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Resident Rotation & Rounding on the RICU

Resident Rotation & Rounding on the RICU. Dr. James Klinger, MD Medical Director, RICU Donalynn Roberts, RN, BSN, NE-BC Clinical Manager, RICU. Root Cause Analysis for a Patient Who Nearly Received the Wrong Procedure.

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Resident Rotation & Rounding on the RICU

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  1. Resident Rotation & Rounding on the RICU Dr. James Klinger, MD Medical Director, RICU Donalynn Roberts, RN, BSN, NE-BC Clinical Manager, RICU

  2. Root Cause Analysis for a Patient Who Nearly Received the Wrong Procedure • A patient on RICU was sent to VIR for an embolization procedure when they should have gone to the OR for a surgical procedure • A Root Cause Analysis was conducted by MDs from ENT, VIR and RICU

  3. The question asked was….. Was the number of handoffs between residents a source of the error?

  4. Monthly Resident Rotation Was Reviewed by Medical Director How was the present schedule constructed to rotate residents? How can we improve the rotation to enhance quality patient outcomes?

  5. The following modifications to the Monthly Resident Rotation were suggested: • Eliminate every 4th day off • Use a night float resident to keep within weekly duty hour limitation • Have daytime resident care for same group of patients for up to 7 days in a row

  6. Sun Mon Tues Wed Thurs Friday Sat Weekly Hours On Call 7a-12m Post Call 12m-1p Short Call 7a-7p CLINIC 1p-6p On Call 7a-12m Post Call 12m-1p Short Call 7a-7p 89 OFF On Call 7a-12m Post Call 12m-1p Short Call 7a-7p OFF On Call 7a-12m Post Call 12m-1p 72 Short Call 7a-7p OFF On Call 7a-12m Post Call 12m-1p Short Call 7a-7p CLINIC 1p-6p On Call 7a-12m 75 Post Call 12m-1p Short Call 7a-7p OFF On Call 7a-12m Post Call 12m-1p Short Call 7a-7p OFF 64 OLD SCHEDULE Resident – 300 hours/month, averaged over 4 weeks = 75 hours/week

  7. M T W R F S S M T W R F S S AM A A A B B B B B C C C C C D AM B B C C C C C D D D D D A A PM D D D D A A A A A B B B B B NEW SCHEDULE FOUR RESIDENTS: A,B,C,D Shifts per 28 days 22 days X 10-14 hours/day = 220-308 hours/4 weeks = 55-77 hours/wk

  8. Implementation • New schedule trialed in May 2009 • End of month feedback solicited from • RN staff • House officers • Respiratory therapist

  9. RN Staff Stated Pros: • “LOVED IT” • “Improved Continuity of Care” • “Better relationship with residents” • “Decreased family and patient complaints about inability to meet with MD” • “Decreased concerns of patient and familyabout who is my doctor?” • Cons: • None to report

  10. Resident Feedback Pros: • “Greater continuity of care” • “improved relationships with nursing & respiratory therapy because of consistent shifts (especially nights)” • “Elimination of 30 hour call” • “Better scheduling – consecutive days off” • “More flexible schedule – trade shifts” • Cons: • “long days” • “long time between days off” • “Some patients have 3 hand offs in 24 hours”

  11. Press Ganey ResultsComparing 1st – 3rd quarter results of Patient Satisfaction

  12. Next Steps Taken: • Meeting held with Chief resident & Director of Resident Education • Discussed Pros and Cons of trial month • Revisions made • decrease number of consecutive days on • decrease hours of one daytime resident • change attending schedule from 1 to 2 weeks • Plan for similar rotation to start in November 2009

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