Beneficial "halo effects" of surgical resident performance feedback.
Venous thromboembolism (VTE) prevention is one of the most frequent measures of quality in hospital settings. In 2013, we began providing individualized feedback to general surgery residents about their VTE prophylaxis prescribing habits for general surgical patients. The purpose of this study was to investigate the indirect, or "halo effects" of providing individualized performance feedback to residents regarding prescription of appropriate VTE prophylaxis.



This retrospective cohort study compared appropriate VTE prophylaxis prescription for all patients admitted to the adult trauma service from July 1, 2012 to May 31, 2015 at The Johns Hopkins Hospital, an academic hospital and Level 1 trauma center in Baltimore, Maryland. On October 1, 2013, we began providing monthly performance feedback to general surgery residents regarding their VTE prophylaxis prescribing habits for general surgery patients. Data were not provided about their prescription practice for trauma patients, or to any other prescribers within the hospital.



During the study period, 931 adult trauma patients were admitted to the adult trauma service. After providing individualized feedback about general surgery patients, general surgery residents' prescribing practice for writing appropriate VTE prophylaxis orders for adult trauma patients significantly improved (93.9% versus 78.1%, P < 0.001). Prescription practice significantly improved among all other prescribers although they did not receive any specific individualized feedback, (84.9% versus 75.1%, P = 0.025); however, practice was significantly better among general surgery residents versus other providers (93.9% versus 84.9%, P = 0.003).



There is a beneficial "halo effect" for patients treated by residents receiving individualized feedback about practice habits. Individualized feedback regarding practice habits for one patient type has both a direct and indirect effect on the quality of care patients receive and should be implemented for all providers.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Electronic address: blau2@jhmi.edu.
Brandyn D
BD
Lau
The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Michael B
MB
Streiff
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Deborah B
DB
Hobson
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
Peggy S
PS
Kraus
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Dauryne L
DL
Shaffer
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Victor O
VO
Popoola
Department of Surgery, Duke University, Durham, North Carolina.
Norma E
NE
Farrow
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
David T
DT
Efron
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Elliott R
ER
Haut
D000328:Adult; D015987:Effect Modifier, Epidemiologic; D004650:Employee Performance Appraisal; D030141:Feedback, Psychological; D005260:Female; D013502:General Surgery / Q000592:standards; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*; D055815:Young Adult
Clinical decision support; Halo effect; Resident feedback; Venous thromboembolism