Four Hurley staff members submitted an abstract about Hurley’s weekly Patient Safety Team activities (which include resident physicians) for the annual national conference of the Accreditation Council for Graduate Medical Education (ACGME). The project was accepted as a poster presentation during the March 1-4, 2012, ACGME Conference in Florida. Then it became one of 10 invited as an oral presentation, too. The presentation was entitled, Patient Safety Innovation – Tracer/ Sweep Methodology Incorporates Residents into Weekly Hospital Patient Safety Teams for Systems-Based, Practical Perspective: A Pilot.

Authors included: Laura Carravallah MD of Davison (director of the Hurley Combined Internal Medicine/ Pediatrics Residency Training Program), James Buterakos MSA of Fenton (director of Hurley Graduate Medical Education and Hurley academic officer), Colette Stearns MSA of Lapeer (former director of Hurley Clinical Effectiveness) and Julie Campe BA of Groveland Township (Hurley Graduate Medical Education Specialist).

Patient safety is an essential part of resident physician training, yet at times it can be challenging to convey the importance of rules, regulations and procedures that result in improved patient safety. To reinforce the importance of patient safety - and to give a sense of what it's like to ensure that the highest patient safety standards are met in such a large institution as Hurley Medical Center - Hurley includes resident physicians in its weekly Patient Safety Team activities – the first educational activity of its kind reported in medical literature.

4 Patient Safety Teams: The institution has 4 different interprofessional teams that each perform one structured patient safety activity per month (so a total of 4 activities per month). They use the same methods (see Table 1) as The Joint Commission, which helps the hospital maintain a constant state of "survey readiness." [The Joint Commission is a national, nonprofit organization responsible for setting national patient safety standards [see Table 2) and for accrediting the quality of health care institutions such as Hurley Medical Center. The Joint Commission conducts periodic site visit surveys to assess quality.]

4 focused question sets/ checklists: Each week, the Hurley Patient Safety Team chooses 1-4 hospital units to "sweep" or "round" with 1 of 4 checklists/ question sets - or they select one patient to "trace" his or her path through the institution to ensure that all patient safety processes were followed. Residents and the rest of the team members complete their patient safety activity and report findings. Managers of the units return a written report with their corrective actions and staff education (if needed) in order to keep patient safety standards at their highest levels possible.

Resident Portfolio Report: Residents, on the other hand, complete their own special portfolio reports, which include some of the details from the institution's official report, plus reflective writing about how the activity affected them and how it may affect their future practice.

Pilot, 41 positive experiences: In the initial pilot of 41 residents who completed at least one weekly Patient Safety Team activity, 100 percent reported a positive experience, and most recommended more frequent "turns" on the team. They also said it should occur earlier in their training if possible. Other themes included: Importance of patient satisfaction, systems awareness, nonjudgmental approach to improvement, nursing roles, effective communication, hand-washing, documentation, establishment of good habits through practice, and enfranchisement.

Comments: The following are excerpts from Resident Portfolio Reports:

• “Initially, when I got the email to round with the Tracer Team, I was not very impressed and thought, ‘(more) paperwork.’ After rounding with the team, I realized that this is something that (could) have been done very early in my training. … By rounding with infection control personnel and observing things with their vision, I realized that certain things which we may consider small are very important and play a very serious role in our patient care and patient relationships.”
• “We should take it easy with nurses when they call for (certain) medication for patients. … Now I know it’s part of their protocols, and we need to answer their calls with knowledge at the background.”
• “I learned good communication skills – asking questions (to) colleagues in a nonjudgmental way and providing immediate feedback without sounding punitive.”

Educational competencies: The activity covers the core competencies measured by the main accrediting body for residency training programs in the United States (ACGME), which holds an annual national conference so that educators and administrators of graduate medical education can share research findings and best practices.