title: Aligning institutional priorities: engaging house staff in a quality improvement and safety initiative to fulfill Clinical Learning Environment Review objectives and electronic medical record Meaningful Use requirements.
abstract: BACKGROUND
  House staff quality improvement projects are often not aligned with training institution priorities. House staff are the primary users of inpatient problem lists in academic medical centers, and list maintenance has significant patient safety and financial implications. Improvement of the problem list is an important objective for hospitals with electronic health records under the Meaningful Use program.
  
  
  METHODS
  House staff surveys were used to create an electronic problem list manager (PLM) tool enabling efficient problem list updating. Number of new problems added and house staff perceptions of the problem list were compared before and after PLM intervention.
  
  
  RESULTS
  The PLM was used by 654 house staff after release. Surveys demonstrated increased problem list updating (P = .002; response rate 47%). Mean new problems added per day increased from 64 pre-PLM to 125 post-PLM (P < .001).
  
  
  CONCLUSIONS
  This innovative project serves as a model for successful engagement of house staff in institutional quality and safety initiatives with tangible institutional benefits.
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA. Electronic address: mrf22@uw.edu.
authors.forename: Meghan R
authors.initials: MR
authors.lastname: Flanagan
authors.affiliation: Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Foster
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA; Hospital Quality and Patient Safety, Harborview Medical Center, Seattle, WA, USA.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Schleyer
authors.affiliation: Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Gene N
authors.initials: GN
authors.lastname: Peterson
authors.affiliation: Department of Surgery, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Mandell
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: Kristina E
authors.initials: KE
authors.lastname: Rudd
authors.affiliation: Graduate Medical Education, University of Washington, Seattle, WA, USA; Department of Urology, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: Byron D
authors.initials: BD
authors.lastname: Joyner
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington Medical Center, Seattle, WA, USA; Department of Biomedical Informatics and Medical Education, University of Washington Medical Center, Seattle, WA, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Payne
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D062527:Meaningful Use; D009937:Organizational Objectives; D012449:Safety
keywords: Clinical Learning Environment Review; Electronic medical record; House staff; Inpatient problem list; Meaningful Use; Quality improvement