O1003: How Are We Doing? A Quality Improvement Project Enhancing Caregiver Feedback for Trainees

Purpose/Objectives: The Accreditation Council for Graduate Medical Education (ACGME) requires that medical trainees, including residents and fellows, must receive direct, formative feedback from patients and caregivers as part of their education. This feedback is vital in helping trainees improve the patient-centered care they deliver. Studies have shown patient satisfaction impacts clinical outcomes. Patients who report higher satisfaction have improved adherence, lower mortality rates, and are more likely to return to care. Historically, less than 2% of patients and caregivers seen in Pediatric Cardiology Fellows’ clinic at TCH have completed a survey about their visit. As part of a fellow quality improvement initiative, we set out to improve the rate of feedback. Our aim was to increase the fellows’ clinic survey completion rate to above 15% over a 3-year period.

Design/Methods: We defined the survey completion rate as the total number of surveys completed divided by the total number of patients seen in clinic. Baseline data was collected from June-October 2019. Process mapping and fishbone diagrams were utilized to guide improvement efforts. From October 2019 to February 2022, 7 plan-do-study act (PDSA) cycles were initiated, each seeking to raise and sustain the rate of survey completion. Our interventions included posting flyers with quick response (QR) codes for the survey, survey modification, posting of color flyers, distribution of QR codes to each family, weekly reminders, creation of individualized survey QR codes printed on business cards, and distribution of paper surveys. Over the study period, only effective changes from prior PDSA cycles were maintained and others were abandoned. Balancing measures included subjective increase in time to room patients reported by the ancillary staff.

Results: The baseline survey completion rate was 1.8%. After the first 3 PDSA cycles, the survey completion rate went up to 2.4% (20 surveys/830 clinic visits). This rate increased to 7.3% (77/1056) after creation of flyers to pass out to each family and addition of weekly reminders (PDSA cycles 4 and 5). After transitioning to individual survey QR codes on business cards (PDSA cycle 6), the survey completion rate increase to 10% (36 /358). None of these rates were satisfactorily sustained. We transitioned to paper surveys in October 2021. With this final PDSA cycle, we saw a remarkable increase in completion rates with 54% surveys completed (212/389), exceeding our minimum completion goal. Ancillary staff reported no increase in time to room in patients with implementation of the final PSDA cycle.

Conclusion/Discussion: At baseline, patient/caregiver feedback for trainees was limited. After multiple PDSA cycles, we learned that returning to the basics and providing families with paper surveys to complete during the office visits dramatically improved the completion rates. While early data are promising, future studies will measure the sustainability of these interventions.