Quality Improvement and Patient Safety

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:

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.

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:

Lectures/Conferences:

• 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.

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