Resident Driven Quality Improvement · Background and Rationale Resident Driven Quality Improvement...
Transcript of Resident Driven Quality Improvement · Background and Rationale Resident Driven Quality Improvement...
Background and Rationale
Resident Driven Quality Improvement
Arash R. Zandieh MD1, Danielle DeMulder MD1, Matthew J. Minn MD1, Cirrelda J. Cooper MD2
1 = Resident Physician, Medstar Georgetown University Hospital, Department of Radiology, Washington DC2 = Vice Chair, Professor and Co-Chief of Abdominal Imaging, Medstar Georgetown University Hospital, Department of Radiology, Washington DC
Example Quality Improvement & Patient Safety Projects Discussion
Conclusion
Acknowledgements
Abstract
At our institution, we hold a regular monthly
Radiology Departmental meeting to review
quality metrics and patient safety in a
comprehensive manner. Resident-driven
quality improvement and safety projects are a
central feature of the conference. The
meeting serves as a platform for integrating
clinical education and quality improvement
while encouraging trainee initiative and
leadership in a practical, hands-on approach.
Such an approach is easily reproducible and
may be employed at other educational clinical
sites to facilitate resident education and
foster a commitment to patient safety.
The Department of Radiology at our
institution hosts a one hour monthly Quality
and Safety Conference in a consistent time
slot and day. The conference is targeted to
attending physicians, fellows and residents
but open to the entire department, including
nurses, technologists, administrators, support
staff and medical students. The conference is
designed to review quality metrics, recent
occurrence reports and safety. The
centerpiece is a resident-driven 20 minute
segment on quality improvement, which
provides a highly visible platform for residents
to showcase individual projects before the
entire department.
The conference is organized and run by the
Vice Chair, who oversees departmental
operations and patient safety. Resident
participation is sanctioned by the residency
program director. Each Radiology resident
selects a project in consultation with the Vice
Chair.
A regular departmental meeting with
structured participation provides residents the
opportunity to gain hands-on experience in
quality improvement and to make positive
and publicly recognized impact on quality and
safety in their daily work environment. Such
an approach can be easily adopted by clinical
sites and integrated into resident education
curricula. Moreover, this approach actively
engages residents and encourages trainee
initiative, with the goal of fostering a life-long
commitment to patient safety and high quality
health care.
Residents review relevant literature on their
topic and outline their approach with the Vice
Chair. In most cases, initial presentations are
structured to briefly review background
information, present current baseline
department data, strategies to improve
outcomes and are followed by group
discussion. After initiation of process
changes, follow-up metrics are obtained and
presented at later conferences. Most
individual projects are designed to be
longitudinal in nature, encompassing more
than one process improvement cycle.
In some cases, presentations are mostly
educational, without measurable outcomes,
to increase awareness of active safety issues
or to develop consensus policies. Residents
are encouraged to make their presentations
interesting and entertaining. The Vice Chair
provides evaluations to the resident and
program director.
Resident-driven projects have generated
visible process changes, improved outcomes
and increased department interest in quality
improvement. For example, the contrast
allergy project resulted in significantly
improved department metrics. “Error-Bot” has
been highly successful in decreasing targeted
report errors, fostering multiple creative spin-
off projects.
The authors gratefully acknowledge Ashley
Stowell for organizing and facilitating the
monthly meetings; Patricia Cloonan PhD,
Bernard J Horak PhD FACHE, and Eileen
Moore MD for their editorial insights; Ross
Filice MD for developing and implementing
Error-Bot, and the Medstar Georgetown
radiology residents for their enthusiastic
participation.
Sources for Topics
Hospital Initiatives
- Patient identification
- Falls
- Line-associated
infections
Occurrence Reports
- Contrast reactions
- Extravasation events
- Wrong exam
Literature Review
- Radiation dose and
shielding
- Dictation errors
Daily Work
- ED / clinical history
reconciliation
- Gender errors
- Left/right errors
Departmental Topics
- Exam quality
- On-call corrections
- Pre-procedure labs
and policy
- Intra-department
communication
- Power-injectable ports
Resident project reviewed contrast media reactions generated from technologist occurrence reports and assessed
documentation in radiology reports and in variably linked, in some cases noncommunicating, databases used for
inpatient and outpatient care. Initial data indicated a disconnect in dissemination of information on allergic reactions in
both radiology reports and hospital IT systems. Intervention with education, follow-up and feedback shows significant
improvement in the documentation of allergies in radiology reports but continuing challenges in the integration and
dissemination of contrast allergy information in other systems.
After presenting a review of literature on errors in mammography reports, this resident noted the erroneous mention of
seminal vesicles in the CT report of a female patient. He and Dr. Ross Filice were inspired to create a detection
system, termed Error-Bot, to flag gender mismatch errors by comparing patient gender with key words in the dictation.
If incompatible elements are found, dictating physician(s) are immediately and automatically paged. Multiple spin-off
projects have resulted, some addressing targeted right-left errors .
Quality of CT PE studies: How can we improve? Arash Zandieh, MD
Tell me where it hurts: Clinical history
in studies ordered by the ED
Amit Kalaria, MD
Inspired by daily work encounters, this resident selected
“r/o stone” abdomen pelvis CT studies from the ED as a
case model to assess if relevant clinical history –
specifically the site of pain – was provided by ordering
physicians and verified by CT technologists at the time
of study. In this case, information provided by the ED
was better than anticipated. Follow-up now underway is
geared toward increasing technologist verification.
Consensus policy Dan daSilva, MD
Falls in radiology PJ Bergquist, MD
Resident reviewed occurrence
reports, outlining root causes
and risk factor analysis, and
proposed strategies for fall
prevention.
Projects also include the
development of department
wide consensus policies.
Contrast allergy reconciliation: How well do we communicate contrast reactions?
Danielle DeMulder, MD
Dictation errors: Why does the CT report say this woman has seminal vesicles?
Matthew Minn, MDError-Bot Improvements
Follow-up
Source: https://www.mededportal.org/icollaborative/resource/741