Professional Coaching in Medicine and Health Care.

Professional coaching can support individuals and organizations in four ways: (1) improving provider experience of working in health care, (2) supporting provider role and career development, (3) helping build team effectiveness, and (4) building an organizational coaching culture. There is evidence about effectiveness of coaching in business, and an increasing body of literature, including small randomized, controlled trials, supporting use of coaching in health care. This article summarizes the framework for professional coaching, describes ways professional coaching can support the four processes above, and provides case scenarios that contextualize understanding of how professional coaching can be of benefit.

Improving Documentation of Postdischarge Issue Mitigation during Postdischarge Phone Calls.

Postdischarge phone calls (PDPCs) are recommended to identify and mitigate postdischarge issues such as missed follow-up appointments, medication errors, and failure to activate contingency plans. A current state assessment showed variability in documenting PDPC content and postdischarge issue mitigation. Therefore, the primary aim was to improve the postdischarge issue mitigation documentation rate from 65% to 100% over 16 months. Methods: An interdisciplinary quality improvement team used the Model for Improvement to perform planned sequential interventions over 16 months. The outcome measure was documentation of postdischarge issue mitigation. Process measures included PDPC template use and completion and postdischarge issue identification. Balancing measures included call attempts and caller perceptions of ease of documentation. Interventions included creating a flowsheet note template, creating caller template training sessions, and sharing team data and feedback. We gathered data via reports generated from the electronic medical record, chart review, and survey. Data were analyzed using statistical process control charts and established rules for detecting special cause variation. Results: The postdischarge issue mitigation documentation increased from 65% to 91% over 16 months. Template use and completion increased from 0% to 100% and 98%, respectively. The number of postdischarge issues identified remained unchanged. Call attempts increased from 40% to 59%. Caller perceptions remained unchanged. Conclusions: Documentation of postdischarge issues and issue mitigation promotes adequate communication with the patient's care providers, improving the quality and safety of care. Data sharing to promote team engagement was the key factor in improving documentation of postdischarge issue mitigation.

One Call Away: Addressing a Safety Gap for Urgent Issues Post Discharge.

OBJECTIVES: The transition period from hospitalization to outpatient care can be high risk for pediatric patients. Our aim was to profile the use of a "safety net" for families through provision of specific inpatient provider contact information for urgent issues post discharge. METHODS: In this prospective study, we implemented an updated after-visit summary that directed families to call the hospital operator and specifically ask for the pediatric hospital medicine attending on call if they were unable to reach their primary care provider (PCP) with an urgent postdischarge concern. Education for nursing staff, operators, and pediatric hospital medicine providers was completed, and contact information was automatically populated into the after-visit summary. Information collected included the number of calls, the topic, time spent, whether the family contacted the PCP first, and the time of day. Descriptive statistics and Fisher's exact test were used to summarize findings. RESULTS: Over a 13-month period, of 5145 discharges, there were 47 postdischarge phone calls, which averaged to 3.6 calls per month. The average length of time spent on a call was 21 minutes. For 30% of calls, families had tried contacting their PCPs first, and 55% of calls occurred at night. Topics of calls included requesting advice about symptoms, time line for reevaluation, and assistance with medications. CONCLUSIONS: This safety net provided families with real-time problem-solving for an urgent need post discharge, which included triaging patient symptoms at home, counseling on medication questions, information about the time line of illness recovery, and provision of additional resources.

Intent, Substance, and Care: Characteristics of Adolescent Ingestion Hospitalizations.

OBJECTIVES: To characterize the patient population of adolescents hospitalized at a tertiary center for ingestions and identify opportunities to improve health care delivered and resources offered to these adolescents. METHODS: Retrospective study of a consecutive sample of adolescent patients (12-18 years old) discharged from the hospitalist service at a large academic pediatric tertiary care center from May 2017 through April 2018. Data were collected regarding patient and hospital encounter characteristics including length of stay, admission service, reason for ingestion, substance(s) ingested, previous suicidal ideation (SI) screening, sexual history documentation, pregnancy testing, disposition at discharge and follow-up with primary care physicians (PCPs). RESULTS: Most hospitalizations for ingestions were reported as intentional suicide attempts (79%). Most commonly, adolescents ingested exclusively prescription medications (45%) or over-the-counter medications (32%). Of adolescents with a reported suicide attempt for whom PCP records were available, 56% did not have SI screening documented in the medical record. One-quarter of adolescents hospitalized for an ingestion did not have a sexual history documented, and 11% of female patients were not tested for pregnancy before discharge. A majority (66%) of the adolescents with PCP records available did not follow-up with their PCP within 2 months after their hospitalization. CONCLUSIONS: On the basis of our study results, opportunities to improve adolescent health include increased screening for SI and mental health symptoms throughout medical environments, comprehensive risk assessment of all adolescents hospitalized for an ingestion and increased guidance for caregivers of adolescents regarding prescription and over-the-counter medication storage in the home.

Ramping Up a Pediatric Hospital Medicine Advanced Practice Provider Team Rapidly.

Pediatric Hospital Medicine (PHM) is a growing subspecialty with a broad scope. The Covid-19 pandemic demands flexible staffing models. Advanced practice providers (APPs) can be a valuable addition to hospital medicine teams, although there is no established training program for APPs within PHM. The authors' purpose is to describe how one institution rapidly established a PHM APP team by collaborating with experienced APPs working in other areas of the hospital. This APP team cared for 16% of the average daily census during the pilot period with no significant difference in length of stay compared to traditional teams.

Sustained Impact of a Pediatric Resident-Led Patient Safety Council.

OBJECTIVES: The aim of the study was to evaluate the impact of a resident-led patient safety council. This study measured change in resident perceptions and knowledge of safety issues for 3 years, as well as behavioral choices to participate in patient safety activities during and after residency. METHODS: Pediatric residents formed a resident-led safety council to engage their peers in patient safety activities. Surveys were distributed annually from 2013 to 2015 to measure residents' perception and knowledge surrounding patient safety. The number of patient safety reports submitted by residents was tracked for the same period. In addition, recent graduates were surveyed to assess the influence of the council on postresidency involvement in patient safety. RESULTS: Resident perception of the institutional culture of safety improved and knowledge of basic patient safety concepts increased. The number of resident-submitted safety reports increased from 6.2 to 15.2 reports per month in the 2013 and 2015 academic years, respectively. Surveys of recent graduates suggest that involvement with the safety council during residency fostered future engagement in patient safety. CONCLUSIONS: This resident-led council models successful involvement of trainees in system-based patient safety. Such involvement can help shape the safety culture within a training program and encourages continued participation in patient safety after residency completion.

Addressing Reproductive Health in Hospitalized Adolescents-A Missed Opportunity.

PURPOSE: Adolescents are at high risk for sexually transmitted infections (STIs) and pregnancy. Since many adolescents have poor access to preventive care, hospitalizations present a critical opportunity to address adolescents' reproductive health. The purpose of this study was to assess provision of reproductive health services within a hospital setting. METHODS: Retrospective study of a consecutive sample of adolescent patients aged 13 years and older hospitalized on the hospitalist service at a large academic pediatric tertiary care center. Measures included sexual history documentation, pregnancy and STI testing, Human papillomavirus immunization status and administration, and provision of contraception. RESULTS: Only 55% of 150 patients had sexual history documentation, and of those, 47% endorsed sexual activity. Associations with increased likelihood of sexual history documentation included female patients (67% vs. 36%, p < .01), hospitalizations for ingestion (71% vs. 48%, p < .01), hospitalizations to hospital medicine compared with critical care (59% vs. 14%, p < .01), and admission note written by an intern compared with a senior resident, advanced practice provider, or fellow (67% vs. 44%, 29%, 13%, p < .01). Eighteen patients (12%) were tested for STIs. Only 19% of patients due for human papillomavirus immunization received it. Sixty percent of females received a pregnancy test. Contraception was provided in two encounters (2% of females). CONCLUSIONS: Results demonstrate a substantial missed opportunity to provide reproductive health services to hospitalized adolescents. Providers in hospital settings should optimize the opportunity to screen for sexual activity and reproductive health needs, provide indicated services, and offer education regarding reproductive health to hospitalized adolescents.

The Impact of Hospital Health Network Affiliation on Discharge Communication Preferences of Primary Care Providers.

Primary care physicians (PCPs) experience differential postdischarge access to electronic health records, depending upon affiliation with the discharging hospital's health network. To better understand whether this affiliation impacts discharge communication preferences, we surveyed a convenience sample of PCPs in and out of our hospital's health network. We also surveyed hospitalists and compared PCPs' and hospitalists' responses. We found that PCP discharge communication preferences differed by hospital health network affiliation. In addition, PCPs and hospitalists reported different expectations of responsibility for pending laboratory test follow-up. More inclusive communication strategies and standardization of responsibility for pending laboratory results may improve discharge communication quality.

Policy to practice: increased family presence and the impact on patient- and family-centered care adoption.

OBJECTIVE: This quality improvement study introduced 24/7 family presence and measured its impact in 3 categories; perceptions, complaints, and patient experience scores. This article offers insight for leaders into the 1st phase of patient- and family-centered care (PFCC) adoption. BACKGROUND: Family presence improves patient safety and satisfaction; however, 70% of US healthcare organizations maintain restrictive visitation policies. METHODS: We surveyed nursing staff 6 months postinnovation to determine staff knowledge, implementation practices, and perceived challenges to implementation. We surveyed system leaders regarding PFCC transformation and trended formal complaints and patient experience scores after family presence innovation. RESULTS: Findings provide insight for leaders into family presence policy adherence challenges experienced by staff. Leaders perceived significant transformation toward PFCC adoption postinnovation. Complaints increased postinnovation, and patient experience scores demonstrated positive trends. CONCLUSIONS: We gained insight regarding challenges to policy adherence and identified next steps for leaders in the transformation toward PFCC adoption.

Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements.

With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.

Senior pediatric residents as teachers for an innovative multidisciplinary mock code curriculum.

BACKGROUND: Resuscitation education for pediatric residents may be limited due to the low frequency of actual codes in children. Mock codes represent an opportunity to increase trainee education in acute resuscitations, and we designed a unique multidisciplinary mock code curriculum that uses senior pediatric residents as teachers. METHODS: A novel mock code curriculum was designed and integrated into an existing night-float rotation. Our 2-tiered curriculum not only focuses on improving teaching proficiency for resident educators (REs) but also includes separate goals to augment simulation-based resuscitation education for resident participants (RPs) and the multidisciplinary staff. RESULTS: Seventy-six residents (17 REs, 59 RPs) and more than 75 nurses have participated in the curriculum. After participation, 100% of residents felt that this curriculum would improve the quality of actual resuscitations, and 94% of RPs reported receiving valuable feedback. Comfort with teaching and feedback increased for REs (P < .05), and comfort in resuscitation and crisis resource management improved for RPs (P < .05). The nursing staff also felt that communication, teamwork, and collaboration improved due to implementation of this curriculum. CONCLUSIONS: A unique mock code curriculum can improve resident comfort with teaching, peer facilitation, feedback, and resuscitation. Curricular interventions of this nature may also be able to improve the balance between service and education within a residency training program. As we move toward a competency based training model within graduate medical education, further investigation is needed to link educational modifications of this nature to clinical outcomes and actual resident performance.