title: Residents contributing to inpatient quality: blending learning and improvement.
abstract: BACKGROUND
  Quality improvement (QI) initiatives reduce medical errors and are an important aspect of resident physician training. Many institutions have limited funding and few QI experts, making it essential to develop effective programs that require only modest resources. We describe a resident-led, hospitalist-facilitated limited root cause analysis (RCA) QI program developed to meet training needs and institutional constraints.
  
  
  METHODS
  We initiated a monthly quality improvement conference (QIC) at the Mount Sinai Hospital in New York City, New York. Before each conference, a third-year resident investigated a patient care issue and completed a limited RCA. At the QIC, the findings were presented to the Internal Medicine residents, followed by a chief resident and hospitalist-facilitated group discussion. All proposed interventions were recorded, and selected interventions were later implemented. The success of these interventions in achieving permanent system-wide change or resident behavior change was tracked. Residents' views on the conferences were solicited via an anonymous questionnaire.
  
  
  RESULTS
  Twenty conferences were held over the first 22 months of the program. Twenty-five (54%) of the 46 suggested interventions were initiated. Eighteen (72%) attempted interventions resulted in system-wide change or resident behavior change. Fifty-three residents evaluated the quality of the conferences. The majority believed the conferences were high quality (98%) and led to patient care improvements (96%).
  
  
  CONCLUSIONS
  Resident-led modified RCAs are an effective method of integrating QI efforts into resident training. As front line providers, residents are uniquely positioned to identify and implement system changes that benefit patients. Conferences were implemented without overburdening facilitators or participants.
authors.affiliation: Division of General Internal Medicine, The Samuel Bronfman Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA. kristofer.smith@mountsinai.org
authors.forename: Kristofer L
authors.initials: KL
authors.lastname: Smith
authors.forename: Sarah
authors.initials: S
authors.lastname: Ashburn
authors.forename: Erin
authors.initials: E
authors.lastname: Rule
authors.forename: Ramiro
authors.initials: R
authors.lastname: Jervis
mesh_terms: D006801:Humans; D007297:Inpatients; D007396:Internship and Residency / Q000592:standards*; D007858:Learning; D058996:Quality Improvement / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D060891:Root Cause Analysis / Q000592:standards*