CIR & PEI QI Update
Wednesday, July 29, 2015 at 11:22AM 14 CIR Leaders Selected for Telluride Patient Safety Summer Camp
14 CIR leaders were selected in a highly competitive process as 2015 Telluride Scholars to participate in the legendary Patient Safety Summer Camps this summer in Colorado and Washington, DC. Telluride is a one-week experience that offer a highly interactive format to address ethical, professional, legal and economic dilemmas regarding patient safety, transparency, disclosure, and the growing need for open and honest communication when medical errors and adverse events occur.
Residents attending the Colorado camp returned from the brisk mountain air and the stimulating discussions inspired and primed to apply their new knowledge. “Standing with a group of leaders who are equally passionate about quality and patient safety has reinvigorated me,” blogged resident Dr. Cassidy Dahn of Boston Medical Center. “I hope to return and teach Patient Safety more effectively to my colleagues with some of these motivating methods.” Reflecting on the experience, Dr. Dahn added, “Don’t let the system help you forget why you practice medicine. It is a privilege that patients allow us into their lives in such a way. Take a breath and remember that between each patient encounter.” More here.
ACP Awards CIR Member First Prize for Resident QI Project
Sparked by experiences with unexplained symptoms of two patients who turned out to be taking herbs, University of New Mexico resident Dr. Christopher Bunn developed an intervention to upgrade the EMR 
Dr. Bunn’s survey of UNM physicians revealed that many were not asking their patients about supplement uses. His intervention includes educating UNM physicians about JCAHO requirements for medication reconciliation and the possible dangers of common supplement-medication interactions. Those providers will also be trained in the supplements’ proper use and in documenting that usage with the newly-created section of the EMR. Dr. Bunn sees his intervention as an example of where QI needs to go next. “A lot of the processes we have are not standardized,” he said. “That’s really the future of medicine -- finding a way to take care of our very diverse population and provide the most accurate care you can by building upon tools that exist.” More here.
Resident QI Clinic Completed as Pilot Project at 2 NYC Hospitals
Residents and faculty at two New York hospitals are armed with new QI tools after a successful six-month pilot Resident QI Clinic. The program, developed by CIR PEI’s QI Innovation Institute in partnership with the Society of Hospital Medicine, included QI skills-training and practical project development for residents at Bronx-Lebanon Hospital Center and Harlem Hospital Center in New York City. After large-group instructional sessions taught by expert educators on quality improvement and patient safety, residents launched capstone projects aimed at improving processes and patient outcomes. The teams’ presentations to their colleagues at the final session were acclaimed by administrators who look forward to to supporting their implementation.
“You can’t do QI work in a vacuum. Part of the exercise is also for residents to learn who they need to engage at their hospital that isn’t a part of their work flow during the day, to help make interventions successful,” said Dr. Alexandra Gottdiener, Chair of Medicine at Englewood Hospital Medical Center, one of the two faculty mentors for the QI Clinic.
“QI clinic has been a great experience,” commented Dr. Mayank Yadav, CIR delegate in Internal Medicine at Bronx Lebanon Hospital. “It helped me to understand what patients go through in the hospital system. It has also helped me to learn the basics of research. It’s really a combination of understanding how to be part doctor, part human and part patient.” More here
CIR Hosts Conference on Addressing Health Disparities in Clinical Practice
On April 25, CIR hosted the latest in its annual What’s Your QI IQ? conference series, “Addressing Health Disparities In Clinical Practice”. The event featured presentations and workshops by faculty from such institutions as the city health department, the NYC public hospital system, and Columbia University. Residents had the opportunity to learn about strategies for reducing disparities in their hospitals; building community partnerships; health literacy training to improve adherence; and CIR’s own Family Health Challenge which has brought scores of residents into schools in low-income Bronx and Brooklyn neighborhoods to teach about obesity prevention.
Many attendees appreciated the training in health literacy, including skills involving simplifying verbal and written explanations and directions, increasing the use of graphics, and other ways to make information more accessible to patients with lower educational levels. One participant said they planned to implement the methods taught “to improve health literacy in [the] population I serve.”
Participants were moved by the passionate argument of Dr. Lydia Isaac, a leader at New York City’s public hospital system , that health disparities should more appropriately be labeled health inequalities. She explained that the former fails to reference the roots of the poorer outcomes among people of color and low-income populations, which lie in discriminatory policies in housing, healthcare, criminal justice, and the environment. More here
Miami Residents Blaze QI Trails
CIR residents at Jackson Memorial Hospital in Miami hosted their first quality improvement conference in May, where they announced grants to three Jackson residents to pursue innovative QI projects. Karyn Baum, MD, a nationally recognized expert in teaching QI, came from the University of Minnesota with a cartoon-laden and highly informative presentation on what QI means for residents. Dr. Baum made a passionate call for housestaff to take the reins of this vital task: "If we don't engage in quality work, someone else will, and we will be irritated with the results.” She offered detailed tips on launching effective QI projects.
The QI grants drew on Jackson’s Housestaff Involvement Fund. CIR had bargained $125,000 annually for resident projects aimed at improving patient care and clinical outcomes. The winners were: Dr. Kathleen Rooney-Otero, for training on long-acting, reversible contraceptives for residents serving adolescents; Dr. Abiona Redwood, for improving medication adherence through motivational interviewing and health-literacy tools; and Dr. Matthew Thomas, for a mobile app for physicians to decrease inappropriate use antibiotics.
“The most recent request for QI proposals was met with incredible enthusiasm and innovation from residents across many different disciplines,” said Dr. James Banks, a member of CIR’s Quality Improvement Committee at Jackson that awarded the grants. “We plan to work hard alongside these quality champions to improve processes and outcomes across the Jackson Health System,” he added. The Committee looks forward to making the grant awards annually.
At the conference, local hospital administrators shared educational resources available to residents and ways to get support for future QI projects. Jackson ophthalmology resident Dr. Scott Walker presented on the Diabetic Retinopathy Pipeline, a successful QI project that was also financed through the Housestaff Fund. More here.
QI and Disparities Are Major Themes at CIR National Convention
When some 250 CIR delegates, leaders, and staff gathered in the nation’s capital in May for the union’s annual convention, quality improvement and health disparities/inequities were key themes that echoed through plenary sessions and workshops alike.
CIR members were in the forefront of presenting successful QI projects. Dr. Alla Lescure Smith and Dr. Ryan Macht laid out the strategies they used at Boston Medical Center to significantly increase housestaff reporting of adverse events and near misses. Dr. Nanna Osei-Tutu, Dr. Amira Shafey, and Dr. Libbat Shaham explained their role in developing the iLISTEN program to improve doctor-patient communication at Jamaica Hospital in NYC. They used their experience to illustrate how to nurture an idea, create effective partnerships, embark on viable large-scale projects, and drive the process forward with QI research.
Attendees also heard from renowned national QI experts. Dr. Neel Shah, Executive Director of Costs of Care, spoke about ways to reduce unnecessary tests and treatments. Rosemary Gibson, M.Sc., Senior Advisor to the Hastings Center, unveiled an exciting new app that allows residents to rate the safety culture of their programs and hospitals -- and to help build a national safety culture database.
Workshops focusing on health disparities/inequities included one on the medical trainee-led “White Coats for Black Lives” movement challenging racism as a threat to the health and well-being of people of color; and another on homophobia and transphobia in medicine and the ways they contribute to LGBT health disparities, which included discussion of CIR’s member survey on these issues.
CIR members said the presentations would help them provide better care. “It was very exciting to take what I learned from the adverse events reporting back to my hospital to further improve patient safety,” wrote one participant. Commenting on the impact of good communication at the iLISTEN workshop, another said, “ We understand our patients better, empathize more and intervene effectively.” More here.
CIR Residents Present QI Projects at AAMC Integrating Quality Conference
A team of residents at New York City’s Metropolitan Medical Center was recognized for an innovative project in their Emergency Department that implemented huddling to improve teamwork and staff satisfaction. Dr. Peter McCorkell, rising chief, secured a prestigious oral presentation on behalf of the team at the Association of American Medical Colleges (AAMC) Integrating Quality Conference in Chicago.
The residents’ 11-month-long intervention, employing simple five-minute all-staff huddles every two hours, achieved stunning results, including greatly increased staff satisfaction, improved communication, faster patient processing, and reduced numbers of patients leaving without being seen. The team will also be presenting at Metropolitan during Patient Safety Week and Interdepartmental Grand Rounds. The team explained their intervention: “Huddles are an easy-to-perform task that can be instituted in any emergency department. In this case, huddling seems to encourage team-building, it allows all staff an opportunity to interact with administration, and it improves communication in the ED even when huddles are not occurring.”
Other CIR residents who were invited to present posters included:
- Drs. Bibi Ayesha & Aisha Siraj from Bronx Lebanon Hospital (Improving Patient Safety Through a Simple Team Approach)
- Drs. Deliana Peykova and Ana Flores from Lincoln Medical Center (Pain Management, Don't Let it be a Pain in the Neck! A Community Hospital's Quality Improvement Initiative)
- Drs. Joslyn Wiley & Alexandria Beranger from Jackson Memorial Hospital (Developing a Patient Safety/QI Curriculum for Residents)
Fellowship Awarded to Reduce Costs in OB-GYN
As cost-conscious medicine comes to the fore, CIR residents are gaining recognition for their cutting-edge work in this field. Dr. AnnMarie Vilkins, PGY-2 in OB-GYN at Boston Medical Center, was awarded a highly competitive fellowship from the American College of Physicians (ACP) for her project to reduce unnecessary and expensive prenatal prescriptions by starting with low-cost treatments.
The Choosing Wisely High Value Care in Action Fellowship will support Dr. Vilkins’ efforts to bring her department’s prescribing practices into conformity with the stepwise approach recommended by the American College of OB-GYNs (ACOG). Dr. Vilkins will be presenting her results at next year’s ACP Internal Medicine meeting.
CIR Residents Present QI Projects at the National Patient Safety Foundation Annual Congress
Residents from CIR chapters at Brookdale, Harlem, and Metropolitan presented posters at the invitation of the National Patient Safety Foundation in Austin, TX. The following initiatives were selected for presentation:
- An adverse-event reporting project by the House Staff Safety Council at Brookdale has allowed residents to spread safety awareness throughout the hospital, promoting a shared vision and strategy, according to research presented by Dr. Miliana de la Cruz and Dr. Snow Trinh Nguyen.
- An educational intervention with residents at Harlem Hospital was followed by a major reduction in needlestick injuries over two years and allowed for the development of a new culture of prevention. The project team was led by Dr. Matthew Chatoor.
- A survey of residents at Metropolitan Hospital found that fatigue, distraction and availability of medication are the three most common factors that affect the prescribing behavior of resident physicians. To address these issues, the team, led by Dr. Sun Young Kim, created an anonymous online patient safety hotline and arranged additional training for all house staff through several QI/PS programs.
Another multidisciplinary survey at Metropolitan found large percentages of providers who were unfamiliar with the definitions and diagnostic criteria for sepsis and the related systemic inflammatory response syndrome (SIRS). The team, led by Dr. Samrina Kahlon, emphasized the need for hospitals to implement a structured educational curriculum for the medical staff highlighting the different definitions, early diagnosis, and treatment of sepsis.
A survey by Metropolitan pediatric residents, whose results were presented by Dr. Naveen Kannekanti, revealed gaps in doctors’ education of parents of overweight children about effective obesity prevention and management methods. The team identified appropriate targets for improving communication between physicians and parents to improve health knowledge.
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