PC1230: Assessing Improvement in Resident Knowledge After Introducing an Institutional Failure to Thrive Protocol

Purpose/Objectives: Introduce residents to a failure to thrive (FTT) protocol with the goal to increase resident knowledge in managing FTT in the inpatient setting.

Design/Methods: We implemented a QI project at the Studer Family Children’s Hospital at Ascension Sacred Heart, in Pensacola, FL and completed one PDSA cycle. A FTT protocol and order set were created by a team of residents, hospitalists, nutritionist, nurses, and IT staff. In January 2022, a questionnaire was given at the beginning of a didactic presentation to assess residents’ baseline knowledge of FTT. Residents then received a presentation on FTT and an introduction to the protocol and order set. The protocol was placed in the resident dictation room for reference. Three weeks later, the same questionnaire was given to the residents. Fifteen of 29 residents participated in the first conference and completed the baseline questionnaire, and 13 of 29 residents completed the follow up questionnaire.

Results: The mean percentage of pediatric residents’ correct answers increased from 63.1% to 70.4% (Fig 1A). Eighty percent of the residents that attended the first session also attended the second one. Number of correct answers for 7 out of 13 questions increased, especially question 1 regarding definition of FTT,

increasing from 40% to 100% correct (Figure 1B). Ten out of 13 residents (77%) felt that the presentation was beneficial. Question 3 on the most common cause of FTT was not answered correctly by any resident at baseline, with 7% improvement on the subsequent questionnaire. A limitation to this project was ensuring full resident participation in presentations due to varying schedules.

Conclusion/Discussion: Failure to thrive is seen in 5-10% of children in the United States in primary care settings1, and accounts for 1.4%-5% of pediatric hospital admissions2. Despite an abundance of literature on FTT, there was a lack of confidence among our residents when managing FTT inpatient. We carried out this project to enhance the knowledge of our residents and standardize the management of FTT in the inpatient setting. Our project is still ongoing. We hope that in the future, increased utilization of our protocol and order set along with reinforcement didactic sessions will help residents to feel more knowledgeable and confident managing FTT. Our long-term goal is to reduce the number of unnecessary investigations ordered and decrease the duration of hospitalization for patients with FTT.