DISCLOSURE. No conflicts of interest to report

Transcription

1 DISCLOSURE No conflicts of interest to report 1

2 SESSION PC004 BRO8 The Coordinator s Role in Engaging Residents in Quality Improvement Projects Beth Blackwell, MBA, Program Coordinator Harpreet Wadhwa, MD, Urology Resident 2

3 Quality Improvement Approach at the University of Illinois at Chicago Harpreet Wadhwa, MD Beth Blackwell, MBA 3

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5 ACGME OUTCOME PROJECT (2002) Two competencies, practice-based learning and improvement and systems-based practice, required programs to enhance resident education and assessment in the areas of quality improvement and patient safety. The ACGME Common Program Requirements stipulate that Residents must demonstrate the ability to continuously improve patient care [and] to systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement. 5

6 ACGME RESIDENT SURVEY Hidden in the survey are questions asking your residents if they participate in Quality Improvement. This falls under the category of Patient Safety/Teamwork. At our institution, this is often a low score because our Residents don t understand what qualifies 6

7 QUALITY IMPROVEMENT The US Agency for Healthcare Research and Quality defines quality health care as doing the right thing, at the right time, in the right way, for the right person and having the best possible results. 7

8 HOW CAN COORDINATORS HELP CLARIFY? We need to fully understand what constitutes Patient Safety and Quality Improvement Projects When you see these projects going on be sure to identify them and point them out Enter them into your management system Have a resident take ownership and get credit for their work 8

9 There are many levels of quality improvement In increasing complexity: Patient Level Individual Resident Level Urology Program Level Department Level Hospital Level Field of Urology Level Society Level 9

10 Patient Level: Deliver excellent care and address the disparities in care for the communities we serve Some patients need more attention than others Quality improvement here has to be a grassroots level effort Example - Mechanisms in place to reschedule appointments from clinic. Especially after procedures. MD reviews charts of all patients who underwent a prostate biopsy in clinic last year (~140 procedures performed) 10

11 Patient Level: Sometimes You Have To Go Fishing For Problems 6 patients diagnosed with prostate cancer did not followup with us after the procedure. They did not know they had prostate cancer! Further investigation revealed that 2 had changed insurance companies and had requested their records from our clinic We sent personalized letters and called patients in order to ensure they maintained their followup 11

12 Patient Level: What else? Performing a query of our EMR database to ensure that all patients diagnosed with prostate cancer at our institution received at least the standard of care. This is performed by an Attending Physician. 12

13 Individual Resident Level: Keep Improving Yourself During Residency and Beyond! Two pronged approach in surgical training: Technical Skills Academic/Book learning Technical Skills with adoption of advanced robotics surgery, attendings anticipate that open surgical skills may suffer for new trainees. 13

14 Individual Resident Level: Solution? Watch Yourself! Creation of an advanced selfcritiquing/mentor critiquing platform of surgical techniques. Surgery recorded with high resolution cameras. Then reviewed with mentor attending physicians. (Think film sessions with coaches in professional sports) Goal is to create a career long mentality of how can I do this surgery even better? 14

15 Group Resident Level: How Do We Improve Those Pesky In-Service Scores??? Academic learning improve inservice scores Residents surveyed about low inservice scores and weaknesses identified Most residents identified fatigue as #1 reason why they were not reading enough 15

16 Group Resident Level: Why Aren t You Reading Enough? When asked to elaborate, they identified that Campbell's (index textbook for Urological education) was too dense to read at the end of the day. Department purchased multimedia formats to encourage technology based learning to help with resident compliance. Results? Pending. But residents enthusiastic about having other options. 16

17 Group Resident Level: What Else?? Multi-disciplinary lectures organized around test curriculum during protected time. The dinner lectures were so popular, some of our attendings insisted on joining us! Staggering rotations of incoming-outgoing teams. 17

18 Department Level: Training Leaders of Tomorrow! Resident input sought at Business Practice meeting every 2 months. Disruptive workflow issues identified and resident input sought to implement solutions. This ensures maximum resident compliance with implemented solutions. 18

19 Department Level: Training Leaders of Tomorrow! Examples: Ancillary staff: New RN, PA. MA training. Patient activities: Questionnaires for sexual health, urinary function. Workflow reassignments: What can attendings do differently to improve workflow? 19

20 Before We Move On Let s Talk About The Innovation Center? Higher level impact made in conjunction with the Innovation Center under direct mentorship from Urology faculty 20

21 What Is The Innovation Center? Gathering place for scholars from multiple disciplines inside and outside of medicine: 21

22 What Is The Innovation Center? Clinicians Urology department highly involved under the leadership of our chairman. You could say that this is his lab. Engineers All levels. Post-doc, doctorate, masters, bachelors Business (graduate and undergraduate) Marketing Designers Experts Industry! 22

23 What Is The Innovation Center? Goal: Create an environment which fosters multidisciplinary teamwork and helps expedite innovations in medicine and technology. Located halfway between undergraduate and medical campus. Free caffeine!! 23

24 Hospital Level: Let s Create Win-Win Mutually beneficial for all parties involved if quality control takes place at all levels. Urology takes an active role. Examples: We had a 76% growth in operative volume in the last 2 years. One of the downsides was that we were working with OR teams which were not Urology trained. Led to some frustrations. 24

25 Hospital Level: Let s Create Win-Win OR in-service training organized. We reached out to vendors and had them bring in their equipment. We then let the OR teams play with the equipment. Goal directed. Competitive. Unfamiliar OR Staff saw some of the intricacies of what we do and gained a better insight of what we do. 25

26 Hospital Level: What else? Investigating various processes and regulations in the hospital to find solutions for common problems: Minimizing workplace injuries Quantifying existing problems so hospital administration can act (i.e. resident fatigue) 26

27 Field of Urology This is probably the most common item. Every academic publication can be in this category. 27

28 UIC Approach To Quality Improvement In Urology Diagnostic modalities collaboration with multiple specialties: Radiology, Ob/Gyn, Surgery. Publications in improving diagnostics for prostate cancer, incontinence, etc. Surgical techniques Video editing team. Also doubles as resident education Medical devices: Patents pending/obtained for: advanced foley catheters, urethral sling placement, etc. The list goes on 28

29 Society Level Community involvement is essential and very gratifying We noticed that our patient population shows a more aggressive and advanced stage of prostate cancer. This can lead to worse outcomes Two pronged approach: Reach out and educate patients. Men s health day organized. All men that showed up received free screening for general medical problems, prostate cancer and colon cancer. Reached out to our epidemiologist. Obtained Cook County specific data for prostate cancer outcomes. Compared to national trends. Pending publication. Goal is to improve awareness of this issue. 29

30 Society Level: Prostate Cancer Screening Day! 30

31 Society Level: Prostate Cancer Screening Day! HIPA A 31

32 The Coordinator s Role Remind the team that QI is a broad field While we have opportunities, resources and projects available at every level, if Beth hadn t taken an active role in informing us of what qualifies as Quality Improvement on the ACGME Survey, some of us would probably still answer that we don t get enough exposure to QI projects! 32

33 Discussion! 33