279 - Pediatric Resident Autonomy: Admissions Calls Overnight from the Pediatric Emergency Department

Poster Number: 279
Publication Number: 279.420

Rishi P. Mediratta, Stanford University School of Medicine, Stanford, CA, United States; Anna Lin, Stanford University School of Medicine, Stanford, CA, United States; Rebecca Ivancie, Stanford School of Medicine, Stanford, CA, United States

Background: Few pediatric residency programs have curricula for residents to learn the skill of triaging admissions from the emergency room over the phone. An opportunity exists to improve the transition of care for patients from the emergency room to the inpatient unit while simultaneously teaching residents how to triage calls.

Objective: Examine attitudes among senior residents before and after the implementation of a phone triage curriculum for admission calls from the pediatric emergency room.

Design/Methods: Prior to this study, no resident triage curriculum existed at our freestanding children’s hospital. We designed an IRB-approved triage curriculum for senior residents who were working in the general pediatrics wards at night. The curriculum consisted of didactic education and an experiential component. Residents triaged admission pages from the emergency room with direct supervision from the hospitalist. Residents received pre- and post-rotation surveys to assess attitudes about the curriculum using a 5-point Likert scale. Faculty and residents received daily open-ended questions about the previous night’s calls. Individual differences were assessed by the Wilcoxon test. For free text responses, authors conducted an inductive approach to thematic analysis to form codes and came to consensus on themes.

Results: Between May and December 2021, senior residents led 251 admission calls overnight from the pediatric emergency room (70% nights). 16 of 35 residents (46% response rate) responded to the pre/post survey. The proportion of residents who were somewhat or extremely comfortable with determining criteria for admission increased from 43% to 94% (p < 0.001). The proportion of residents who were somewhat or extremely comfortable with determining the patient’s disposition increased from 44% to 88% (p=0.003). The proportion of residents who were somewhat or extremely comfortable with asking the necessary questions to determine the need for admission increased from 50% to 94% (p=0.002). Thematic analysis revealed: 1) faculty and residents felt the paging process was efficient, 2) residents appreciated debriefing with the hospitalist after each call, and 3) some residents felt less empowered to advocate against perceived unnecessary admissions.Conclusion(s): After 7 months of implementing a triage curriculum, senior residents improved their confidence in triaging admissions overnight from the pediatric emergency department. Future research includes determining the impact of this program on residents’ careers in both primary and subspecialty care.