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A Longitudinal Quality Improvement Curriculum to Prepare Residents for the Growing Field of Healthcare Quality (Descriptive Abstract)
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ABSTRACTS
immunization initiation rates. Chi square test was used to assess the significance of improvement in three key questions in pre and post intervention tests. RESULTS: Pre-intervention vaccine initiation rates for 109 patients was 42%. Post-intervention average vaccine initiation rates were 62%. Residents’ HPV virus knowledge was strong at baseline, but immunization and recommendation knowledge was weaker. Significant improvement in vaccine knowledge and importance of a strong recommendation (?2(2)¼17.3, p<0.05) was seen. CONCLUSIONS AND NEXT STEPS: While HPV vaccination is important and effective, vaccination rates remain low. Simple and practical QI interventions in a resident clinic led to an increase in HPV vaccination rates, and demonstrated improvement in resident vaccine knowledge and increased confidence in recommending the vaccine. Similar strategies can be applied towards other vaccines. 52. A LONGITUDINAL QUALITY IMPROVEMENT CURRICULUM TO PREPARE RESIDENTS FOR THE GROWING FIELD OF HEALTHCARE QUALITY (DESCRIPTIVE ABSTRACT) Paula J. Soung, MD, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI BACKGROUND: Developing a Quality Improvement (QI) curriculum is essential to comply with ACGME requirements. In the era of the expanding field of healthcare quality, curriculums need to provide skills that prepare residents for roles in quality that are now affecting all medical professionals. Despite time constraints on resident training, the importance of integrating a longitudinal QI curriculum and project to provide adult learning opportunities and hands on experiences are essential. OBJECTIVE: Our primary objective was to develop a longitudinal quality improvement curriculum that supports residents through the completion of inter-professional improvement projects while increasing knowledge and competence in QI skill sets. METHODS: Available literature and learning resources in medical education and quality improvement were reviewed to assess the variety in which programs were meeting ACGME requirements. A longitudinal curriculum was developed with subsequent modifications including enhanced workshop opportunities, increased curriculum timeframe and faculty mentorship since 2012. RESULTS: A 2+ year longitudinal QI curriculum was developed with learning concepts based on the model of improvement in a combination of 6-8 didactic, workshop, and project review sessions per academic year. Residents self-identify projects of interest and work within small groups to develop and complete inter-professional team QI projects over approximately 2 years; culminating in a presentation experience. On self assessment, residents have an increased proportion of rating moderate to extreme comfort in QI skill sets on completion of the curriculum. CONCLUSION: An effective longitudinal QI curriculum can be implemented despite time constraints, and support residents with hands on experience in the development, implementation, and presentation of QI projects. Further evaluation of data from our QI knowledge assessment tools and formally assessing the quality of improvement projects completed during the curriculum, may further demonstrate the benefits of this model.
ACADEMIC PEDIATRICS 53. RAPID CYCLE IMPROVEMENTS: USING EVERY DAY NUISANCES TO FUEL CHANGE (DESCRIPTIVE ABSTRACT) Kristen Samaddar, MD, Lilia Parra-Roide, MD, Phoenix Children’s Hospital, Phoenix, AZ BACKGROUND: Completing relevant quality improvement (QI) projects in residency is sometimes difficult. Some efforts falter due to inconsistent time, competing priorities, and an ever-changing work environment. Program leaders wanted to see if rapid cycle QI projects could be accomplished in a one-month rotation. METHODS: Teams of PGY-2 residents were given weekly protected time to implement a QI project. Residents were required to write an aim, gather baseline and follow up data, implement at least one intervention, and reflect on next steps for success. Teams chose their own topics but were also encouraged to further other team’s’ efforts. QI mentors provided a template, scoring rubric, and guidance to help overcome obstacles. Residents presented their work at division meetings. RESULTS: Over the course of a year, residents accomplished 8 unique projects: recognizing elevated blood pressure, improving end-of-visit instructions, obtaining records, decreasing time writing school excuses, implementing a new protocol for pulse oximetry, performing developmental screens, providing asthma action plans, and screening for food insecurity. 10 teams accomplished at least one full PDSA cycle while 2 were able to implement two full cycles of change. All teams demonstrated core QI knowledge and skills. CONCLUSIONS: While all processes cannot be fixed in one month, resident teams were able to achieve much in a short time. Two resident-inspired projects became annual division level quality goals: identifying elevated blood pressure and improving asthma management. The screening questions for food insecurity were included in new electronic note templates. New processes for obtaining patient records and writing school excuses were continued after only one month of concentrated effort. Key to the successful rapid cycle projects is setting realistic goals. By working on their biggest nuisances, residents stay motivated and see the benefits of their efforts. Providing sufficient time for QI emphasizes its importance and allows residents the freedom necessary for success. 54. PEDIATRIC RESIDENTS’ PERCEPTIONS OF EVENT REPORTING (RESEARCH ABSTRACT) John Szymusiak, MD, Thomas J. Walk, MD, Maggie Benson, MD, MS, Megan Hamm, PhD, UPMC Medical Education, Pittsburgh, PA, Susan Zickmund, PhD, University of Utah, Salt Lake City, UT, Alda Maria Gonzaga, MD, MS, Greg M. Bump, MD, UPMC Medical Education, Pittsburgh, PA BACKGROUND: Event reporting is an important tool for recognizing the types of errors occurring in a hospital & identifying ways to improve patient safety. Reporting data show that a minority of reports are made by physicians, which has been targeted for improvement both nationally & locally. Residents are front line providers, yet little is known about their reporting attitudes. Our study aims to identify drivers and barriers to reporting among pediatric residents at a tertiary care, academic institution and to identify modifiable aspects of an institution’’s culture of safety that could encourage resident reporting. In so doing, we hope to improve patient care and promote career-long reporting in trainees.
ABSTRACTS
immunization initiation rates. Chi square test was used to assess the significance of improvement in three key questions in pre and post intervention tests. RESULTS: Pre-intervention vaccine initiation rates for 109 patients was 42%. Post-intervention average vaccine initiation rates were 62%. Residents’ HPV virus knowledge was strong at baseline, but immunization and recommendation knowledge was weaker. Significant improvement in vaccine knowledge and importance of a strong recommendation (?2(2)¼17.3, p<0.05) was seen. CONCLUSIONS AND NEXT STEPS: While HPV vaccination is important and effective, vaccination rates remain low. Simple and practical QI interventions in a resident clinic led to an increase in HPV vaccination rates, and demonstrated improvement in resident vaccine knowledge and increased confidence in recommending the vaccine. Similar strategies can be applied towards other vaccines. 52. A LONGITUDINAL QUALITY IMPROVEMENT CURRICULUM TO PREPARE RESIDENTS FOR THE GROWING FIELD OF HEALTHCARE QUALITY (DESCRIPTIVE ABSTRACT) Paula J. Soung, MD, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI BACKGROUND: Developing a Quality Improvement (QI) curriculum is essential to comply with ACGME requirements. In the era of the expanding field of healthcare quality, curriculums need to provide skills that prepare residents for roles in quality that are now affecting all medical professionals. Despite time constraints on resident training, the importance of integrating a longitudinal QI curriculum and project to provide adult learning opportunities and hands on experiences are essential. OBJECTIVE: Our primary objective was to develop a longitudinal quality improvement curriculum that supports residents through the completion of inter-professional improvement projects while increasing knowledge and competence in QI skill sets. METHODS: Available literature and learning resources in medical education and quality improvement were reviewed to assess the variety in which programs were meeting ACGME requirements. A longitudinal curriculum was developed with subsequent modifications including enhanced workshop opportunities, increased curriculum timeframe and faculty mentorship since 2012. RESULTS: A 2+ year longitudinal QI curriculum was developed with learning concepts based on the model of improvement in a combination of 6-8 didactic, workshop, and project review sessions per academic year. Residents self-identify projects of interest and work within small groups to develop and complete inter-professional team QI projects over approximately 2 years; culminating in a presentation experience. On self assessment, residents have an increased proportion of rating moderate to extreme comfort in QI skill sets on completion of the curriculum. CONCLUSION: An effective longitudinal QI curriculum can be implemented despite time constraints, and support residents with hands on experience in the development, implementation, and presentation of QI projects. Further evaluation of data from our QI knowledge assessment tools and formally assessing the quality of improvement projects completed during the curriculum, may further demonstrate the benefits of this model.
ACADEMIC PEDIATRICS 53. RAPID CYCLE IMPROVEMENTS: USING EVERY DAY NUISANCES TO FUEL CHANGE (DESCRIPTIVE ABSTRACT) Kristen Samaddar, MD, Lilia Parra-Roide, MD, Phoenix Children’s Hospital, Phoenix, AZ BACKGROUND: Completing relevant quality improvement (QI) projects in residency is sometimes difficult. Some efforts falter due to inconsistent time, competing priorities, and an ever-changing work environment. Program leaders wanted to see if rapid cycle QI projects could be accomplished in a one-month rotation. METHODS: Teams of PGY-2 residents were given weekly protected time to implement a QI project. Residents were required to write an aim, gather baseline and follow up data, implement at least one intervention, and reflect on next steps for success. Teams chose their own topics but were also encouraged to further other team’s’ efforts. QI mentors provided a template, scoring rubric, and guidance to help overcome obstacles. Residents presented their work at division meetings. RESULTS: Over the course of a year, residents accomplished 8 unique projects: recognizing elevated blood pressure, improving end-of-visit instructions, obtaining records, decreasing time writing school excuses, implementing a new protocol for pulse oximetry, performing developmental screens, providing asthma action plans, and screening for food insecurity. 10 teams accomplished at least one full PDSA cycle while 2 were able to implement two full cycles of change. All teams demonstrated core QI knowledge and skills. CONCLUSIONS: While all processes cannot be fixed in one month, resident teams were able to achieve much in a short time. Two resident-inspired projects became annual division level quality goals: identifying elevated blood pressure and improving asthma management. The screening questions for food insecurity were included in new electronic note templates. New processes for obtaining patient records and writing school excuses were continued after only one month of concentrated effort. Key to the successful rapid cycle projects is setting realistic goals. By working on their biggest nuisances, residents stay motivated and see the benefits of their efforts. Providing sufficient time for QI emphasizes its importance and allows residents the freedom necessary for success. 54. PEDIATRIC RESIDENTS’ PERCEPTIONS OF EVENT REPORTING (RESEARCH ABSTRACT) John Szymusiak, MD, Thomas J. Walk, MD, Maggie Benson, MD, MS, Megan Hamm, PhD, UPMC Medical Education, Pittsburgh, PA, Susan Zickmund, PhD, University of Utah, Salt Lake City, UT, Alda Maria Gonzaga, MD, MS, Greg M. Bump, MD, UPMC Medical Education, Pittsburgh, PA BACKGROUND: Event reporting is an important tool for recognizing the types of errors occurring in a hospital & identifying ways to improve patient safety. Reporting data show that a minority of reports are made by physicians, which has been targeted for improvement both nationally & locally. Residents are front line providers, yet little is known about their reporting attitudes. Our study aims to identify drivers and barriers to reporting among pediatric residents at a tertiary care, academic institution and to identify modifiable aspects of an institution’’s culture of safety that could encourage resident reporting. In so doing, we hope to improve patient care and promote career-long reporting in trainees.