title: Improved clinical outcomes combining house staff self-assessment with an audit-based quality improvement program.
abstract: BACKGROUND
  There is a focus on integrating quality improvement with medical education and advancement of the American College of Graduate Medical Education (ACGME) core competencies.
  
  
  OBJECTIVE
  To determine if audits of patients with unexpected admission to the medical intensive care unit using a self-assessment tool and a focused Morbidity and Mortality (M&M) conference improves patient care.
  
  
  METHODS
  Charts from patients transferred from the general medical floor (GMF) to the medical intensive care unit (ICU) were reviewed by a multidisciplinary team. Physician and nursing self-assessment tools and a targeted monthly M&M conference were part of the educational component.
  
  
  METHODS
  Physicians and nurses participated in root cause analysis.
  
  
  METHODS
  Records of all patients transferred from a general medical floor (GMF) to the ICU were audited. One hundred ninety-four cases were reviewed over a 10-month period.
  
  
  RESULTS
  New policies regarding vital signs and house staff escalation of care were initiated. 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 3.1/1,000 discharges to 0.6/1,000 discharges (p = 0.002), and deaths on the Medicine Service decreased from 34/1,000 discharges to 24/1,000 discharges (p = 0.024).
  
  
  CONCLUSIONS
  We describe an audit-based program that involves nurses, house staff, a self-assessment tool and a focused M&M conference. The program resulted in significant policy changes, more rapid assessment of unstable patients and improved hospital outcomes.
authors.affiliation: Saint Vincents Hospital, New York Medical College, Lenox Hill Hospital, New York, NY 10075, USA. lkirschenbaum@Lenoxhill.net
authors.forename: Linda
authors.initials: L
authors.lastname: Kirschenbaum
authors.forename: Susannah
authors.initials: S
authors.lastname: Kurtz
authors.forename: Mark
authors.initials: M
authors.lastname: Astiz
mesh_terms: D054869:Clinical Audit / Q000592:standards* / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000639:trends; D007396:Internship and Residency / Q000592:standards* / Q000639:trends; D011785:Quality Assurance, Health Care / Q000592:standards / Q000639:trends; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D012647:Self-Assessment; D016896:Treatment Outcome