New guidance from the Accreditation Council for Graduate Medical Education aims to upgrade resident and fellow instruction in patient safety and quality improvement.
The guidance is designed to address a shortcoming ACGME officials saw during the course of site visits to more than 100 hospitals.
The problem can be summed up in an example from a site visit: A second-year anesthesiology resident administered the wrong dose of fentanyl, and the procedure had to be temporarily halted after the patient developed severe hypotension. Ultimately, the patient suffered no harm from the mix-up. After reporting the incident in the department’s morbidity and mortality conference and discussing it with the attending physician, the resident was told to review the approach to dosing fentanyl and to "be more careful."
The hospital’s response focuses on the resident’s actions, but misses all of the systems issues that may have contributed to the error, Dr. Thomas J. Nasca, Dr. Kevin B. Weiss, and Dr. James P. Bagian of ACGME, wrote in a perspective published Jan. 27 in the New England Journal of Medicine (doi:10.1056/NEJMp1314628).
"Such an approach does little to expand the resident’s knowledge and reflects poorly on the institutional clinical environment," they wrote.
The ACGME is calling on hospitals to ensure that all residents and faculty members know how to report patient safety events and that they receive periodic, interprofessional, and team training on patient safety. Residents and fellows should also have the chance to participate in either real or simulated interprofessional patient-safety investigations, such as root cause analyses. And hospitals should give feedback after an adverse event so that residents and fellows know what actions the institution is taking to fix any systems issues that may have been involved.
The new guidance also recommends that:
• Residents and fellows engage in periodic quality improvement education that highlights systems-based challenges.
• Hospitals provide residents and fellows with specialty-specific data on quality metrics and benchmarks for the patients they treat.
• Hospitals include residents and fellows in quality improvement committees.
• Residents and fellows receive training cultural competency relevant to the patient population at their hospital.
• Residents and fellows participate in simulated or real-time interprofessional training on better communicating transitions of care.
Site visits were conducted as part of ACGME’s Clinical Learning Environment Review (CLER) program, which assesses teaching institutions in terms of patient safety, quality improvement, transitions of care, supervision, duty hour oversight, and professionalism.
mschneider@frontlinemedcom.com
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