Quality Improvement and Patient Safety
Quality improvement and patient safety initiatives permeate the inpatient and outpatient setting that residents work in at Northwestern Medicine. The residency program has a strong focus on quality improvement and patient safety ranging from experiential learning through clinical care to unique quality projects and hospital committee work. As our healthcare system rapidly evolves, we have been able to adapt our educational curriculum to keep up with the changes.
For residents set on a career path in quality improvement and patient safety, Northwestern offers a master’s degree in Healthcare Quality and Patient Safety.
For more information about education in Quality Improvement and Patient Safety for Northwestern residents, contact Aashish Didwania, MD, residency program director.
A featured program for residents interested in quality improvement is the Academy for Quality and Safety Improvement (AQSI). AQSI is a six-month professional development program designed to equip healthcare professionals with the knowledge and skills needed to effectively lead quality improvement.
Residents and fellows at any level are able to join teams focused on a particular clinical area. Individuals join teams of shared interest, participate in workshops and didactics and develop a quality improvement project over the course of an academic year. Here is a listing of recent and current residents who have participated:
Internal Medicine Teams
|AQSI Projects 2021-2022
|To The ER Boarders: ICU
|Eliminating time between ICU acceptance and ICU transfer for critically ill patients in the emergency room.
|Jason Arnold and Alison Szabo
|PICCing Up the Slack
|New discharge checklist for outpatient antibiotic to help reduce number of readmissions or calls
|Shalini Jayawickrama and Tom Enke
|Leggo My Echo
|Help reduce the overuse of inpatient TTE's for low risk non-cardiogenic syncope.
Pamela Wax and Michael Jiang
|AQSI Projects 2020-2021
|Patients undergoing LE bypass at NMH are 2x likely to receive periop transfusion vs national average. Aims to reduce overall transfusion rate in patients undergoing bypass by 1/2
|Improve medical oversight of orthopedic surgery patients who are identified in the NMH preoperative clinci to have sub-optimally controlled diabetes and who are canceled for surgery
|Alice Kerr, Martin Gruca
|Leggo My Echo
|Our goal is to reduce the overuse of echocardiograms for appropriately identified patients with low-risk non-cardiac syncope
|Michael Jiang, Pamela Wax
|Saturday Night Fever
|Reduce time in the ED for patients presenting with neutropenia/neutropenic fevers
|Eric Silberman, Chelsea Thompson, Cait Visek
Residents are actively recruited to participate in hospital quality committees and projects. Each quarter, committees are advertised to program directors who then send the information to residents. Committees offer a learning opportunity into the operations of hospital systems and large quality initiatives ranging from appropriate use of blood products to fall prevention. Residents often serve as front-line clinician consultants and in some instances take a lead in committee work that turns into a research project. Below is the recent listing of quality committees.
Subcomittee of Medicine and ED quality committees focused on improving care of the patient with sepsis
Committee focused on improving and reviewing processes regarding inpatient telemetry including proper telemetry indications.
Peer Review Committee
To review clinician practice
2 residents (protected)
Glycemic Control Committee
Providing better care for our diabetic patients
Department of Medicine Quality Committee
Main Quality Committee for the Department of Medicine
Dr. Anna Briker
Dr. Jeffrey Than
Dr. Jakub Glowala
Dr. Joe Fuchs
Dr. Ali Hammoud
Dr. Patrick Keller
Dr. Danielle Dressler
Dr. Daina Ringus
Dr. Dylan Olson
All residents rotate on the general inpatient wards at Northwestern Memorial Hospital. The wards are geographically localized where clinical teams work only on one to two wards (30 beds per ward), thus enhancing teamwork between clinicians and the rest of the healthcare team. In addition to geographic localization, all residents participate in structured interdisciplinary rounds. These rounds consist of the entire team in one room: senior resident (or intern), the entire wards nursing staff, pharmacy, physical therapy and social work. The team’s resident runs their list of patients covering a checklist of inpatient quality measures ranging from IVs and indwelling urinary catheters to telemetry needs to discharge planning. Along with improved care, the experience is highly educational, as the full healthcare team has face-to-face communication and can help each other solve clinical needs and systemic issues. View a video about SIDR on the teaching service from the Center for Education in Medicine.
Faculty Directors: Maria Theodorou, Rachel Cyrus and Aashish Didwania
Goals and Objectives:
- Prepare physicians to be leaders in the practice of safe, high-quality, patient-centered medicine
- Foster a culture that encourages proactive reporting, analysis and innovation
- Teach key principles of patient safety, quality improvement, health equity and delivering high-value care
Inpatient QI/PS Training Details:
- Monthly Morbidity and Mortality Conference
- Quarterly High Value Care Morning Reports
- Quarterly QI/PS-centered Noon Conference
- QI Elective Participant Noon Conference
- Intern Academic Half Day Lectures
- Adverse Event Reporting and Mock RCA
- QI Methods and Project Design
- Error Disclosure and Adverse Event Debrief
- Social Determinants of Health
- Trauma Informed Care
- Monthly NMH-wide Patient Safety Grand Rounds
- Select Department of Medicine Grand Rounds focused on QI/PS and systems based practice
Institute for Healthcare Improvement modules: IHI QI101, PS 101, PS104 required as part of onboarding process
Quality Metrics: Inpatient and outpatient panel quality metrics provided to every resident on units and in the newsletter
NETS reports: Require minimum 1 per resident per year
QI All Stars Residency Committee: Meets quarterly, runs QI website, members sit on institutional QI committees
Resident-Run QI Website: Bi-monthly posts on current quality efforts, inpatient and outpatient metrics, value-based care tips, and ways to get involved
Institutional QI Committees: Shock/EPR VA ECMO Committee, Sepsis Committee, Peer Review Committee, Nets Working Group, Lung Rescue VV ECMO Committee, Glycemic Control Committee, Department of Medicine Quality Committee, NMCH Quality Equity Committee
Academy for Quality and Safety Improvement (AQSI): Professional development program with embedded interdisciplinary QI project
Quality Improvement and Patient Safety Elective: Four-week elective rotation offered to senior residents to provide exposure to QI project design, Patient Safety Event identification and team consultation, and high value care
The majority of internal medicine residents maintain continuity clinics at both the Northwestern Medical Faculty Foundation academic practice and at the Veteran’s Administration site. Residents build a panel of patients over time through self-referral and inpatient to outpatient transitions. Standard quality measures for primary care practices in the United States are given on a quarterly basis to residents’ continuity panels both to guide high-quality care to their patients, but also to serve as an educational curriculum to discuss primary care measures and concepts in quality improvement, such as public reporting and pay-for-performance. Measures are discussed in a quarterly quality conference and directly with mentors who review reports with residents. Topics from the conference have included colon cancer screening, aspirin for primary prevention, bone health, pay for performance, quality as research and a study of VA quality initiatives.
Residents have consistently provided high-quality care in CAD, CHF, HTN and DM that matches attending practices and is comparable to some of the highest quality ratings in primary care in the country. Preventative services remain an area of improvement but have also been found to reflect a more complex patient population that residents care for.
Some residents have maintained an interest in community health and choose to do one of their two continuity clinics at one of three community health clinics. Opportunities for quality projects in the community health setting are available with mentors in healthcare disparities and health literacy. Read more about a resident project improving patient education materials at a local community health clinic.
Visit us here!
ABIM Foundation Choosing Wisely Campaign
Campaign lists areas of overutilization of care to improve delivery of cost-effective care.
Access Medicine Patient Safety Modules
Modules providing a foundation with principles of patient safety.
Agency for Healthcare Research and Quality
Comprehensive website with numerous educational resources and tools. AHRQ WebM&M is highly recommended.
American College of Physicians
Excellent collection of resources.
Institute for Healthcare Improvement
Excellent courses. Second link is required prior to the start of residency.