SHM Converge Scientific Abstract ePoster Gallery-Preliminary Implementation of Resident-Focused Project Aimed at Reducing Hospital-Acquired Debility

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This project evaluated a resident-focused quality improvement initiative, Enhanced Recovery Medical (ERM), designed to reduce hospital-acquired deconditioning among adults on medical-surgical floors at Kaiser Permanente San Francisco. Hospitalization can worsen patients’ functional, nutritional, and cognitive status, increasing the risk of readmission and loss of independence. ERM is a multimodal pathway modeled after ERAS, with predefined orders, nursing workflows, and strategies to support mobility, minimize tethers, and improve overall function.<br /><br />The intervention targeted internal medicine residents (PGY1–3) through three Plan-Do-Study-Act cycles: an educational curriculum on ERM elements, a Smartphrase “Bundle” in the electronic health record that auto-populated patient-specific data and included hard stops, and ICU work groups to strengthen resident-led quality discussions. The team gathered continuous feedback and compared pre- and post-intervention data using SAS. Due to sample size limitations, three ERM elements were selected for analysis.<br /><br />Survey results suggested improved resident awareness, especially after the educational campaign and Smartphrase rollout. For example, awareness of tethers improved from 65% to 94% between September and October (p=0.05), while awareness changes for mobility and multimodal analgesia were smaller and not statistically significant. However, system-level hospital metrics showed only modest changes: average tethers decreased from 1.8 to 1.5, multimodal analgesia use increased from 27.6% to 43.7%, and max mobility returned to baseline after a dip.<br /><br />Overall, the educational effort appeared to increase resident awareness and shift attitudes toward preventing hospital-acquired debility, but resident practice alone did not produce clear hospital-wide improvements. The authors note that ERM depends on nursing and ancillary staff as well as residents, and future work should focus on barriers to sustained adoption and analyze outcomes for the exact patient subset cared for by residents.

Asset Subtitle

Emily Fink

Meta Tag

Author List Ann-Marie Surmava, Emily Fink, Vishal Patel

Category Research

Concept Hospitalization-associated Deconditioning

Concept Post-Hospital Syndrome

Concept Enhanced Recovery Medical

Concept Readmission Risk

Concept Patient Independence

Distinguished Non-Finalist

Presenter Organization Kaiser San Francisco

Presenting Author Emily Fink

Track Quality Improvement

Keywords

hospital-acquired deconditioning

quality improvement

Enhanced Recovery Medical

resident education

medical-surgical floors

mobility

multimodal analgesia

electronic health record

Plan-Do-Study-Act

Kaiser Permanente San Francisco

Hospitalization-associated Deconditioning

Post-Hospital Syndrome

Enhanced Recovery Medical

Readmission Risk

Patient Independence