LAUSR

Background Management of an acutely ill or decompensating child is pivotal to a pediatric resident's training. Pediatric physicians should be prepared to recognize and respond to pediatric emergencies. Starting in 2014, senior residents in our program were designated as the code team leader on even days. Subsequent data demonstrate that residents rarely led codes on even days. We therefore developed a quality improvement initiative to improve resident code team leadership skills. Aim Statement Our primary aim was to increase the percent of even day codes led by a resident to 50% by May 2018. Interventions A needs assessment survey was conducted to identify barriers to resident code team leadership. A fishbone diagram developed to categorize barriers to target. Plan Do Study Act cycles were conducted to implement and test various interventions including a simulation-based workshop on code team leadership, data sharing about code events, and just-in-time resources addressing common questions. Measures Outcome measures included the percentage of even day codes led by resident. Process measures included resident self-confidence in their code team leaders. Balancing Measures included the percent of even day codes with subsequent negative events. Results Baseline data demonstrated no even day codes led by residents. Special cause variation was seen following interventions of simulation-based education and just-in-time training with 40% of codes led by senior residents. Improvements were sustained throughout the academic year. Conclusions and Next Steps Using quality improvement methodology we were able to successfully increase the number of codes led by senior residents without increased negative outcomes. Future interventions will aim at sustaining improvement into a new academic year.