ACGME Honors D.C. Children’s Resident for Quality Improvement Study

In September 2011, Dr. Daniel DeSalvo received a surprise phone call. He was to be the sole resident to receive the 2012 ACGME David C. Leach Award for his QI project “Can a Learner-Centered Diabetes Management Curriculum Serve to Reduce Resident Errors on an Inpatient Diabetes Pathway?”

According to the ACGME, the David C. Leach award “is unique in that it acknowledges and honors residents, fellows, and resident/fellow teams and their contribution to graduate medical education.”

Dr. Daniel DeSalvo, a Pediatric Resident at Children’s National Medical Center, won the David C. Leach Award for his research on medical errors with Type 1 diabetes patients.

Unbeknownst to Dr. DeSalvo, a chief resident in Pediatrics at the Children’s National Medical Center in Washington, D.C., his program director, the vice chair of medication and education, and his mentor Dr. Fran Cogan had nominated him for his study, which had demonstrated a greater than 50 percent reduction in resident-related errors as a result of the educational modules he had created with Dr. Cogan.

“I didn’t know what it was for,” said Dr. DeSalvo. “So I was surprised, humbled, and honored to receive this outstanding award. This really is a testament to my mentors and their guidance and encouragement.

“From my time as a resident I had noticed that there were medical errors occurring with Type 1 diabetes,” said Dr. DeSalvo, who has an interest in medical education and endocrinology. He worked with Dr. Cogan to develop a multifaceted educational intervention that activates learners.

His colleagues worked through the four modules: one web-based; one interactive Q&A session; one that guides residents through a diabetes pathway; and one in which residents are presented with the hospital course of a make-believe patient where several errors were embedded in the case and residents had to identify the errors and figure out how to prevent them.

Dr. DeSalvo compared the sentinel and near-sentinel related medical errors secondary to Type 1 diabetes 10 months before and after the education intervention. “It was the Mecca of education intervention,” he said. “Not only did it improve knowledge, but it also translated to improved patient outcomes.

“I felt incredibly pleased at the results and I was surprised by just how significant the decrease in errors was.” His colleagues were equally impressed though less surprised at their dramatic improvement. “They really felt they were empowered with this new knowledge to provide competent and complete care,” Dr. DeSalvo said.

At about six months after the intervention, Dr. DeSalvo noted that there was a spike in the number of errors that were occurring, and that an education booster emphasizing proper insulin dosing and communication between team members would be beneficial. When the hospital rolls out the education intervention again next September for the new residents, the course will include this booster.

“I definitely have a passion for education, and diabetes education in particular. We’d like to roll this out to members of multidisciplinary teams, including nurses and dieticians, and also possibly standardize these modules so they can be used at children’s hospitals across the country.”

Dr. DeSalvo will be moving to Palo Alto in July to begin a Pediatric Endrocrinology fellowship at Stanford’s Lucile Packard Children’s Hospital.

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