Comparing Peer and Staff Evaluations of Pediatric Residents Using the Acgme Milestones

Abstract

BACKGROUND: The IOM’s report To Err Is Human identified that in the United States medical errors are a significant cause of deaths annually. The ACGME’s CLER program states that residents should participate in patient safety education and experiential learning. From 2011-14, our institution, required interns to present a self identified patient safety event at a monthly conference entitled the Systems Improvement Conference(SIC). This retrospective study aimed to classify the types and severity of events interns most often self identified as part of a required systems based practice experience. METHODS: In May 2014, we performed a retrospective analysis of resident cases presented from 2011-2014 by interns during the SIC. We reviewed each presentation for the following: 1.) Type of safety event presented, 2.)Classification and severity of safety events brought forward by residents, 3.)Proximate causes developed, 4.) Action items developed and implemented. This was an IRB approved study. RESULTS: Our retrospective data revealed that 27 different patient safety events were brought forward by pediatric residents. The majority of these events were delay in patient care (12/27), followed by adverse drug events (7/27), failed communication, and readmission. 10 of the events were classified as potential safety events, 8 were classified as serious safety events, 4 were classified as near miss events, and 5 were unclassified. Of the 12 documented action items, 3 have been implemented including central line protocol and diabetes care pathway and order set. Other action items were difficult to implement or unsustainable. Resident feedback included frustration with implementation, lack of interprofessional buy-in, and repeated errors presented. CONCLUSIONS: Pediatric residents are able to identify and investigate patient safety events. Our residents recognized the value of investigating near miss and serious safety events. However, completion of action items and implementation that affect patient outcomes was difficult due to lack of interprofessional teams.