news, please visit www.residencymanager.com.

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