PMID- 30552003 OWN - NLM STAT- MEDLINE DCOM- 20200819 LR - 20200819 IS - 1878-7452 (Electronic) IS - 1878-7452 (Linking) VI - 76 IP - 3 DP - 2019 May-Jun TI - Focused Resident Education and Engagement in Quality Improvement Enhances Documentation, Shortens Hospital Length of Stay, and Creates a Culture of Continuous Improvement. PG - 771-778 LID - S1931-7204(18)30190-9 [pii] LID - 10.1016/j.jsurg.2018.09.016 [doi] AB - PURPOSE: System-based practice with an emphasis on quality improvement (QI) is a recent initiative for the American College of Surgeons and a core-competency for surgical trainees. Few surgical training programs have a curriculum for hospital-based QI. METHODS: Our vascular surgery service implemented several QI initiatives focused on decreasing length of stay (LOS) by targeting resident education and engagement. Residents were educated on terminology and processes impacting hospital and CMS QI metrics such as Medicare geometric mean LOS (CMS GMLOS) and diagnostic-related groups (DRG) with complication or comorbidity (CC/MCC) coding. LOS initiatives focused on identifying, tracking and removing avoidable perioperative delays, and improving accuracy of clinical documentation. Residents were given specific roles in QI initiatives and the impact on LOS was quantified. Patients' CMS GMLOS were compared to actual LOS during daily rounds, with confirmation that resident progress notes contained thorough and accurate documentation of diagnoses, comorbidities, and complications. Ten minutes during weekly preoperative conferences were dedicated to ongoing QI, with LOS metrics for the inpatient census presented by trainees and reviewed by attendings. Feedback was given addressing barriers to avoidable delays and impact on LOS. Data for July 2016-June 2017 (FY17) was compared to preimplementation baseline data (FY16) for vascular discharges overall. Accurate documentation of acuity was evaluated with in-depth review of notes and overall case mix index. RESULTS: Within the first year of implementation, overall vascular admissions demonstrated a 21% reduction in LOS, closing the gap between observed LOS and expected CMS GMLOS, from 2.1days to 0.5days on average. Documentation improved, with a shift in 24% of DRGs to accurately reflect CC/MCC. Overall case mix index increased by 10%, from 3.07 to 3.37. CONCLUSIONS: A culture of continuous quality improvement can be created with the establishment of a QI infrastructure that educates and involves trainees as stakeholders. Assigning discrete roles to increase resident accountability supports both formal and informal resident education that can substantially impact hospital benchmarking metrics. CI - Copyright (c) 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. FAU - Johnson, Cali E AU - Johnson CE AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. FAU - Peralta, Joyce AU - Peralta J AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. FAU - Lawrence, Lindsey AU - Lawrence L AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. FAU - Issai, Alice AU - Issai A AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. FAU - Weaver, Fred A AU - Weaver FA AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. FAU - Ham, Sung W AU - Ham SW AD - Comprehensive Aortic Center, Cardiovascular Thoracic Institute, Keck Medical Center of University of Southern California, Los Angeles, California. Electronic address: Sung.Ham@med.usc.edu. LA - eng PT - Journal Article DEP - 20181212 PL - United States TA - J Surg Educ JT - Journal of surgical education JID - 101303204 SB - IM MH - Clinical Coding MH - Curriculum MH - Diagnosis-Related Groups MH - Documentation/*standards MH - Education, Medical, Graduate/*methods MH - Humans MH - Internship and Residency MH - Length of Stay/*statistics & numerical data MH - Medicare MH - Mobile Applications MH - *Organizational Culture MH - *Quality Improvement MH - United States MH - Vascular Surgical Procedures/*education OTO - NOTNLM OT - Practice-Based Learning and Improvement OT - Systems-Based Practice OT - Vascular surgery education OT - quality improvement in health care system OT - resident education EDAT- 2018/12/16 06:00 MHDA- 2020/08/20 06:00 CRDT- 2018/12/16 06:00 PHST- 2018/04/02 00:00 [received] PHST- 2018/08/11 00:00 [revised] PHST- 2018/09/27 00:00 [accepted] PHST- 2018/12/16 06:00 [pubmed] PHST- 2020/08/20 06:00 [medline] PHST- 2018/12/16 06:00 [entrez] AID - S1931-7204(18)30190-9 [pii] AID - 10.1016/j.jsurg.2018.09.016 [doi] PST - ppublish SO - J Surg Educ. 2019 May-Jun;76(3):771-778. doi: 10.1016/j.jsurg.2018.09.016. Epub 2018 Dec 12.