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. 2014 Spring;14(Spec AIAMC Iss):4–36.

Abstracts

PMCID: PMC3966085
Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Advocate Lutheran General Hospital, Park Ridge, IL

Process Improvement and the ACGME Annual Program Evaluation: Teaching the Teachers

J Gravdal, P Hyziak, MA Clemens, F Belmonte, S Sulo

Background: Process improvement science (PIS) is relatively new to healthcare, and the Advocate Lutheran team identified the need for instruction and incorporation of PIS at the GME level. This study was designed to share knowledge and develop skills in PIS by having residency program directors (PDs) and associate program directors (APDs) complete an educational program on PIS and use these concepts and tools to prepare the required ACGME annual program evaluations (APE).

Methods: Investigators developed a pre- and postintervention survey to measure 18 participating PDs' and APDs' knowledge of and attitudes toward PIS application in evaluation and curriculum programs. The team conducted 4 education sessions, and trained, independent reviewers analyzed the APEs from the 2 years prior to the intervention (2010 and 2011) and the year following (2012).

Results: The survey revealed subjects reported either an increase in using or no knowledge of PIS practices, including PDSA models, fishbone diagrams, and process-mapping techniques. Not all subjects completed the pretest and/or attended the education sessions, which may be a factor in the PIS knowledge result. APE metrics revealed the content and format of data provided on APEs varied and some content was copied and pasted year to year. Little evidence of dynamic or process improvement existed in APEs over 3 years. The 2012 APEs did not reflect an impact from the educational sessions.

Conclusions: The study confirmed the need for education on PIS through a program that can serve those with a variety of skill levels and busy schedules. The team will next revise the APE instructions and integrate APEs into performance reviews. The PDs and faculty will continue to help develop PIS knowledge and skill programs.

FINAL WORK PLAN – Advocate Lutheran General Hospital (Team 1)

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Advocate Lutheran General Hospital, Park Ridge, IL

Development of a QI and Patient Safety Curriculum for a Family Practice Residency Program

Stuart Goldman, Robert Maslo, Patrick Piper, Reji Ninan

Background: QI and PS are 2 interrelated subjects that are not routinely taught to residents and residency faculty. Our Family Medicine residency program planned to teach these concepts through both didactics and hands-on projects. We implemented an ongoing lecture series on QI and PS and completed QI projects targeting the patient-centered medical home model.

Methods: We presented 8 topics on QI and PS to the residents. Faculty received online training on PS prior to this intervention and attended a faculty development session on the basics of QI. PGY2s and PGY3s reviewed the IHI online modules about PDSA cycles. Concurrently, 5 newly established teams (1 inpatient and 4 outpatient) started projects that would improve care in their respective settings and met twice a month for the duration of the project.

Results: The 5 teams saw area-specific results: (1) the geriatric wellness team saw an increase of annual wellness visits, (2) the patient satisfaction team performed an office time study, (3) the immunizations team created a refusal-to-vaccinate form, (4) the inpatient team is conducting an ongoing readmission reduction study, and (5) the coronary artery disease team developed group visits. The projects involved Family Medicine residents, utilized timely didactic information, and required regularly scheduled meetings for successful completion. Not all QI team members had QI training, and some teams did not initially choose measurable outcomes.

Conclusions: Residents learned the steps used in QI processes by participating in projects, attending didactic sessions that preceded the projects, and discussing project content during the didactic sessions. Future projects will be different than previous projects, and outcome measurement of the relative success of each team's project will be expected for future projects.

FINAL WORK PLAN – Advocate Lutheran General Hospital (Team 2)

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Akron General Medical Center, Akron, OH

Providing Feedback to PGY1 Residents on Professionalism: Teaching the Teacher

Rebecca Brauch, Cheryl Goliath, Laurie Patterson, Titus Sheers, Nairmeen Haller

Background: To better standardize the teaching of professionalism, the American Board of Internal Medicine and ACGME established competency-based training milestones for internal medicine residency programs. Accordingly, professionalism milestones served as the basis for a faculty development program centered on providing feedback to PGY1 residents (interns) on their own professionalism behaviors during preceptor-resident sessions in the internal medicine continuity clinic.

Methods: To determine the level of faculty (n=8) understanding and comfort in providing feedback, surveys listing 12-month professionalism milestones were distributed to core internal medicine teaching faculty. Current interns (n=10) also rated their understanding of the same milestones. The faculty development program included interpersonal communication education, role plays of difficult situations, and pocket resources, as well as direct feedback on videotaped sessions with residents. At the end of the intervention period, participating faculty completed a postdevelopment survey, and the current 6-month interns completed a follow-up assessment.

Results: Average ratings between the pre- and postintervention teaching faculty surveys fell approximately 0.25%–0.50% on all measures of understanding but increased slightly on measures of comfort. Conversely, average ratings between the pre- and postintervention 6-month intern surveys generally increased 0.25%–0.50% for measures of comfort and understanding.

Conclusions: The faculty perceived the intervention as helpful in teaching them to focus on behaviors that change the context of overall feedback delivery. However, the study results showed that the system in place was not conducive to implementing such a program without modification and the introduction of resources.

FINAL WORK PLAN – Akron General Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Aurora Health Care, Milwaukee, WI

Team Competency: A Key Element for Excellence in the Patient Experience

Andy Anderson, Lynn Gunn, Jeffrey Stearns, Janie Jewett, Stephanie Mehl, Deb Simpson

Background: Quality metrics and patient experience data (CGCAHPS) in our resident clinics lag behind those of ambulatory clinics elsewhere in the Aurora Health Care (AHC) system. Team functioning is a critical factor in patient experience scores, but we have no initiatives to date that explicitly address the competencies required to be a member of an effective team. By implementing TeamSTEPPS (healthcare teamwork training), we will see improved patient experience metrics and caregiver satisfaction.

Methods: All providers, including faculty, residents, and staff, at 2 Family Medicine residency sites completed a 4-hour, 3-module TeamSTEPPS training. The modules included background, team structure, and mutual support and were adapted to ambulatory care settings. A 2-month follow-up obtained data on caregiver commitment to change and team assessments. AHC also compared patient experience metrics at baseline and posttraining.

Results: With a response rate of 69% (55 of 80), participants showed no change or slight increase in teamwork assessments in 13 of 15 categories on a scale of 1 (strongly disagree) to 5 (strongly agree). Respondents had a slight decrease in perceived support from their boss/supervisor (4.0 post/4.1 pre) and in confidence in team harmony (3.3 post/3.4 pre). Participants reported an increase in all commitment-to-change categories. Merged patient experience metrics revealed an increase in all service impact domains postintervention. All sites have committed to and are engaged in performing better as a team. We identified tensions between balancing immediate clinical care needs with cultural change training and also the difficulty of creating a process for both local and systemwide implementation.

Conclusions: Team competency may be the critical process element enabling AHC to achieve clinical and system strategic targets. TeamSTEPPS is an excellent and comprehensive yet flexible tool to teach team competency. Leadership support from conception through test phase is critical for initiating and disseminating team training.

FINAL WORK PLAN – Aurora Health Care

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Bassett Medical Center, Cooperstown, NY

Creating a Core Faculty in Quality and Safety

James Dalton, Kelly Currie, Edward Bischof, Charlotte Hoag

Background: We aimed to create an educated and enthusiastic core faculty of senior and resident physicians and administrators who would take ownership of the curriculum in quality and safety for all residents. Most physician faculty across all disciplines have not been engaged in and have had little or no formal training concerning the process of quality and safety. With new ACGME requirements, residents need to be actively involved in quality and safety activities. We planned to establish a curriculum in quality and safety for all postgraduate trainees that is highly valued by the residents and is sustained by a dedicated faculty skilled in the science of quality and safety.

Method: We identified core faculty by surveying residents and faculty for interest in developing a quality and safety program. The core faculty held monthly meetings to discuss quality and safety issues with residents and create a learning curriculum. Residents attended a house staff quality council meeting. The core group held monthly teleconferences with NI III colleagues, establishing relationships and common ground.

Results: We have developed a lecture series and are in the process of executing it. Cultural obstacles have become apparent to both core faculty and residents. Participants' collaboration fostered courage, creativity, and resident empowerment, and the teleconferences resulted in a collaborative research project with an outside partner. We recognized the tension concerning securing time to teach and develop as a faculty, and the implementation of an electronic health record program was an additional time concern. The project is still ongoing and long-term effects are not yet discernible.

Conclusions: The outcome of the program remains to be seen, but we have found the process invaluable. Our experience also demonstrated the need to collaborate among residency programs for common curricular goals and the importance of administrative support.

FINAL WORK PLAN – Bassett Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Baystate Medical Center, Springfield, MA

Development of an Interdisciplinary, Interprofessional Resident Quality Council

Reham Shaaban, Adrianne Seiler, Melody Brewer, Kevin Hinchey

Background: House staff play a key role in patient care but are not optimally involved in efforts to improve care. Current assessment procedures do not always include resident input, which can lead to lack of engagement. To help meet ACGME requirements, we planned to develop an interdisciplinary, interprofessional resident quality council (RQC) to engage residents in QI culture, teach them about QI, and enhance communication with administrators.

Methods: We initiated the RQC in 2012 and selected the chiefs of all 10 residency programs in the hospital as the first class. Our primary focus was teaching the teacher through monthly didactic sessions, allowing us to disseminate information and knowledge about QI science to all residencies. The secondary focus was to form parallel quality tracks in all residencies to perform at least 1 quality project per year, as well as to develop participation criteria and interest for the RQC.

Results: We saw significant improvement and comfort with interdisciplinary communication among the 10 participants. We were able to identify QI champion attendings within each program to support the council and connected the psychiatry chief resident to a psychiatry attending to develop a QI track. Participants also generated multiple interdisciplinary project ideas for the future. Residents were chosen to participate without gauging their level of interest, which led to lack of engagement. Residents also had a variety of responsibilities, so scheduling time for the RQC meetings was difficult. The initiative lacked a strong emphasis on the main goal of RQC participation.

Conclusions: Although the RQC did not reach all of the initial goals, it successfully formed interdisciplinary working relationships and gauged the house staff's interest in and knowledge of QI. Moving forward, the council will consist of residents who have applied and have shown interest in QI as recognized by their programs.

FINAL WORK PLAN – Baystate Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Christiana Care Health System, Newark-Wilmington, DE

Leadership Development in Integrating Quality and Academic Training Programs

Robert Dressler, Michael Eppehimer, Neil Jasani, Loretta Consiglio-Ward

Background: We plan to increase faculty capability as experts and leaders in quality and safety improvement sciences through a faculty development program. Drawing from our successful interprofessional resident QI curriculum, we plan to examine the effect of QI curricula on faculty's expertise, teaching, leadership, and system improvement.

Methods: We designed a professional development program and used a 19-question assessment addressing 6 competencies to determine the program's focus. Faculty/teaching staff participants (11) proposed 9 QI projects to be started in August 2012 and conclude in May 2013. Participants attended 16 structured sessions including prereadings, project milestones, and report-outs. Internal and external content experts used didactic and experiential teaching methods, and mentoring occurred during and between sessions. We used preprogram, midpoint, and postprogram surveys to gauge participants' confidence in teaching quality and safety competencies.

Results: Competency ratings before the program illustrated QI knowledge gaps for the faculty and teaching staff. We conducted a midpoint evaluation in February 2013 that indicated all 6 competency ratings had increased since the start of the program. When the program is complete, we will perform the postprogram survey. Longitudinal outcomes include measurements of perceived impact of the program on residents (annual ACGME survey), perceived impact within the institution (project review 90 and 180 days post), and percent of participants who achieve a professionally recognized QI certification within 1 year of the program. Project progress has varied, and teams with the most relevant projects have seen more success.

Conclusions: Time-constrained faculty can acquire knowledge and apply it through QI curricula. Early dialogue with key stakeholders during program design was instrumental in realizing organizational support. The integration of interdepartmental, interprofessional course faculty created valuable teaching and learning experiences. It is too early to determine whether the program effectively trains the trainer in improvement and safety.

FINAL WORK PLAN – Christiana Care Health System

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Wayne State University and Crittenton Hospital Medical Center, MI

Aligning Graduate Medical Education with Hospital's Quality Improvement and Safety Strategies

T Markova, F Sottile, P Morris, K Zakaria, W Murdoch

Background: We designed a QI and safety initiative for interprofessional teams of residents involving QI knowledge acquisition, teambuilding, and experience-based strategies. Our GME program worked to align ACGME core competency curricula with the hospital's strategic planning to improve patient care, quality, and safety; reduce overutilization of healthcare resources; and improve efficiency.

Methods: After 6 days of training sessions including didactics, team exercises, and project charter completion, participants created 3 projects that were evaluated for their clinical, organizational, and financial outcomes. These evaluations indicated QI knowledge, participant satisfaction, presentations and publications, teamwork and safety climate, and ROI. Project 1 focused on global immunization, particularly the influenza vaccination for all patients (6 mos +) and the pneumococcal vaccine for all (50+ yrs) and high-risk patients (6–50 yrs), to ensure patients were assessed and vaccines are delivered. Project 2 focused on reducing COPD readmissions. Project 3 focused on addressing rapid response to septic shock in patients admitted to the general floors, using keystone sepsis EBM tools.

Results: The immunization project saw an increase in percentage vaccinated in all pneumonia and influenza categories. The COPD project studied data from 2011 readmission rates within 30 days (19.85%) to identify factors that would decrease readmission. The sepsis project analyzed compliance with EBM requirements, developed a sepsis order set, activated a rapid response protocol, and educated clinical staff. Overall, participants showed a QI knowledge improvement from 3/5 pre to 3.4/5 post (QIKAT). We learned residents and staff were lacking in QI competencies but were able to engage with and lead interdisciplinary teams and were motivated by patient care improvements. We encountered some challenges in coordinating schedules and had no funding.

Conclusion: We demonstrated that aligning GME process improvement projects with the hospital's strategic objectives can lead to superior educational outcomes, reduce overutilization of resources, improve PS, and deliver more efficient care through teamwork.

FINAL WORK PLAN – Wayne State University and Crittenton Hospital Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Florida Hospital, Orlando, FL

Florida Hospital Graduate Medical Education National Initiative III

J Portoghese, J Keehbauch, D Lamb, J Pepe

Background: We developed a longitudinal and sustainable GME-based quality and safety curriculum to assess institutional, physician, and patient needs. We will address ACGME requirements for residents, enable physicians to meet CME requirements and maintain certification, and provide improved care for patients. We will equip learners with skills to engage in QI and PS projects.

Method: We used pre- and postintervention measures to determine GME faculty interest in and knowledge of QI and PS, the number of participants completing IHI training, the number of faculty QI/PS mentors, the number of PS/QI projects initiated and adopted, and the number of PS/QI projects disseminated in scholarly fashion.

Results: Of the faculty, 29 answered surveys about PS/QI. On a scale of 1–5, they had a mean interest of 3.17 in process improvement as it applies to patient care and a mean interest of 3.14 in utilizing quality assurance processes to identify system errors. Faculty showed a lower knowledge of QI skills with a mean knowledge of 2.43 of process improvement as it applies to patients and a 2.62 knowledge of using quality assurance processes to identify system errors. We developed a multitiered curriculum covering knowledge, application, and leading/mentoring, and selected IHI online modules for knowledge development.

Conclusion: The faculty had a moderate interest in and below average baseline knowledge of process improvement and identification of system errors. We experienced success in the adoption of IHI curriculum for all GME programs, multidepartment engagement in quality and safety studies, and the alignment of CME department goals with certification requirements for medical staff.

FINAL WORK PLAN – Florida Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

MedStar Franklin Square Medical Center, Baltimore, MD

A Simple Intervention to Improve Timely Follow-Up for Laboratory Test Results in an Outpatient Resident and Faculty Clinic

Claudia Kroker-Bode, Nargiz Muganlinskaya, Nancy Beth Barr, Aysegul Gozu

Background: Much outpatient care occurs when the patient is not in the office, including phone calls, requests for medication refills, and review of test results. We chose to study the response times to outpatient laboratories and develop a simple intervention to improve timely follow-up. Through weekly reminders via pagers or email, we hoped to shorten healthcare providers' response time to addressing test results and to improve awareness of outpatient follow-up.

Methods: Using EMRs in 2 primary care practice sites, we defined the sign time as the time between the responsible healthcare provider receiving an email notice of test results and signing off on the results. Before the intervention, the study was announced at 2 departmentwide conferences and providers received 4 weekly emails. All providers received weekly pager reminders to check their EMR inboxes during the intervention period (March 2, 2012–June 30, 2012), and EMR data was extracted to measure the response time.

Results: Compared to the preintervention control period of July 1, 2011 to January 31, 2012, we saw a shorter response time during the intervention. Preintervention, the sites had 8,390 laboratory tests with a mean sign time of 1.41 (standard deviation 1.61). During the intervention, the sites had 4,257 tests with a mean sign time of 1.20 (standard deviation 1.56).

Conclusion: Our brief intervention showed that a simple weekly reminder to providers to check their inboxes resulted in shorter viewing and signing times. Further study is needed to determine if other forms of reminders, such as cell phone texts, would produce similar results and to extend the intervention beyond 16 weeks. Our study did not determine if medical errors were prevented or if patients received higher quality of care. Further, the study was completed at 1 medical center, so the results may not be applicable to other settings.

FINAL WORK PLAN – MedStar Franklin Square Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

MedStar Georgetown University Hospital, Washington, DC

Quality and Safety in the Balance: An Integrated and Comprehensive Approach to Education on Patient Safety for UME & GME

Avram H Mack, Eileen S Moore

Background: At the inception of this project, neither Georgetown University Hospital (GUH) nor Georgetown University School of Medicine (GUSOM) had a full, tested plan for education in PS/QI at the GME or UME level. We hoped to generate a campuswide plan for teaching and learning PS/QI that would integrate GUH and GUSOM residents and faculty. GUH is operated by MedStar, an independent nonprofit, and GUSOM's curriculum did not match the PS/QI emphasis that MedStar stressed at GUH. A collaborative project would allow the students and hospital to interact throughout the program and form a cohesive relationship.

Methods: We interviewed key stakeholders, developed education activities for third- and fourth-year medical students (MS3, MS4), visited other hospitals, attended conferences (AAMC, IHI, AIAMC), held check-in meetings, participated in hospital PS/QI leadership, and assessed students at the end of their fourth year.

Results: The intervention was sporadic in 2009–2010, was piloted in 2010–2011, established a baseline for MS3 and MS4 in 2011–2012, and continued for MS3 and MS4 in 2012–2013. The simulation score baseline was established in 2011–2012 and was pending for 2012–2013. The patient safety culture score baseline was established in 2010–2011 and no results were reported in following years. We met with great success in participant openness to collaboration but learned that many additional parallel collaborations were necessary across the system. We did not create an agreed-upon measurement or intervention for student or resident safety culture, but we made tremendous progress toward this goal.

Conclusions: Engineering a campus plan is hard enough when the 2 components are a single unit; it is uniquely challenging in an independent academic medical center. Many enterprises within the overall project must align to drive the program. The presence of many collaborators taught us that we have to keep abreast of all developments, not just our particular specialization.

FINAL WORK PLAN – MedStar Georgetown University Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Guthrie Clinic / Robert Packer Hospital, Sayre, PA

Promoting QI & Enhancing Patient Safety Through Graduate Medical Education: The Next Step?

A Kulkarni, N Pease, D Stapleton

Background: Given the changing paradigm in healthcare and GME that emphasizes the importance of QI projects to enhance PS, we felt the need to incorporate this theory into resident education. We hoped to integrate PS/QI into the existing residency curriculum, increase the yield of QI projects, and have publications of resident-initiated QI projects.

Methods: We determined the success of our program by measuring the increase in resident QI activities as calculated on our new QI process scale. The scale has a score for each level of completion as follows: (1) conceptualization of project (no formal proposal), (2) formal hypothesis generated and submitted for review, (3) hypothesis approved by faculty mentor/QI supervisor after changes, (4) formal IRB proposal and IRB application completed, (5) IRB approval granted, (6) data collection underway, (7) preliminary manuscript developed and submitted for review, (8) manuscript finalized/submitted/under review, (9) manuscript accepted, and (10) project published/presented.

Results: We have seen a greater than 100% increase in resident-initiated QI projects since the beginning of this process. We worked to achieve resident buy-in and active contribution by discussing the significance of the program and its goals with residents. The most successful component of our work was generating interest from the faculty and increasing awareness of the significance of QI initiatives in practice and GME. We also established a streamlined procedure for seeking IRB review specifically for QI projects.

Conclusions: We were able to engage residents early by outlining resident-specific benefits of the process, maintaining an open dialogue between residents and faculty to identify specific needs and avoid attrition, and monitoring progress throughout the process to provide constructive feedback.

FINAL WORK PLAN – Guthrie Clinic / Robert Packer Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

HealthPartners/Regions Hospital, Bloomington, MN

Faculty Development–Quality Improvement Training

Marcella de la Torre, Andrew Zinkel, Adetolu Oyewo, Kara Kim, Richard Mahr, Deb Curran, Jon O'Neal, Gary Collins

Background: Since 2008, HealthPartners has taught an ACGME-aligned QI curriculum to medical residents through presentations, videos, readings, QI projects, and Minnesota's first IHI chapter. Residents reported that they needed more mentors and coaches onsite, thus creating a need to train faculty. HealthPartners hopes to educate faculty on QI methods and tools, equipping them with the skills and abilities to educate and guide medical residents.

Methods: In a series of 4 steps, interested faculty responded to invitations and completed a pretest assessment of their QI knowledge. Faculty then led or participated in a relevant, committee-approved QI project. Faculty also completed 6 IHI modules on their own time covering the fundamentals of, the model for, and measurement of improvement; putting it all together; the human aspect of QI; and level 100 tools. Finally, faculty took a posttest of QI knowledge and provided qualitative interviews.

Results: Eight faculty members participated and generated 2 large-scale QI projects with positive outcomes: Dialysis Shared Decision Making and Emergency Medicine Department Communication. The pre- and posttest analysis shows an increase in all aspects of QI knowledge for the 2 faculty who completed the modules and no change in knowledge for the 6 faculty who did not complete the modules. The qualitative data revealed the IHI modules and training in general were useful, a coach in the GME office was helpful, having a project aligned with organization/department goals was ideal, and the limited availability of protected time was a large barrier. Because this was a voluntary program, participation was low and no funding was available.

Conclusions: Those physicians who completed all the requirements felt grateful and more prepared than others (without training) to educate and mentor residents on QI projects. Participants reported that learning QI tools furthers work on QI projects. The initiative requires more leadership support, protected time for faculty, and integration into a program, such as a maintenance of certification program.

FINAL WORK PLAN – HealthPartners/Regions Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Iowa Health Des Moines, Des Moines, IA

Implementation of a Resident Quality Improvement Council within a Health System

Hanna C Engel-Brower, Hayden L Smith, Julie A Gibbons, Valerie M Boelman, Angela R Claytor, Michael Rodemyer, W John Yost, Douglas B Dorner

Background: We aimed to improve resident knowledge of and engagement in QI projects through a resident quality council (RQC). Because residents have limited time, adding educational components can be difficult, but ACGME has emphasized QI. Through the council, residents will become further engaged in QI projects and see measurable increases in QI knowledge, attitudes, and practices.

Methods: A survey assessing baseline QI knowledge, attitudes, and practices was sent to all 130 residents. The survey was cross-sectional and electronic, had standardized responses, had space for open-ended response, and incorporated reverse scored questions. Selected residents from each of the 5 residency programs formed the RQC with support from staff representatives from medical education, nursing quality, clinical quality, and research.

Results: With a 78% response rate (n=102), the survey revealed residents were familiar or very familiar with most aspects of QI knowledge (on a scale of not familiar/somewhat familiar/familiar/very familiar). The majority of the residents were not familiar/somewhat familiar with linking data to specific processes. Residents also were equally divided on knowledge of implementing structured plans to evaluate a change and using a PDSA framework. Regarding QI attitudes, the majority agreed or strongly agreed with the importance of QI projects and teams (on a scale of strongly disagree/disagree/agree/strongly agree). The majority strongly disagreed/disagreed that they had enough time to work on QI projects. Regarding participating in QI practices, the majority have had some prior QI training and project work. However, the majority have not participated in a multidisciplinary QI project team or suggested a QI project themselves.

Conclusions: The survey identified program-specific opportunities to improve QI education and the RQC facilitated collaboration across the hospital, providing residents a chance to attend quality meetings for clinical, nursing, pediatric, and adult intensive care committees. Although time constraints and clinical obligations limited resident time, resident-driven QI projects provided opportunities for sustainable results.

FINAL WORK PLAN – Iowa Health Des Moines

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

JPS Health Network, Fort Worth, TX

Teaching Process Improvement and Patient Safety in GME

J Fowler, B Estment, L Hadley, T Sanders, A Peddle

Background: We aimed to increase quality and patient safety through experiential learning with program directors (PDs), faculty, and residents. Trainees are limited to a 16-hour workday, and residents and faculty have limited knowledge of standardized process methods. We hoped to identify the best method for training residents and faculty within their time constraints and program mandates, to introduce performance improvement (PI), and to identify potential barriers and competing assignments.

Methods: A team of new interns completed a pre- and postintervention assessment of the training and its effectiveness. During active training, each participant was asked to (1) choose a group of peers to form a process improvement team, (2) select a potential problem to address, (3) develop a hypothesis, and (4) select a team leader. The teams met quarterly to review progress, interval outcomes, and barriers.

Results: At the initial meeting, 73 new residents attended, generating 11 projects. At the second meeting, only 8 residents and 2 faculty attended. At the time of this assessment, 6 QI projects were active among residents. The first training session was held during new resident orientation with 100% participation, but subsequent training had lower participation. New residents were initially excited and willing to learn improvement skills and develop projects but had limited time. We could improve the program by modifying improvement training to better meet time restraints and engage faculty in the process. Institutional site visits and audits also interrupted the flow of learning, leading to missed deadlines.

Conclusions: Residents and faculty who actively participated gained more awareness of system dynamics and available support, were motivated to address problems in a multidisciplinary fashion, and could be forces for change. Identifying time for new programs and training with new interns and residents is difficult given new work hour restraints. Traditional learning models need modification.

FINAL WORK PLAN – JPS Health Network

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

MedStar Health, Baltimore, MD, and Washington, DC

MedStar Health Handoff Initiative

S Hafiz, A Saini, M Vohra, K Cross, D Weisman, R Williams, S Detterline, J Gilbert, J Remington, C Emrich, M Shaver, J Slowey, N Ledesma

Background: The goal of the initiative was to create and implement a comprehensive handoff curriculum across all training programs in accordance with Joint Commission priorities and ACGME requirements for patient safety and continuity of care. This study investigated the current state of resident handoffs throughout MedStar hospitals and the efficacy of a new resident handoff workshop.

Methods: The study was conducted at 4 teaching hospitals in MedStar Health. To establish a baseline, an anonymous survey was distributed among residents. Researchers developed a standardized handoff workshop employing the S-T-I-R model (Summary, To Do, If-Then, Readback/Feedback) and offered it to internal medicine, general surgery, and obstetrics/gynecology. Workshop sessions included didactics and simulation with audience interaction. The quality of resident handoffs was evaluated both before and 3–4 months after the workshop by direct observation.

Results: Residents from levels PGY1-5 completed 206 preliminary surveys. At baseline, a significant portion of residents across various disciplines lacked handoff protocols (26%) and training (47%); 75% of PGY1 residents said they received no formal training on handoffs in medical school. The postintervention survey was completed by 119 residents. Postworkshop observations found that interns who had received the intervention were significantly more likely to report To Do and If-Then statements, along with facilitating receiver Readback.

Conclusions: A handoff workshop led to sustained improvement in handoff quality. Next steps include (1) establishing a handoff workshop with emphasis on the S-T-I-R model at the start of each academic year for all residents and (2) using the handoff checklist to evaluate progress in transitions-of-care milestones and to provide formative feedback on protocol implementation.

FINAL WORK PLAN – MedStar Health

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

MedStar Georgetown University Hospital / MedStar National Rehabilitation Hospital, Washington, DC

Experiential Process Improvement Curriculum (EPIC)

Dane C Pohlman, Curtis L Whitehair

Background: We recognized the need for a comprehensive, sustainable experiential PI curriculum (EPIC) for our residency program that enables multiple quality projects. Our team's goal was to create an interactive QI curriculum that matches residents with attending physicians needing to complete a PI project for maintenance of certification (MOC). Curriculum projects will satisfy ABPMR MOC-4 for attending physicians, as well as ACGME Residency Review Committee requirements.

Methods: The team distributed a needs assessment survey to all inpatient attending physicians. Each physician who participated in our pilot curriculum was matched with a group of residents. Together they were to be led through an interactive online QI curriculum using Moodle, group meetings, and the PDSA framework.

Results: Per the initial needs assessment, 75% of respondents had not completed the MOC-4 requirement because they were not sure what to do with regard to PI methodology, 50% were not sure what to do with regard to MOC-4 requirements, and 37.5% were not able to find time in their schedules to complete the requirement. Although we saw clear interest in the project from both attending physicians and residents, we encountered a barrier to curriculum implementation in coordinating participant schedules and organizing the curriculum. Positive unintended consequences included increased awareness of the need for QI and its requirement for MOC.

Conclusions: We plan to fulfill our goals in the next few months after implementation of our online curriculum. We believe that enabling attending physicians to complete their required MOC PI project via this course will help sustain this initiative. As the participating groups complete the stages of EPIC, we expect to see a number of PI projects completed and several needed adjustments to our facility.

FINAL WORK PLAN – MedStar Georgetown University Hospital / MedStar National Rehabilitation Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Mount Carmel Health, Columbus, OH

Quality and Safety: Building the Culture

Thomas Hartranft, John C Weiss

Background: Per ACGME requirements, our goal was to produce a comprehensive Q&S curriculum for PGY1 residents, implement the curriculum, and develop at least 2 teams of residents, faculty, CME physicians, and Q&S representatives working on a systemwide Q&S project.

Methods: PGY1 residents use IHI Open School techniques to develop their own Q&S project with the support of GME faculty and system leaders. The residents implement the designed project in their second year of training. They gather outcome measures during the third year; the process culminates in a multidisciplinary systemwide formal presentation of their project. Residents are strongly encouraged to author 1 or more peer-reviewed manuscripts at the conclusion of the process.

Results: We measured progress by tracking IHI Open School completion and the establishment of 3 active teams developing Q&S projects via Open School techniques, including PDSA cycles and evaluation methods. The most successful components of our work were the implementation of the curriculum, the buy-in from residents recognizing the need for quality patient care, and the level of Q&S and faculty support. The long-term results of curriculum implementation (to be repeated with each incoming intern class) remain to be seen; Q&S impact will be determined over the next 2 years. This project meets the ACGME requirement of integrating Q&S into the curriculum. The curriculum crossed all programs within GME.

Conclusions: A formal Q&S curriculum enriches teaching skills and improves methods in the field of Q&S. We believe this curriculum will lead to positive reviews and continued full accreditation by the ACGME for both the institution and our individual programs.

FINAL WORK PLAN – Mount Carmel Health

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Ochsner Clinic Foundation and University of Queensland-Ochsner Clinical School, New Orleans, LA

Developing a Practical and Sustainable Faculty Development Program with a Focus on Teaching Quality Improvement: An AIAMC National Initiative III Project

Christopher Rodrigue, Leonardo Seoane, Rajiv Gala, Janice Piazza, Ronald Amedee

Background: We developed a faculty development curriculum emphasizing QI and PS. Our project focused on developing a learning environment that fosters resident education in QI and PS.

Methods: A multidisciplinary team developed a survey to assess baseline perceptions of QI tools and training and resident participation in QI and PS programs. We then developed a curriculum to address deficiencies. The curriculum paired residents with faculty. At the completion of the first curriculum cycle, we asked faculty and residents to complete the same survey.

Results: Our pilot survey revealed a need for a comprehensive program to teach faculty and residents the art of teaching. Our follow-up study showed an increase in the number of residents and faculty who reported that their programs were extremely or very good at providing tools to develop skills and habits to practice QI. We also had a statistically significant decrease (15.8%, P=0.0128) in faculty who reported their program as not at all effective at providing resident QI tools and skills. Among residents and faculty, we had a 12% (P=0.2422) and a 38.2% (P=0.0010), respectively, improvement in reported monthly resident involvement in QI and PS projects.

Conclusion: We demonstrated that developing a sustainable and practical faculty development program within a large academic medical center is feasible. Our postimplementation survey demonstrated an improvement in perceived participation in QI, PS, and faculty development among faculty and residents. Future targets will focus on sustaining and spreading the program to all faculty and residents in the institution.

FINAL WORK PLAN – Ochsner Clinic Foundation and University of Queensland-Ochsner Clinical School

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Orlando Health, Orlando, FL

Quality Improvement Curriculum at Orlando Regional Medical Center

Caroline Nguyen-Min, Bridgette Provost, Kwabena Ayesu

Background: The ACGME now includes QI as a core competency, and many hospital institutions are implementing QI goals to improve the quality of healthcare. Our team's goal was to create a QI curriculum that is simple and adaptable to all residency programs at Orlando Regional Medical Center. This goal was important because we currently do not have standardized QI training for our residents.

Methods: Prior to implementation, a questionnaire was administered to residents across a range of disciplines to evaluate their baseline knowledge of QI. We determined project success by comparing the baseline QI knowledge of residents to a reassessment of QI knowledge after curriculum implementation. Our preintervention and postintervention measures were questionnaires developed from a literature survey.

Results: The most successful components of our work were achieving a response rate above 50% from each participating department on our baseline QI evaluation and recruiting QI interest from other programs. The largest barrier we encountered was difficulty regarding time management to complete the training modules. We worked to overcome this barrier by discussing with each program's champion the appropriate length of time to complete the QI modules.

Conclusions: There is evidence of inadequate knowledge of QI among residents. A QI curriculum is essential not only to enhance patient care but also to meet ACGME accreditation standards. Our residency programs have now chosen the IHI Open School QI modules as part of their QI training of residents.

FINAL WORK PLAN – Orlando Health

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

OSF Saint Francis Medical Center and University of Illinois College of Medicine, Peoria, IL

Performance Improvement Curriculum Collaboration

Julie Wohrley, Tom Santoro, Tim Miller, Mike Cruz, Lisa Fuller, Bob Wolford, Vernon Large

Background: ACGME mandates that residents receive PI/QI education. Many practicing physicians lack formal education in PI/QI yet are required to teach this curriculum to residents. The objectives of the project were (1) understand the barriers to physician engagement in PI efforts, (2) develop a PI curriculum focused on the needs of physicians from various environments, (3) develop an integrated structure for guiding and monitoring PI, and (4) develop an oversight committee to provide decision makers with quality data for strategic planning.

Methods: All core faculty from our 11 residency programs received face-to-face communication regarding the need for physician-specific PI/QI curriculum and their role in teaching this curriculum. We developed a core curriculum (developing competency in core tenets of PI/QI) and an advanced curriculum (supporting 90-day cycles of project work) that were piloted by 18 core faculty. A gap analysis was performed in the 2 participating residency program areas and charters were created (MICU Continuity of Care and Error Reporting in the Family Medical Center). We established an oversight committee to develop an integrated structure to support curricular development and a reporting structure for project work. We are developing a tool to assess resident core learning and self-assessed PI proficiency.

Results: Early results indicate a recognized need for physicians to become proficient in PI/QI as part of their daily work. As an outcome of the project, the Internal Medicine and Med-Peds residency programs are partnering with us to develop a practice-based learning and improvement (PBLI) curriculum in PI/QI.

Conclusions: Stakeholder analysis and face-to-face communication at all levels are critical to success. Developing an accessible and easy-to-use online PI core curriculum increases physician participation. Project work is successful when tightly scoped and within the area of responsibility of the physician leading the effort. Feedback on the pilot project will be used to continue to increase the quality of our curriculum.

FINAL WORK PLAN – OSF Saint Francis Medical Center and University of Illinois College of Medicine

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

The Reading Health System, Reading, PA

Resident-Led Education in Process Improvement

Background: QI leads to better patient care, and residents need QI training to be successful in future practice. Many of our physicians never received training in QI and no mechanism currently exists within the institution for support of QI learning. Our team's goal was to create a train-the-trainer model in which residents receive additional training in QI and teach that material to our ambulatory offices. The train-the-trainer model is a cost-effective method of harnessing available resources to provide education across the institution.

Methods: The team sought to develop a train-the-trainer supplementary curriculum for primary care residents in leadership and education, create a QI curriculum for physicians and staff at the ambulatory offices, train physicians and staff via 5 1-hour sessions, engage physicians and staff in project selection and implementation, enable residents' ongoing project support, provide data to QI department for analysis, and report findings to hospital leadership.

Results: Evaluation measures included (1) a case-study analysis of the train-the-trainer model to examine the feasibility and efficacy of our program; (2) participant surveys, before and after the intervention, abstracted from the AIAMC NI III; and (3) presurvey and postsurvey documents to assess participant understanding of process improvement. Other process and outcome measures were specific to trainee-selected projects. Barriers included obtaining buy-in from administration, physicians, and staff and limited resident availability due to other responsibilities and scheduling conflicts.

Conclusions: Next steps will include implementation of the educational sessions for the physicians and staff of the primary care office, project rollout and assessment, and completion of qualitative analysis resident perspectives. After a follow-up survey of office staff, final project metrics will be reported to administrative leadership. The curriculum will be modified based upon findings, and the program will be repeated in 2 practices. Graduating residents who join the staff will assume leadership positions in PI.

FINAL WORK PLAN – The Reading Health System

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Riverside Methodist Hospital, Columbus, OH

Monitoring Resident Burnout While Building Resilience in a Multidisciplinary Community Hospital

Andrew Rhinehart, Laurie Hommema, Jim Schmidt

Background: A 2010 safety attitudes questionnaire showed a disparity in safety culture and stress recognition among our residency programs. Demanding work hours, high amounts of debt from medical education, emotional exhaustion, and decreased sense of control cultivate resident burnout, which negatively impacts patient safety and QI. We sought to implement a sustainable curriculum that would better monitor stress recognition and resident burnout while also improving resilience and the safety culture in GME.

Methods: Project staff developed and distributed burnout surveys to all program residents and incoming interns. Based on the results of a curricular needs assessment, a resilience and safety curriculum was implemented in 3 of 4 residency programs. Project staff also introduced a monthly interdisciplinary conference.

Results: Initial data showed the need for change that reinforced buy-in. Interdisciplinary conferences were well attended. CME is now offered to attending physicians for participation in QI and safety lectures. We have seen a gradual but palpable shift in the safety culture. Survey results after intervention are pending.

Conclusions: Residents in all specialties exhibit moderate to high amounts of burnout; burnout was evident even in incoming interns. As burnout is directly related to patient safety, it is essential that residents receive training in resilience. We will implement curriculum changes in the remaining residency program, continue to develop the new standard for morbidity and mortality (M&M) conferences, and introduce new resilience conferences.

FINAL WORK PLAN – Riverside Methodist Hospital

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Saint Francis Hospital and Medical Center, Hartford, CT

Effects of Formalized Healthcare Delivery Science Curriculum on Scholarly Activity in an Obstetrics and Gynecology Residency Program

L Shlansky, P Roland, R Crowell, G Makoul, A Negrini

Background: Our Department of Obstetrics and Gynecology instituted a healthcare delivery science curriculum focusing on QI and research with the goal of improving the quality and quantity of research initiatives among faculty and residents. Desired outcomes included increased resident and faculty confidence to conduct or oversee QI/PI and research projects, as well as increased resident ability to accomplish essential communication tasks during clinical encounters.

Methods: Our curriculum consists of 20 hours of protected resident time during the academic year. Topics include fundamentals of healthcare delivery science, principles of QI, research design and statistical analysis, and teamwork and communication. The lectures are attended by PGY2-PGY4 residents; 15-minute postlecture work sessions focus on different areas for each year of residency. QI and research staff guide residents through project coordination.

Results: We measured progress via completion of the first iteration of the resident curriculum, completion of a QI/PI project by PGY2 residents, and completion of research projects by PGY3 and PGY4 residents. Our pre- and postintervention measure was a survey of residents and faculty concerning QI/PI knowledge and skills. A communication assessment tool provided systematic feedback to residents on patient perspectives. We also compared residents' scholarly activity pre- and postintervention; preintervention, 75% of residents were engaged in independent research projects and 0 grants were obtained, compared to 91% engagement and 3 grants obtained postintervention. We have observed more coherence, greater resident-faculty interaction, and better integration of GME and QI/PI. Barriers included time constraints, resident-staff skepticism, and organizational challenges.

Conclusions: Next year, we plan to split topics by PGY cohorts, engage more faculty in the initiative, and incorporate both resident and faculty feedback before beginning the next curricular cycle.

FINAL WORK PLAN – Saint Francis Hospital and Medical Center

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Scott & White Healthcare and Texas A&M Health Science Center College of Medicine, Temple, TX

The Results of a House Staff Quality Council (HSQC) in its Inaugural Year

JL Dixon, CS Swendsen, A Best, M Brackman, J Campbell, J Collins, S Hovland, J Knabe, J Morelli, A Morris, W Rodriguez-Collado, H Stagg, T Berry, JP Erwin III, RK McAllister, HT Papaconstantinou, H Wehbe-Janek

Background: Residents and fellows perform a large portion of the hands-on patient care in tertiary referral centers. As frontline providers, they are well suited to identify quality and patient safety issues. As payment reform shifts hospitals to a fee-for-value–type system with reimbursement contingent on quality outcomes, preventive health, and patient satisfaction, house staff must be intimately involved in identifying and solving care delivery problems related to quality, outcomes, and patient safety. Many challenges exist in integrating house staff into the QI infrastructure; these challenges may ideally be managed by the development of a house staff quality council (HSQC).

Methods: Residents and fellows at Scott & White Memorial Hospital interested in participating in a quality council submitted an application, curriculum vitae, and letter of support from their program director. Twelve residents and fellows were selected based on their prior QI experience and/or their interest in quality and safety initiatives.

Results: In only 1 year, our HSQC initiated 3 quality projects and began development of a fourth project.

Conclusion: Academic medical centers should consider establishing HSQCs to align institutional quality goals with residency training and medical education.

FINAL WORK PLAN – Scott & White Healthcare and Texas A&M Health Science Center College of Medicine

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Scottsdale Healthcare Family Medicine Residency / Scottsdale Healthcare, Scottsdale, AZ

Development of a Multidisciplinary Quality Improvement Clinical Forum: Improving Patient Outcomes Across the Continuum of Care

N Johnson, R Marlow, C Kegowicz, C Beaudry, Charles Finch

Background: Our goal was to identify a systemwide, sustainable model of integrated patient care that embraces education and patient-oriented quality measures. Objectives included (1) at least 1 family medicine resident will participate in every quarterly quality review meeting between January 2012 and April 2013; (2) family medicine chief residents and the medical director of CME will implement at least one Grand Rounds meeting quarterly between October 2012 and April 2013; (3) case review will evaluate strengths and opportunities related to integrated patient care and patient-oriented outcomes; (4) attendance at Grand Rounds will reflect multidisciplinary participation as relevant to the case review; (5) participants will demonstrate improved understanding of integrated patient care, including QI knowledge; (6) all CME and GME learning activities tied to curricular development will include quality metrics starting in November 2013.

Methods: Program activities included development of a multidisciplinary QI clinical forum that focuses on improving patient outcomes across the continuum of care, alignment of CME and GME learning activities to curricular development, and the development of quality metrics.

Results: The most successful component of our work was teamwork and identifying a high-quality sustainable educational program. The largest barrier we encountered was sustainment across the system. We worked to overcome this by involving multiple levels of the system, driven by physician leadership. We have observed integration of QI into the curriculum and GME into the QI process.

Conclusions: We have identified opportunities for improvement regarding knowledge and adoption of QI methods. Fewer than half of the participants had working competency in QI prior to the forum. Almost 90% will adopt QI methods and measures in their clinical practice. Baseline pediatric asthma quality metrics showed favorable results. In the next PDSA cycle, physician leaders will assist in defining key metrics, and we will implement quarterly project monitoring.

FINAL WORK PLAN – Scottsdale Healthcare Family Medicine Residency / Scottsdale Healthcare

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

TriHealth, Cincinnati, OH

A Systemwide Resident Quality Improvement Program

D Dhanraj, L Stephens, R Welling, A Fulbright, L Galvin, A Kumar, A Uebele, B Singletary, F Warsi, B Khan

Background: This project focused on developing an organized approach to incorporating quality and patient safety into the resident program. The goal was to provide a strong foundation in performance improvement that can sustain residents into their careers as licensed independent practitioners.

Methods: We performed an assessment of existing resources across the 4 residency programs and a gap analysis of the assessment findings. A reporting structure was established, as well as a scorecard and metrics for monitoring improvement efforts. We administered baseline and postintervention surveys of residents' QI knowledge.

Results: We successfully defined metrics for each residency program; formalized a residency council; and aligned a reporting structure with the organizational quality, safety, and service council. Resident projects were incorporated into existing quality and patient safety days. Survey results aided in defining residents' understanding of current quality, patient safety, and service standards. Varied resident schedules made it difficult to find a common time for meetings. Cultural shift will be slow, due to changing groups of residents; project impact will not be fully realized for 3 years. Changing ACGME requirements add complexity to formalizing the program.

Conclusions: Our next steps include standardizing documentation for accurate reporting, developing a scorecard for clinical and academic performance that aligns with defined metrics, continuing resident involvement in quality and patient safety projects, and administering a postintervention survey.

FINAL WORK PLAN – TriHealth

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Virginia Mason, Seattle, WA

Pause for Feedback

Gillian Abshire, Kathleen Agard, Alvin Calderon, David Coy, Brian D Owens, Joey Parker, Ryan Pong

Background: Effective feedback is necessary to reinforce positive behavior, correct deficits in clinical knowledge and skills, and provide residents with an understanding of their progress and opportunities. Our goal was to advance the culture of QI and PS and enrich faculty and resident educational experience by improving competence of team members who give and receive feedback. Both resident and faculty surveys identify feedback as the top development opportunity within GME.

Methods: Initial investigation revealed a gap between resident and faculty perceptions about the frequency of feedback provision. In all GME programs, 72% of faculty reported providing feedback at least weekly; only 46% of residents reported receiving feedback weekly. A Pause for Feedback process and checklist tool were implemented in the radiology and anesthesiology programs. Residents and faculty were briefed on the new process. In radiology, residents were asked to initiate the request for face-to-face feedback at least 1 time each week from faculty of their choice. Anesthesiology incorporated the checklist into an established weekly feedback process. Faculty were asked to actively participate in and to validate the resident's self-appraisal and to verbally guide improvement strategies and tactics.

Results: The most successful component of our work was faculty and resident engagement in the process. Both participating departments saw increased concordance between faculty and resident perception of the frequency of feedback exchanged. Scheduling difficulties when working across multiple GME programs restricted the time available to work collaboratively. The process of team visioning delayed fail forward fast and rapid-cycle PDSA implementation. Sample size was limited.

Conclusions: Using a checklist and allowing GME programs to operationalize a process for weekly feedback resulted in increased concordance in resident and attending perceptions of frequency of feedback. Different processes for implementing Pause for Feedback were equally effective in radiology and anesthesiology programs.

FINAL WORK PLAN – Virginia Mason

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

Western Michigan University School of Medicine, Kalamazoo, MI

Closing the Feedback Loop: Effectively Communicating Pap Smear Results Using an Electronic Health Record

Carrie Janiski, Elizabeth Doherty, Mark Schauer

Background: Screening for cervical cancer is currently recommended for all women with a cervix who are ages 21–65. Reporting test results to patients offers a valuable educational opportunity for both the patient and the clinician. Our initial goal was to gain experience with a small, discrete project based in a high-traffic process (ie, standardizing normal Pap smear reporting) that would have measurable impact for patients and residents in our primary care clinics. Secondarily, the project would serve as a means for NI III participants to become better trained facilitators and disseminators of QI curricula.

Methods: A 3-question survey was distributed among primary care residents to determine their knowledge of lab reporting policies and preferences for patient contact regarding lab results. Common practices among practitioners and reporting capabilities of a newly launched EHR were reviewed. Aims, measures, and a timeline were developed across a multidisciplinary team of clinicians and staff.

Results: For normal Pap results, a standardized letter is generated with educational language and follow-up recommendations as noted by the ordering physician when reviewing the lab result in the EHR. Weekly compliance reports are provided to clinic directors for feedback. Preimplementation, 7 of 42 resident physicians indicated they knew what the lab reporting policy was. At baseline, 39% (n=64) of normal Pap results were compliant with the new policy; within 6 months, 78% (n=85) of normal Pap results were compliant.

Conclusions: This project provides a framework for patient-provider communication that could be expanded to other test results; it also provided QI exposure to key stakeholders and mentors toward affecting a positive culture change at our institution. Curriculum development is ongoing and is likely to be most successful in conjunction with resident-driven hands-on projects. One small but measurable contribution to curriculum development was the incorporation of IHI Open School modules for residents across all programs.

FINAL WORK PLAN – Western Michigan University School of Medicine

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Ochsner J. 2014 Spring;14(Spec AIAMC Iss):4–36.

York Hospital / WellSpan Health, York, PA

Improving Obstetrical Rapid Response Teams (Code Neon): Multidisciplinary Simulation Training Using the Plan-Do-Study-Act Cycle

Karen Smith, Jennifer Leash, Tracy Cadawas, Jennifer Aguilar, Eileen Garavente, Duane Patterson, Meredith McMullen, Denita Boschulte

Background: Citing a rise in maternal mortality and mrbidity, the American College of Obstetricians and Gynecologists (ACOG) and The Joint Commission (TJC) called for creation of obstetrical rapid response teams (RRT). Our objective was to create a multidisciplinary RRT via implementation of a mass page alert system; improve access to medication, equipment, and supplies; improve teamwork and communication during emergencies; improve staff satisfaction with emergency response; and identify the most common errors in OB emergencies.

Methods: The RRT commits to 4 half-day simulations annually. Each multidisciplinary training session includes a performance-improvement lecture for nurses and residents, a lecture in 1 emergency, small-group discussion using PDSA to consider trial changes for simulation, and group trial of PDSA changes during simulation. The in situ simulation is witnessed by the full team, videotaped, and added to the PDSA library. The team debriefs and creates an action plan; the PDSA changes are trialed clinically during real calls. Successful changes are implemented and reviewed at the next simulation.

Results: The team reduced the number of emergency response calls from 10 individual calls to one hospitalwide Code Neon Alert and reduced access to emergency medications from 12 steps to 2. A preintervention survey found that up to 30% of obstetrical providers perceived a deficit in teamwork and communication, and 40% perceived a deficit in access to equipment and supplies during emergencies. In a 2012 postsimulation survey, 98% of participants responded positively to a statement regarding the speed of staff emergency response, 75% responded positively regarding clear emergency communication, and 84% responded positively regarding the availability of emergency supplies and medications.

Conclusions: Multidisciplinary PDSA cycle training and simulation helped the RRT identify process and system barriers and encouraged team building and problem solving. PDSA simulation training empowers staff to implement clinical changes and improves patient care. Lack of obstetric EHRs impedes data collection needed for pre and post comparison.

FINAL WORK PLAN – York Hospital / WellSpan Health

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Articles from The Ochsner Journal are provided here courtesy of Ochsner Clinic Foundation

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