In Reply to Sedgh

Abstract

We are pleased to learn more about Dr. Sedgh and colleagues’ experiences with a resident and fellow quality improvement (QI) incentive program at Bronx–Lebanon Hospital Center and Maimonides Medical Center. They join a group of teaching hospitals, including Yale–New Haven Hospital, Children’s Hospital of Colorado, Duke University Medical Center, Palmetto Health, St. Joseph’s Hospital and Medical Center, and San Francisco General Hospital, that have also implemented programs similar to our University of California, San Francisco Resident and Fellow Quality Improvement Incentive Program.1 It is increasingly clear that this model can be used effectively in a wide variety of clinical settings, including university, children’s, community, and public teaching hospitals. Our experience with this approach continues to demonstrate important improvements in patient experience, quality of care, and health care value while building resident and fellow competence and improving the clinical learning environment. Since our published report, we have continued to work on ambitious goals. Our patient satisfaction measures are at their highest level. We have increased and sustained our observed institution-wide hand hygiene compliance to over 90%. This year, we increased the percentage of patients who were discharged before noon, improving patient throughput. Our work to reduce laboratory test volume has resulted in over $2 million in savings in three years.2 We have also expanded our work on program-specific QI goals, now including several fellowship programs. In these projects, each residency or fellowship program develops and implements an improvement goal specific to that program’s needs and aligned with health system priorities. Over the last two years, over two-thirds of our programs have achieved their goals. These resident- and fellow-led projects have improved preventive services, clinical practice, medication monitoring, patient education, clinical documentation, transitions of care, communication between clinical services, and patient education. Projects have included improvements in both inpatient and outpatient settings. We believe that programs similar to ours and others, such as those described by Dr. Sedgh, which engage learners in institutionally aligned QI efforts, can improve patient care outcomes, health care value, and the clinical learning environment. Robert B. Baron, MD, MS Professor of medicine and associate dean for graduate and continuing medical education, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California; [email protected] Glenn Rosenbluth, MD Associate professor of pediatrics, Division of Hospital Medicine, Department of Pediatrics, and director of quality and safety programs, Office of Graduate Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California. Adrienne L. Green, MD Professor of medicine, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, and associate chief medical officer, UCSF Medical Center, San Francisco, California. Arpana R. Vidyarthi, MD Consultant, Division of Internal Medicine, Singapore General Hospital, and associate professor of education and Health Systems and Services Research, Duke-NUS Graduate Medical School, Singapore.