A Quality Improvement Project to Improve Family Recognition of Medical Team Member Roles.

OBJECTIVE: Previous studies have shown that inpatients and families in academic settings have a limited ability to recall either their medical team members or the roles of those members. This is an important issue for patient and family satisfaction as well as patient safety. The objective of this study was to increase families' recognition of medical team members' roles. METHODS: We established a multidisciplinary quality improvement leadership team, measured family recognition of medical team members and their roles, and conducted 2 PDSA (Plan-Do-Study-Act) cycles. The first intervention was standardization of the content and delivery of our verbal team introductions to ensure inclusion of essential elements and family engagement. The second intervention was addition of an informational white board in each patient room. The prospective study included 105 families in the preintervention phase, 103 post-PDSA cycle 1, and 92 post-PDSA cycle 2. RESULTS: After conduction of 2 PDSA cycles, the recognition of the attending role increased from 49% to 87% (P = .000), the resident role from 39% to 73% (P = .000), and the medical student from 75% to 89% (P = .038). CONCLUSIONS: The multidisciplinary quality improvement model was effective in improving family recognition of the roles of attending physicians, resident physicians, and medical students. Consistent attention to engaging the families and explaining our roles as well as providing informational white boards are effective interventions to facilitate this process.

After-hours pediatric care compared with emergency department care: a retrospective charge analysis.

OBJECTIVE: To compare financial charges between children treated and released from an emergency department (ED) with those evaluated in an after-hours (AH) pediatric clinic. METHODS: Medical records were retrospectively reviewed for 200 children <15 years of age treated in a hospital-based ED and compared with 200 children seen in an AH pediatric clinic. Our main outcome was median overall patient charges by clinic setting. We additionally examined charges by the 6 most common disease diagnoses. RESULTS: Median charges for children treated and released from the ED were $457 [interquartile range (IQR) $320-$628] compared with $140 (IQR $140-$140) for those treated in the AH clinic (P < .01). In addition, median charges were higher for the ED group in the 6 most common disease classes shared between the 2 study groups, both overall and for individual disease class comparison between study groups (all P < .01). We examined the association between charges and clinic setting in multiple quantile regression model while simultaneously adjusting for age, gender, insurance status, and diagnosis. Median costs were $305 (95% CI = $261 to $348; P < .01) more for the ED compared with the AH group. CONCLUSION: We found that financial charges for pediatric health care delivered in an AH clinic were less than those in an ED. We found significantly higher charges for the ED when like diagnoses were compared. Patients should be encouraged to attend AH clinics for urgent care needs when appropriate, which could result in significant cost savings to the health care system.