The BCRP residents and faculty have established Interest Groups across a wide range of specialties. The purpose of these groups is to introduce residents to subspecialties they are considering after residency and to faculty in those fields, and to help in identifying mentors. Each interest group is headed by one or more residents and one or more faculty members, who recruit members and organize activities. The activities vary but often include dinners or other social affairs that promote discussion. The interest groups include:
- Adolescent Medicine
- Allergy, Immunology & Rheumatology
- Critical Care
- Developmental-Behavioral Pediatrics
- Emergency Medicine
- Gastroenterology & Hepatology
- General Pediatrics
- Genetics and Genomics
- Hospital Medicine
- Infectious Diseases
- Newborn Medicine
- Primary Care
Geographic Ward Team Structure and Family Centered Rounds
Several years ago, the BCRP created multiple geographic (unit-based) ward teams to improve patient care, optimize communication with the nursing staff, and enhance efficiency of team function. Subsequently, we implemented family-centered rounds on our general pediatrics teams at BCH and BMC. The aim of this change was to increase time at the bedside, to empower interns with greater ownership of their patients and direct communication with patients and families on rounds, and to create a more efficient team structure. To facilitate this change in rounds format, we split our traditional four intern teams (with one Senior and an Associate Senior) into two teams, each with its own Senior. The two projects have been a success and have improved nurse-resident communication (Gordon MB. Arch Pediatr Adolesc Med 2011; 165:424-428).
The I-PASS Handoff Curriculum
As part of our aim to improve communication and patient safety (reduction in medical errors), we piloted and implemented a standardized approach to resident handoffs on the inpatient units with the introduction of the I-PASS handoff process. We employ a standard language for our verbal handoffs to focus the discussion at evening sign-out. Using our electronic medical record, we developed an electronic handoff tool that imports medical information automatically and residents update text fields within the electronic handoff tool to provide timely information about:
- Illness severity
- Patient summary
- Action lists
- Situation awareness and contingency planning
- Synthesis by receiver
This curriculum is evidence-based and ensures a shared mental model for the care of patients on the team. The pilot study demonstrated a 40% reduction in medical errors, a decrease of time at the computer (roughly 30 minutes per day), and increased time at the bedside (30 minutes per resident per day). On the basis of these results, we are implementing the I-PASS handoff process across our program. More information about the I-PASS study and the educational curriculum is available at www.ipasshandoffstudy.com, and in several publications: Sectish TC. Pediatrics 2010;126:619-622, Starmer AJ. Pediatrics 2012;129:201-204, and O’Toole JK. J Peds 2013;162: 887-888, and Starmer AJ. JAMA 2013;310:2262-2270 (Featured article in the annual JAMA Medical Education Issue).
As we have always done, we continue to emphasize educational scholarship in our program and study the impacts of curricular change.
Bringing I-PASS to the Bedside: Standardizing Patient Centered Communication to Improve Understanding and Enhance Patient Safety
This initiative aims to reduce medical errors, improve the patient, family, and provider experiences, and promote a shared mental model of the plan of care. Based on pilot data that patients and families had a discordant understanding of the plan of care, Boston Children’s investigators Alisa Khan and Christopher Landrigan developed an Intervention Bundle and launched a multisite project across North America. They found impressive results, with a 38% reduction in adverse events following implementation of the Intervention Bundle!
We have implemented the new approach to care at Boston Children’s Hospital and Boston Medical Center on the general inpatient units The Intervention Bundle consists of:
- Engaging and empowering patients and families with an orientation to Patient and Family Centered Rounds on admission (with a brochure)
- A new format of discussion on rounds based on the organizing framework of the mnemonic, I-PASS, plus a written Rounds Report that summarizes what we discussed
- Standardized communication techniques throughout the day and night shifts with an inter-professional Huddle at mid-shift
We have been training faculty at both sites this Spring and will do training at Rising Junior Orientation, Rising Senior Orientation and New Intern Orientation. Patients, families and nurses have responded positively to this enhanced rounds structure.