Other Program Features
Geographic Ward Team Structure and Family Centered Rounds
Several years ago, the BCRP created multiple geographic (unit-based) ward teams to improve patient care, optimize communication with the nursing staff, and enhance efficiency of team function. Subsequently, we implemented family-centered rounds on our general pediatrics teams at BCH and BMC. The aim of this change was to increase time at the bedside, to empower interns with greater ownership of their patients and direct communication with patients and families on rounds, and to create a more efficient team structure. To facilitate this change in rounds format, we split our traditional four intern teams (with one Senior and an Associate Senior) into two teams, each with its own Senior. The two projects have been a success and have improved nurse-resident communication (Gordon MB. Arch Pediatr Adolesc Med 2011; 165:424-428).
The I-PASS Handoff Curriculum
As part of our aim to improve communication and patient safety (reduction in medical errors), we piloted and implemented a standardized approach to resident handoffs on the inpatient units with the introduction of the I-PASS handoff process. We employ a standard language for our verbal handoffs to focus the discussion at evening sign-out. Using our electronic medical record, we developed an electronic handoff tool that imports medical information automatically and residents update text fields within the electronic handoff tool to provide timely information about:
- Illness severity
- Patient summary
- Action lists
- Situation awareness and contingency planning
- Synthesis by receiver
This curriculum is evidence-based and ensures a shared mental model for the care of patients on the team. The pilot study demonstrated a 40% reduction in medical errors, a decrease of time at the computer (roughly 30 minutes per day), and increased time at the bedside (30 minutes per resident per day). On the basis of these results, we are implementing the I-PASS handoff process across our program. More information about the I-PASS study and the educational curriculum is available at www.ipasshandoffstudy.com, and in several publications: Sectish TC. Pediatrics 2010;126:619-622, Starmer AJ. Pediatrics 2012;129:201-204, and O’Toole JK. J Peds 2013;162: 887-888, and Starmer AJ. JAMA 2013;310:2262-2270 (Featured article in the annual JAMA Medical Education Issue).
We continue to emphasize educational scholarship in our program and study the impacts of curricular change.