Improving resident experience during the pediatric intensive care unit rotation

Abstract

BackgroundIt was recognized through rotation evaluations that residents were dissatisfied with their Pediatric Intensive Care Unit (PICU) experience. It is essential to consistently review resident satisfaction and intervene in a timely manner, as resident dissatisfaction may impact well-being. ObjectiveThrough PICU rotation evaluations and confidential discussion with pediatric residents, key drivers of resident dissatisfaction were identified. A multidisciplinary PICU improvement team was formed, interventions were developed, and a key driver diagram was created. Our aim was to have a minimum of 50% of participating residents agree that implemented interventions were beneficial to their PICU experience upon completion of their PICU rotation. Design/MethodsThe key driver diagram focused on 5 areas: expectation of knowledge, structure of rounds, resolution of conflicts, patient load, and nursing experience. Interventions began in April 2020. The improvement team consistently discussed the status of implementation, as well as met formally on a quarterly basis. Resident satisfaction was evaluated and monitored with three tools: intensivist and PICU rotation evaluations during the study period, pre- and post-mock code surveys during the study period, and a post-intervention satisfaction survey following the study period. ResultsThe post-intervention satisfaction survey revealed that ten of the eleven interventions were reported as either occurring regularly or overall beneficial by 55% to 100% of residents, with an average of 80%. 100% of residents reported the following interventions to be beneficial: being exposed to PICU before their formal rotation, participating in bedside teaching, and completing online modules of core PICU topics. Only 27% of residents agreed that the transport nurse routinely took transport calls during rounds, making this the only intervention that did not regularly occur. Pre- and post-mock code surveys revealed that 67% of residents participated in a mock code and 100% of participating residents agreed that the code was beneficial. Resident evaluations of the PICU rotation revealed that overall resident satisfaction with the rotation improved from 78% to 88%. Resident evaluations of attending intensivists revealed that 75% of intensivists had either sustained or improved resident satisfaction. ConclusionThis study demonstrates that timely and successful creation of an improvement team in response to resident dissatisfaction can be beneficial to residents’ rotation experience and well-being.