Internal Medicine GME: Patient Safety and Quality Improvement Learning Program
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1 Internal Medicine GME: Patient Safety and Quality Improvement Learning Program RESULTS OF EXPERIENTIAL PROJECT LEARNING FOR 2 ND YEAR RESIDENTS ACADEMIC YEAR: JULY 2017 JUNE 2018 LAST UPDATED: 3/5/18
2 Program Summary: Academic Year Projects July 2017 June 2018 AS OF Program Evaluation 50% (4/8) had impact - presented, published, implemented, or connected to larger QI project Project Evaluation Residents self-reported 34% improvement in knowledge and 43% improvement in comfort level with QI methodology 89% extremely satisfied with faculty facilitator overall support of project 85% extremely satisfied with PI team member overall support of project Impact Summary Scholarly Work CVC Value Challenge Finalist, Oct 2017 (Add-on Labs) Change implemented in MiChart, Jan 2018 (Anion Gap) Change implemented at VA, Dec 2017 (Vital signs in CPRS) Poster at SHM 2018 (J. Zhang submitted, HospMed/Onc Communication, from FY17) Faculty/resident education implementation in progress, Jan 2018 (Priority Discharge) 1 HO2 pursuing 2-week QI elective after project month (Project TBD) 1 HO3 initiating independent QI project (Advanced care planning for Liver Transplant patients)
3 July 2017 Faculty Facilitator: Gabe Solomon PI Team member: Matt Johnson House Officers: Irene Tsung, Arthur Taylor, Russell Dolan, Ryan Cooney, Jonathan Bender Ann Arbor VA Vital Sign Incorporation into CPRS This work was piloted on one unit at the VA in December 2017, and will be rolled out to all units if the pilot goes well.
4 August 2017 Faculty Facilitator: David Stewart PI Consultant: Tammy Ellies House Officers: Catherine Wilson, Kaitlyn Vitale, Christopher Grondin, Jackson Murrey-Ittmann, Khalid Abdul Majeed Other: Zach Haupt (VA) A3 coming soon This group independently submitted their project to the CVC Value Innovation Challenge and were selected as finalists.
5 September 2017 Faculty Facilitator: Jen Stojan PI Team member: Katie Schwalm House Officers: Justin Sovich, Patrick Green, Tori Nault, Lina Brinker, Alicia Alvarez A3 coming soon Incidental Pulmonary Nodules follow up after discharge
6 October 2017 Faculty Facilitator: Lauren Heidemann PI Team member: Liz Spranger House Officers: Mark Ziats, Alexandria Miller, Apurba Chakrabarti, Katherine Chakrabarti Mind the gap: unnoticed anion gaps leading to missed clinical opportunities MiChart Tell-All January 16, 2017: Screenshot example:
7 November 2017 Faculty Facilitator: David Stewart PI Team member: Liz Spranger House Officers: Rachel Criner, Emily Hautman, Kelli Paice, Suraj Suresh Other: Obsinet Merid (Hospital Medicine) Medical Vampirism: Reducing Unnecessary Diagnostic Phlebotomy
8 December 2017 Faculty Facilitator: Gabe Soloman PI Team member: Tammy Ellies House Officers: Ashley Cobb, Raymond Yeow, Emma Weeding, Max Wayne, Daniel Chun Resident services are not meeting priority discharge goals Created slides to be used by CMR at morning report discussions. Meeting with Robert Chang in January 2018 about education to faculty who attend with residents. Received positive feedback from Priority Discharge project manager.
9 January 2018 Faculty Facilitator: John Gosbee PI Team member: Tammy Ellies House Officers: David Saxon, Anthony Scott, Molly Tokaz, Tracey Alperin Other members: Zach Haupt (VAMC), Clara Kil, Kathryn Li (IHI students in MSHA program) Appropriate triage of Hem/Onc patients in ED to General Medicine or Hem/Onc services
10 February 2018 Faculty Facilitator: Jen Stojan PI Team member: Liz Spranger House Officers: Anand Venugopal, Matthew Thau, Stephen Simmer, Yaser Carcora Other members: IHI-OS students: Esha Kamath, Kayla Mandel, Krittika Pant, Sarah Sugar Potassium OverSupplementation is a potential risk among CHF patients admitted to the University Hospital Medicine Cardiology Service
11 March 2018 Faculty Facilitator: Sandro Cinti PI Team member: Matt Johnson House Officers: Other members: Title
12 April 2018 Faculty Facilitator: PI Team member: House Officers: Other members: Title
13 May 2018 Faculty Facilitator: PI Team member: House Officers: Other members: Title
14 June 2018 Faculty Facilitator: PI Team member: House Officers: Other members: Title
15 Academic Year HIGHLIGHTS
16 Program Summary: Academic Year Projects July 2016 June 2017 Program Assessment 33% (4/12) had impact (presented, published, implemented, or connected to larger QI project) Scholarly Work CBC daily labs (poster) SHM 2017 conference DNAR Code status reversals for cardiac procedures (poster) - Quality Month, October 2017 and CVC Leadership quality showcase, December 2017 Impact Summary New curriculum modules and PI team/data support began January 2017 (pilot observations occurred Oct-Dec 2016) Pre/post survey began Jan 2017 Communication between providers of hospitalized patients and Oncologists (Feb 2017) part of larger QI project that is still ongoing and scheduled to be completed in How well can you run a code? Assessing resident comfort and confidence with in-house cardiac arrest (poster). American Heart Association, Quality of Care and Outcomes Research (QCOR) Conference 2017.
17 Project Topics Jul Dec 2016 Jul: Lost orders upon patient transfer at AA VAMC Aug: Sept: Floor to ICU transfers Oct: Utilization of Interpreter Services Nov: CBC Daily lab draws Dec: The CODES project: Coordinating Onsite Debriefing, Education and Simulation for In-hospital cardiac arrests. Jan Jun 2017 Jan: Improving inter-hospital transfers Feb: Communication between providers of hospitalized patients and Oncologists Mar: DNAR reversals after cardiac cath Apr: VA SHIFT tool May: Anticipatory Management of Bleeding Complications of Heart Catheterization Jun: Addressing Communication Barriers Between Medical Providers and Physical Therapists PI team observations and pilot of new materials occurred Oct 16 Jun 17
18 Project leading to conference poster Nov 2016: CBC Daily lab utilization
19 Project supporting existing faculty project Feb 2017, Hospital Medicine/Oncologist Communication
20 Project presented at AHA QCOR Dec 2016, How well can you run a code?
21 Quality Month submission and project that continued after project month March 2017: DNAR Code Status Reversals for Cardiac Procedures
22 Acknowledgements Faculty Facilitators: John Gosbee, Lauren Heidemann, David Stewart, Sandro Cinti, Jen Stojan, Gabe Soloman Internal Medicine Performance Improvement Team: Tammy Ellies, Matt Johnson, Katie Schwalm, Liz Spranger, Linda Bashaw Chief Residents: Zach Haupt (VAMC), Kate Levy PSLP Steering Committee: Nate Houchens, Chris Petrilli, Kate Levy, Lauren Heidemann GME Program Leadership: Nate Houchens, John Del Valle, Jen Lukela
23 References M-Box: Curriculum modules A3 and Powerpoint slides from each monthly rotation Catalog of past projects Surveys Program Evaluation: Learner Assessment: Project Evaluation:
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