Improving Pediatric Resident Safety Event Reporting Using Quality Improvement Methods

Abstract

Background and objectives: Safety event reporting systems facilitate identification of system-level targets to improve patient safety. Resident physicians report few safety events despite their role as frontline providers and the frequent occurrence of events. The objective of this study is to increase the number of pediatric resident safety event submissions from <1 to 4 submissions per 14-day period within 12 months.

Methods: We conducted an iterative quality improvement process with 39 pediatric residents at a children's hospital. Interventions focused on 4 key drivers: user-friendly event submission process, resident buy-in, nonpunitive safety culture, and data transparency. The primary outcome measure of number of pediatric resident event submissions was analyzed by using statistical process control. Balancing measures included time from submission to feedback, duplicate submissions, and nonevent submissions. As a control, the primary outcome measure was monitored for nonpediatric residents during the same period.

Results: The mean number of pediatric resident event submissions increased from 0.9 to 5.7 submissions per 14 days. Impactful interventions included a designated space in the resident workroom to list safety events to submit, monthly project updates, and an interresident competition. There were no duplicate submissions or nonevent submissions in the postintervention period. Time to feedback in the postintervention period had both upward and downward shifts, with >8 consecutive points above and below the baseline period's centerline. The control group showed no sustained change in event submissions.

Conclusions: Our improvement process was associated with significant increase in pediatric resident safety event submissions without an increase in the number of submissions categorized as duplicates or nonevents.

FIGURE 1

Key driver diagram summarizing the project aim and interventions implemented.

FIGURE 2

C‐chart revealing pediatric resident safety event submissions per 14 days. UCL, upper control limit.

FIGURE 3

C‐chart revealing nonpediatric resident safety event submissions per 14 days. LCL, lower control limit; UCL, upper control limit

FIGURE 4

I‐chart revealing safety report feedback turnaround time for pediatric resident event submissions. A total 141 samples are included in the study period; days to feedback data were missing for 7 of the 148 pediatric residents event submissions during the study period. UCL, upper control limit.