P0119 - A resident-led quality improvement initiative to increase nursing presence on inpatient rounds

Background: Nursing presence on bedside rounds improves patient safety, enhances team communication, and increases family satisfaction. Competing clinical priorities, however, often prevent interdisciplinary rounds from occurring. Recognized as an issue on our pediatric inpatient unit, our residents designed and executed a quality improvement (QI) initiative to address this utilizing a novel experiential QI curriculum.

Aim: To increase nursing presence during the medical decision-making component of rounds for pediatric hospitalist patients from baseline (34%) to 80% attendance over 6 months.

Methodology: In response to increasing emphasis on experiential QI education for residents by the ACGME we developed an immersive longitudinal QI curriculum based on our inpatient unit. Residents selected nursing presence on rounds as the critical issue to target during this cycle of the QI curriculum. The Institute for Healthcare Improvement’s model for improvement was used to develop and implement 4 plan-do-study-act (PDSA) cycles (Table 1). Each PDSA cycle was stewarded by a senior resident, with participation from nurses, nursing leadership, residents, and hospitalists. Nursing attendance on pediatric hospital medicine rounds was measured and qualitative interviews were conducted to analyze nursing perceptions and guide subsequent interventions. Residents met monthly to discuss progress, hand off project leadership, and co-teach core QI concepts using a curriculum developed by the hospitalist team. PDSA cycle timing and teaching content were adapted to maximize learning within each cycle.

Discussion: Pre-intervention data was collected for 1 month to establish a baseline after which PDSA cycles were begun and outcomes were assessed for the subsequent 6 months. Nursing attendance improved from a baseline of 34% to 87% after the interventions (Figure 1). Qualitative data obtained after PDSA cycle 2 prompted a focus on scheduling rounds by nurse (PDSA 3). Feedback obtained following cycle 3 led to incorporation of nursing input early in rounds (PDSA 4).

Conclusion: Improvement in nursing presence on rounds was seen throughout the PDSA cycles in this resident-led QI initiative. Creating a nursing-centered rounding schedule and eliciting nursing input at the start of rounds were identified as key interventions to improving attendance. Interprofessional dialogue, immediate clinical relevance, and measurable improvement made this an immersive QI learning experience for residents. This project demonstrates feasibility of resident-led QI endeavors within an effective educational model that addresses core residency program requirements for education in quality and safety.