The Medicine Quality Improvement and Patient Safety (QI/PS) educational programs seek to ensure that all faculty members and trainees understand the rationale behind continuous quality improvement and have the skills to improve systematically the care they give.
- Development of continuous self-directed learning with respect to quality of care.
- Satisfaction of the Accreditation Council on Graduate Medical Education (ACGME) core competencies in systems based practice, practice-based learning and improvement.
- Demonstration of the importance of provider reporting of medical errors and near misses.
- Increased participation in QI/PS initiatives in the Department of Medicine.
The training efforts in QI/PS for residents form an important component of an Educational Innovation Project, which was awarded to the department by the Residency Review Committee (RRC) of the American Committee on Graduate Medical Education (ACGME).
Examples of QI/PS Education Programs include:
- Medical Procedure Service
- Re-organization of ward residents into unit-based
- Geographically-integrated teams
- Stoneman QI/PS Rotation.
Medical Procedure Service
Medical residents perform all procedures such as placement of central lines, paracentesis, lumbar puncture, and thoracentesis while they rotate on this inpatient service. Certified faculty members and fellows from either the hospital medicine or critical care attending staff directly supervise all house-staff procedures. The rotation includes didactic sessions and simulator training.
Geographic Microsystems Initiative
Ward residents are now organized into unit-based, geographically-integrated teams. Clinical process and outcome measures are collected for each unit, and results are periodically reported back to the unit-based resident teams. Such direct feedback on local clinical performance serves as the basis for engaging residents in analysis of their own system-based practice and participation in unit-based quality improvement initiatives.
The Stoneman QI/PS Rotation
As part of the residency educational curriculum, junior and senior residents participate in small group discussions and work on a project related to performance improvement on the medical units or in the clinics. Resident projects have included improving handoffs between interns and from the emergency room to the floor; standards around venous thromboembolism prophylaxis, Foley catheter use, and use of oxygen on the units; patient satisfaction and ability to identify their physicians, nurses, and the plan for the day; improving access to follow-up appointments; and compliance with influenza vaccination. Each group of residents identifies key issues, outlines the process of care and selects a metric for measurement. Interventions are developed and results are achieved over several 3 week "Plan-Do-Study-Act" (PDSA) cycles.
In addition to performance improvement, residents participate in our peer review process around medical errors and near misses. Residents investigate a case, and with the help of a patient safety coordinator, write up and present a Root Cause Analysis (RCA). They review the chart, speak to parties involved, and identify contributing factors. In the last year, 45 residents have participated and over 80% have presented the cases at Medical Peer Review Committee for discussion. Lastly, residents have an opportunity to attend a variety of quality improvement committee meetings as they learn how the QI/PS process functions within the medical center.
A core faculty comprised of 8 attending physicians and a patient care coordinator with expertise in QI/PS methodology, support and mentor residents in this rotation.
Mark D. Aronson, Naama Neeman, Alexander Carbo, Anjala V. Tess, Julius J. Yang, Patricia Folcarelli, Kenneth F. Sands, and Mark L. Zeidel. A Model for Quality Improvement and Patient Safety Programs in Academic Departments of Medicine. Am J Med. 2008 Oct;121(10):922-9.