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More Time with Patients Can Lead to Improved Care.

While most of us are still fumbling around in the dark for the snooze button, dedicated residents are arriving at Johns Hopkins All Children’s Hospital at an impressive 6 a.m. to begin getting vital signs and reviewing patient information.

Their days are long and hectic, rounding to see patients, combining lunch and lectures, then returning to patient care. Because they rotate to a new area of the hospital every six weeks, residents’ jobs are a constant stream of learning, which can make it challenging to find time to prioritize bedside manner and patient-centered communication skills.

Grant Allows Additional Patient Time for Residents

That’s why third-year resident Nicole Nghiem, M.D., jumped at an opportunity offered by the Accreditation Council for Graduate Medical Education (ACGME) to create a resident-led initiative called Back to Bedside, designing ways to increase time with patients.

Nghiem, pronounced “Nim,” who is specializing in general pediatrics, led a team that offered a winning idea: a program called “All About Us,” which creates protected time each week to be spent with patients. The Johns Hopkins All Children’s residency program received a $10,000 grant from ACGME, renewable for up to two years, all but ensuring success of the program, which kicks off this month.

“Between patient care, learning, teaching, working on our research and community projects, residents have so much going on that it can be easy to forget why we got into medicine in the first place,” Nghiem explains. “It was our goal to design a program that would ensure residents protected time to form meaningful connections with patients that not only reinvigorates us—but can often lead to improved outcomes for patients.”

“Our residency is thrilled to be awarded this grant—especially as one of only five programs across the country to receive full funding for this prestigious reward,” explains Raquel Hernandez, M.D., M.P.H., director of the Office of Medical Education at Johns Hopkins All Children’s. “We know that our residents in particular are able to succeed in this project because they already receive training on patient-centered care and on leadership. The Back to Bedside/All About Us program is simply a natural next step where our residents will gain even more purpose and satisfaction as physicians.”

All About Us is an initiative in collaboration with nurses and Child Life specialists. It will use grant money for games, toys and medical team baseball cards (used in place of business cards) that patients can collect from their doctors, nurses and Child Life specialists. They include fun facts on each caregiver, such as favorite foods, hobbies and trivia. In turn, patients are asked to design an “All About Us” poster for their room that offers their own personal facts, all of which can help start a great conversation and get everyone acquainted.

The program allows residents to sit with a patient, get to know him or her, play games and form a connection that builds trust and can improve care. “For instance,” Nghiem offers, “I had an infant who needed oxygen, but her mom threatened to leave against medical advice. We did not understand why until I sat down and talked to her one-on-one. It turned out she was concerned that she had run out of money for food. We were able to connect her with the appropriate resources so she could stay until her baby fully recovered without worrying about meeting her own needs.”

Little pieces of information can lead to solutions. “I ran into a mom in our General Pediatrics Clinic recently,” she adds. “I had taken care of her baby since she was born, but it was only through this conversation months later that I learned that every time they came to our clinic for care, they had to walk. Once I realized that, I was able to arrange for some bus passes for her.”

The residents are thrilled about the opportunities All About Us will provide to help patients.

“I’ve already been able to get back to bedside a few times and those are the days I leave the hospital in the best mood,” says an enthusiastic Alana Koehler, M.D. “Not only does it help me feel more fulfilled, I am able to provide better patient care because I’m getting to know the kids and families as individuals rather than a diagnosis or problems list. It’s a great program.”

Nghiem agrees. “It’s really a win-win for the patient and the resident to have that hour to focus on patients who have needs and fears. It helps to put everything back into perspective, even for a brief moment. It’s a practice we hope the residents will then carry with them throughout their medical careers.”

The long-term goal is to disseminate this to other inpatient teams and eventually across the entire hospital once residents have tried it out. The Office of Medical Education as well as the inpatient hospitalist faculty will be providing resources and mentorship throughout the grant process.

Nghiem is excited to have selected an innovative residency program like the one that Johns Hopkins All Children’s offers, allowing her to explore ideas and find solutions that improve care for patients and work experiences for her fellow residents. “This hospital is pretty special,” she says. “I felt very supported in pursuing this idea, and I can’t wait to get it fully implemented.”

After all, there are resident baseball cards to start trading.