Immersion of House Staff in Case Review: Blending Education with Quality Improvement

1UCSF Medical Center, San Francisco, CA
2UCSF Medical Center, San Francisco, CA
3UCSF Medical Center, San Francisco, CA
4UCSF Medical Center, San Francisco, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 194


The ACGME requires that residents achieve competence in systems‐based practice (SBP) and practice‐based learning and improvement (PBL). Residency programs are challenged to develop, teach, and measure the impact of educational curricula in These arenas. Meanwhile, hospitalist programs are responsible for quality assessment and improvement of their own practice. We describe the immersion of interns into an existing hospital medicine case review process as a means of improving capacity in Biese educational arenas and contributing to improved systems of care.


To teach internal medicine interns SBP and PBL by integrating them into the medical service's case review process and to improve the quality of the case review process through involving frontline clinicians.


Interns rotating through a quality and safety elective reviewed cases of possible adverse events that were referred to the UCSF Division of Hospital Medicine Case Review Committee. This committee is composed of hospitalists representing various roles of the division who review and assess problem cases (generally arising from incident reports and physician referrals) anc plan improvements. Interns systematically assessed each case using information gathered through chart review and interviews with clinicians, under the supervision of a hospitalist QI/educational expert. Interns then presented their findings at a monthly case review committee meeting that generales discussion and improvement activities. In the first year of the elective, 17 cases were reviewed by interns. Eight of 17 cases (47%) resulted in preventable harm to the patient. Care delivery problems identified are described in Table 1. Actions resulting from these cases included: communication with other services to share findings and engage them in problem solving (9). presentation at resident M&M (4). development of working groups to address The problerr (4), house staff educational efforts (6), and collaboration with the medical center for hospitaJwide efforts (5). Interns agreed that the experience taught them how to analyze an adverse event and detect underlying system flaws (mean response 4.33 on a 5‐point Likert scale, from 1 ‐ strongly disagree to 5‐ strongly agree) and helped them to understand the causes of care delivery problems in the hospital (mean 4.11). All interns who performed a case review believed the committee valued their case analysis and suggestions for improvement Committee members perceived that the input of the house staff provided an important perspective that often guided new improvements for problems not previously recognized by faculty.


Intern involvement in an existing case review structure provides an opportunity to blend meaningful education in SBP and PBL wilh quality assessment and improvement. This blending is mutually beneficial to the educational mission for residents and improvement imperative for hospitalists.

Author Disclosure:

D. Sliwka, none; A, Vidyarthi, none; L. Carr, none; S. Ranji, none.

To cite this abstract:

Sliwka D, Vidyarthi A, Carr L, Ranji S. Immersion of House Staff in Case Review: Blending Education with Quality Improvement. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 194. Journal of Hospital Medicine. 2010; 5 (suppl 1). Accessed May 23, 2019.

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