ACADEMIC PEDIATRICS ABSTRACTS e11

residents understanding of disability, levels of bias did not changeover the course of residency training.FUTURE RESEARCH: Further research is needed to determine

the effect of disability bias on pediatric patient care and ifimpacted what curricular interventions mitigate the impacts ofthis bias.

29. RESIDENT FEEDBACK: THE PERSPECTIVES OFATTENDINGS AND RESIDENTSAnuja V. Jain, MD, MEd, Boston Children’s Hospital/BostonMedical Center, Daniel J. Schumacher, MD, MEd, BostonMedical Center, Boston, MA

BACKGROUND: Two major stakeholders in resident feedbackare the attendings delivering feedback and the residents receivingfeedback. Therefore, it is critical to assess the perspectives of bothgroups regarding the strengths and challenges of current residentfeedback systems. The purpose of this study was to ascertainthose perspectives.METHODS: An online survey was designed to investigate the

perceptions of the Boston Combined Residency Program resi-dents and attendings regarding the current state of resident feed-back. The survey consisted of questions about the quality ofdifferent types of feedback; the differences between in-personand written feedback; and the largest limiting factors in providingquality resident feedback.RESULTS: Only 57% of all attendings have had any formal

training in giving feedback to residents. On average, attendingsrated their comfort with giving feedback to residents 3.7 out of5 (SD 0.7). Attendings reported the largest barriers to providingquality in-person feedback include time constraints and feelingthey cannot adequately assess residents given limited observation.Only 14% of attendings report not wanting to harm rapport withresidents as a barrier. Most residents are receiving feedback on50e75% of all rotations; however, only 6% of residents havereceived feedback on every rotation. Residents reported thelargest limiting factors for receiving quality feedback includetime constraints, the belief that attendings cannot adequatelyassess residents given limited observation of them, attendingsforget to give feedback, and attendings do not seem interestedin giving feedback. 92% of residents find in-person feedbackmore useful than written feedback. Most attendings and residentsagree that the optimal length of time needed to give quality in-per-son feedback is 6e10 minutes.CONCLUSIONS:Residents and attendings have differing percep-

tions of the current feedbackmechanisms in place. Addressing theconcerns of both will be crucial in improving feedback mecha-nisms. A shared belief of both is that not enough time is spentin direct observation, perhaps a reasonable starting point.

30. RESIDENT DRIVEN IMPROVEMENT OF PCPCOMMUNICATION AT DISCHARGEAmy R. Dixit, MD, Anna Harbison, MD, Lauren Destino, MD,Lucile Packard Children’s Hospital, Palo Alto, CA

BACKGROUND: At Lucile Packard Childrens Hospital, therewas concern that primary care physicians (PCPs) were dissatisfiedwith communication from hospital providers based on a Press Ga-ney Survey performed in 2012. In mid-2013, only 52% of PCPshad been contacted by the time of discharge, which inhibited con-tinuity of patient care and provider relationships.AIM: To create a standard process for communicating with

PCPs at discharge improving notification to 80% by December2013.

METHODS: A multidisciplinary team led by pediatric residentswas established in July 2013. Utilizing Lean methodology, specif-ically the A3 Quality Improvement tool, the team identified bar-riers to PCP communication and established recommendationsand action items. We ran 2 PDSA cycles based on our initial anal-ysis of the problem. In the first cycle, August 2013, resident edu-cation was targeted through morning report, blog posting, emails,and a hospital wide screen saver. In the second cycle, September2013, we made changes to the electronic medical record (EMR)including notification at the time of discharge if communicationwith the PCP had not been documented. Ongoing action itemsinclude updating the PCP phone database to facilitate ease ofcommunication from inpatient providers, obtaining real timefeedback from PCPs on recently discharged patients, and utilizingcare coordinators to fax admission notifications. Throughout theimplementation of these measures, the data regarding PCPcommunication was tracked from the EMR.RESULTS: After implementation of two PDSA cycles, PCP

notification at discharge improved by 60% relative to priormonths. Documentation of discharge communication with PCPsreached the goal of 80% on medical resident teams.CONCLUSION: Resident participation was key to the early suc-

cess of this PCP communication improvement project. Resultswill continue to be followed and new PDSA cycles utilized asnecessary for sustainment. Residents are uniquely positioned tolead hospital driven initiatives given their expertise with systemsof care and direct involvement in the daily work surrounding hos-pitalized patients.

31. IMPLEMENTATION OF ASTHMA CONTROL TESTSCREENING TOOL IN PEDIATRIC RESIDENT CLINICPooja M. Oza, MD, Children’s Hospital of University ofIllinois, Gulsah Vural, MD, Melissa Ruiz, MD, Children’sHospital at University of Illinois, Chicago, IL

BACKGROUND: Asthma is one of the most common chronicpediatric conditions. Asthma Control Test (ACT: for ages >12years) or Childhood Asthma Control Test (C-ACT: for ages4e11 years) is an easy assessment tool for asthma control. TheC-ACT is a 7-question, 2-part questionnaire, with one part to becompleted by the child age 4e11 with caregiver assistance andthe other part to be completed by the caregiver. The ACT is aself-administered 5-item survey completed by the children age12 and above. Uncontrolled asthma is defined as ACT <19.AIM STATEMENT: To increase the use of the ACTand C-ACTas

a screening tool in a pediatric resident clinic to improve asthmamanagement for patients with a history of asthma by 20%.METHODS: We performed two PDSA cycles to increase use of

the ACT and C-ACT screening tool. We included any patientwith asthma age >4 years who presented for well child careand acute care visits. In the planning phase of each cycle weused the experiences gained from the previous PDSA cycles tointroduce new strategies and implement changes. In the firstPDSA cycle, we informed the providers about ACT screeningthrough emails, educated faculty and residents at faculty meetingsand noon conference, respectively, increased resident awarenessby speaking to each continuity clinic group, and posted screenshots in resident work room. For the second PDSA cycle, we addi-tionally posted flyers in the patient waiting area, resident lounge,and in examination rooms to increase awareness of ACTscreening tool.RESULTS: The pre- implementation chart review showed 2.53%

of patients age >4 with history of asthma had ACT completed.The post- implementation first PDSA cycle demonstrated