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Improving Morning Report Using Quality Improvement

June 29, 2022

Most teaching hospitals have some version of a morning report, during which patient cases are discussed. An important goal of morning report is to provide teaching points to learners.

In my experience, there is a lot of variability in how morning reports are structured. In some institutions, cases from the prior day’s admissions are discussed, with a dual purpose of teaching and enhancing clinical decision-making. In others, the sessions are more didactic, with cases chosen for their teaching value. In others, there is a hybrid approach.

The pediatric residency program at the University of Vermont takes the second, more didactic approach. Because the quality of the teaching at the individual morning reports was highly variable, they used a quality-improvement (QI) approach to more consistently improve the educational value of their morning reports. This group of pediatric residents and faculty, led by Dr. Anna Zuckerman, has published their results in a Quality Report, entitled “Increasing Pediatric Morning Report Educational Value Through Quality Improvement,” which is being early released by Pediatrics this week (10.1542/peds.2021-053103).

The authors systematically used QI methodology to understand the problem, and to identify and test strategies:

  • They interviewed graduating residents and faculty to better understand the shortcomings of morning report
  • Using educational theory, they identified the elements of high-quality morning reports
  • They developed and implemented a new standardized morning report process that included core educational elements and structured mentorship by faculty

Authors then used Plan-Do-Study-Act (PDSA) cycles to implement changes. Their primary outcomes were:

  • The number of core educational elements in each morning report
  • Faculty and resident satisfaction with morning report educational quality and medical content

They achieved their goals for both of these primary outcomes, and found that converting the morning report to a virtual format during the pandemic did not adversely impact on their new structure.

I appreciate how QI methodology is now being used for much more than clinical outcomes. In a prior blog, I discussed an article that reported on the use of QI for improving clinician-parent communication during inpatient rounds, and now we have this report for using QI to improve education.

Take a look at this quality report, and even if your institution’s morning report has a different format – or even if you don’t have a morning report, you will likely get some ideas for how you can improve educational programs in your institution.

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