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Northwestern University Feinberg School of Medicine
Department of Medicine
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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.

 

 Academy for Quality and Safety Improvement

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:

ASQI Projects 2019-2020

Team Members

Internal Medicine Teams

Decrease opioid prescriptions from hospitalist units John Bowers, Jordan Gavin, Jasleen Ghuman
Increase the use of prone positioning in patients with severe Acute Respiratory Distress syndrome (ARDS) Elisa McEachern, Jamie Treadway (Chief Resident), Eleanor Yang
Decrease hospitalization and technique failure in home dialysis outpatient unit Harini Gurram
Decrease the CT utilization for inappropriate PE studies Cece Johnson-Sasso
Decrease the prevalence of primary hyperalsosteronism in patients with hypertension Philip Speigel

ASQI Projects 2018-2019

Team Members*

Pulmonary and Critical Care Team

Improving documentation and timeliness of shared decision making meetings with patients and surrogate decision makers in the MICU

ASQI Team Members: Quinn Halverson, Matt Peller

Internal Medicine Teams

Acute alcohol withdrawal syndromes in patients admitted to general medicine inpatient units ASQI Team Members: Jasleen Ghuman, Nisha Raiker
Crisis Management guidelines AQSI Team Member: Dom Farina 
Improving HCC screening at the VA AQSI Team Member: Erin Cleveland 
Reducing the amount of interruptions of patients during the night AQSI Team Members: Eleanor Yang, Elissa McEachern, Lauren Lee
Communication and collaboration between general medicine and consulting services AQSI Team Member: Jordan Gavin

Medicine & Emergency Medicine Team Collaborations

Repeat dosing of antimicrobial agents on sepsis patients boarding in the ED AQSI Team Member: Jamie Treadway

AQSI Projects 2017-2018

Team Members

Hematology/Oncology Teams 

Decrease unnecessary C. difficile testing in patients undergiong a Hematopoietic Stem Cell Transplant (HSCT) AQSI Leader: Kehinde Adekola
AQSI Team Members: Katie McGowan, Briana Steffenhagen, Sarah Sutton, Daniel Wojenski, Viki Barr, Joanna Varkos, Chao Qi, Asra Salim, Edra Sierra, Jessica McClure, Nicolas Simon

Pulmonary and Critical Care Teams 

To decrease the use of broad spectrum antibiotic use on intubated MICU patients AQSI Leader: Chiagozie Pickens
AQSI Team Members: Joe Bodkin, Nicole DeCredico, Madeleine Heldman, Stephanie Katcheriean, Laura Kelly, Natalia Molinas, Sankit Thakkar, Bryan Lizza, Joseph Paonessa 

Nephrology Teams 

Improving the care of ESRD patients diagnosed with upper extremity DVT AQSI Leader: Adam Safdi
AQSI Team Members: Thomas Byrd, Courtney Furlough, Alex Leidner, Christine Limonte, Shamsa Baaj, Yuan Cao, Patricia Astleford

AQSI Projects 2016-2017

Team Members

Medicine, Cardiology, & Hospital Medicine Collaborations

Improving understanding of and adherence to discharge cardiac medications for patients leaving the hospital with acute heart failure AQSI Leader: R. Kannan Mutharasan, Gopi Astik, Maya Defoe
AQSI Team Members: Ansel Amaral, Mansi Bhat, Baljash Cheema, Hawkins Gay, Neta Linnville, Kaleigh Nolan, Amanda Vlcek, Quentin Youmans

Medicine & Pulmonary & Critical Care Team Collaborations

Improving end-of-life care for patients who are suffering from respiratory illnesses AQSI Leader: Alexandra Frogameni and Susan Russell
AQSI Team Members: Lauren Chiec, Sarah Chuzi, Adeboye Ogunseitan, Melanie Smith, Michael Washingon
Implementing daily spontaneous awakening trials for patients on continuous sedatives while mechanically ventilated in the medical intensive care unit (MICU)

AQSI Leader: Joseph Paonessa and Alexandra Frogameni
AQSI Team Members: Victoria Behrend, Christopher French, Elizabeth Short, Keerthi Ranganath 

AQSI Projects 2015-2016

Team Members

Emergency Medicine & Medicine Team Collaborations

Guideline-based care of cellulitis beginning in the ED AQSI Leader: Ashfaq Ahmad
AQSI Team Members: Gopi Astik, Darren Boyd, Adnan Hussain, Andrew Moore, Heather Provencher, Margaret Ragland, Deepti Singhvi
Proper utilization of blood cultures for bacteremia in the ED and appropriate use of re-culturing on the general medicine floor AQSI Leader: Grant Scott and Michael Angarone
AQSI Team Members: Eric Cantey, Erica Donnan, Abra Fant, Eric Hansen, Jordan Kaylor, Vanessa Kiepura

Medicine Teams

Improving patients' understanding of the heart failure disease process and managing the disease AQSI Leader: Corrine Benacka
AQSI Team Members: Farah Barada, Alexandra Goodwin, Jacqueline Jimenez, Abbey Lichten, Chiagozie Ononye
Improving vaccination practices for heart transplant candidates and recipients AQSI Leader: Ellie Sukerman
AQSI Team Members: Mary Alice Ackerman, Amy Chen, Michelle Huber, Valentina Stosor, Stephanie Wedlake, Jane Wilcox

Surgery & Medicine Team Collaborations

More efficiently evaluate and care for patients referred for lung transplant evaluation AQSI Leader: David Odell
AQSI Team Members: Sangeeta Bhorade, Jennifer Wright, PJ DeCamp, Cindy Parker

*2018-2019 Team Members List represents only IM residents who participated in each group. Click here for a full AQSI member list.

 Northwestern Memorial Hospital Quality Committees

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.

Committee

Purpose

Internal Medicine Representation

Department of Medicine Quality Management Committee

Main quality committee for the Department of Medicine

Patrick Campbell, MD; Peter Glynn, MD;  Michael Jiang, MD; Amanda Krause, MD; Elyse Linson, MD

Sepsis Quality Committee

Subcomittee of Medicine and ED quality committees focused on improving care of the patient with sepsis

Michael Jiang, MD; Amanda Krause, MD; Sneha Thatipelli, MD; Todd Vankerkhoff, MD

Clinical Care Evaluation Committee

Reviews patient safety events

Patrick Campbell, MD; Elyse Linson, MD

Glycemic Control Committee

Providing better care for our diabetic patients

Kaysey Coyne, MD; Sally Friedman, MD

Peer Review Committee

To review clinician practice

3 residents (protected)

Nets (Error Reporting) Working Group

Trends in medication-related nets or nets representative of front line issues

Sarah Hale, MD; Caitlin Visek, MD

Shock/ECPR (VA ECMO) Committee

Multidisciplinary group working to improve the care of patients on VA ECMO

Peter Glynn, MD; Martin Gruca, MD; Yossi Schwartz, MD

Lung Rescue (VV ECMO) Committee

Multidisciplinary group working to improve the care of patients on VV ECMO

CeCe Johnson-Sasso, MD

 Structured Interdisciplinary Rounds

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. 

 Northwestern Internal Medicine Residency Program Quality Improvement and Patient Safety Curriculum

Faculty Directors: Rachel Cyrus, MD, and Aashish Didwania, MD

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 and delivering high-value care

Key Concepts: 

Patient Safety 

Quality Improvement

High-Value Healthcare

Impact of medical error

Types of measures

Systems and principles (handoffs and transitions of care)

Error reporting

Analysis of care/metrics

Value and equity

Analysis of failures/error reduction strategies

Improvement methods

Politics and law

 

Curriculum by training year

PGY1 PGY2 PGY3

Patient Safety 

  • IHI MOdule PS101 & 104
  • Handoffs
  • SIDR backup
  • RCA Conference
  • Nets Reporting
  • M&M conference participant
  • Team Training in ACLS
  • M&M conference leader*
  • Quality committees*
  • SIDR
  • RCA Conference
  • Nets Reporting
  • M&M conference participant
  • M&M conference leader*
  • Quality committees*
  • SIDR
  • RCA Conference
  • Nets Reporting
  • M&M conference participant
Quality Improvement
  • IHI module QI 101
  • SIDR backup
  • Quality newsletter
  • Didactics during Intern Academic Half Day
  • DMAIC participant*
  • Metric review
  • SIDR
  • DMAIC lead*
  • AQSI participant* 
  • Quality newsletter
  • DMAIC participant*
  • Metric review
  • SIDR
  • DMAIC lead*
  • AQSI participant* 
  • Quality newsletter
  • DMAIC participant*
  • Metric review
High Value Healthcare
  • Value based care conferences
  • Social determinants of health
  • Value based care conferences
  • Social determinants of health
  • Value based care conferences

*Denotes optional activity and advanced opportunity

Inpatient QI/PS Training details:

Lectures/Conferences:
  • Monthly Morbidity and Mortality Conference
  • Quarterly Root Cause Analyses Morning Reports
  • Quarterly High Value Care Morning Reports
  • Quarterly QI/PS-centered Noon Conference
  • Monthly NMH-wide Patient Safety Grand Rounds
  • Select Department of Medicine Grand Rounds are focused on QI/PS and systems based practice

Newsletter: Quarterly and includes current quality efforts, inpatient and outpatient metrics, value based care tips, and ways to get involved
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
Online modules: IHI QI101, PS 101, PS104 as an intern
QI project involvement/advanced training: DMAIC leadership or participation, AQSI certificate 


Mapping to ACGME Milestones: 

ACGME Core Competency

Developmental Milestone

NM Quality Curriculum

Practice Based Learning 

  • Learning and improving via audit of performance

Improve the quality of care for a panel of patients 

  • Analysis of care/metrics 
  • Types of measures
  • Improvement methods

Systems Based Practice 

  • Works effectively with other care providers and settings
  • Improving health care delivery 
  • Cost-effective care for patients and populations

Works effectively within:

  • Multiple health delivery systems
  • An interprofessional team 
Practices cost-effective care
  • Systems and principles of high value care
  • Impact of medical error
  • Error reporting
  • Analysis of failure/error reduction strategies
  • Improvement methods
  • Value and equity 
  • Politics and law

Interpersonal and Communication Skills

  • Communicate effectively with physicians, other health professionals and health related agencies 

Transitions of care

  • Systems and principles

Professionalism 

  • Patient centeredness

Respect the dignity, culture, beliefs, values, and opinions of the patient

  • Value and equity

 Quality Improvement Curriculum in Resident Continuity Clinics

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.

qi

 Residency Quality and Safety Quarterly Newsletter

View our Winter 2019 newsletter here

View our Summer 2019 newsletter here

View our Spring 2019 newsletter here.

View our Fall 2018 newsletter here.

View our Spring 2018 newsletter here

View our Fall 2017 newsletter here.

View our Spring 2017 newsletter here

 Resources

ABIM Foundation Choosing Wisely Campaign

Campaign lists areas of overutilization of care to improve delivery of cost-effective care.

http://www.choosingwisely.org/

Access Medicine Patient Safety Modules

Modules providing a foundation with principles of patient safety.

http://accessmedicine.mhmedical.com/multimedia.aspx#tab=4

Agency for Healthcare Research and Quality

Comprehensive website with numerous educational resources and tools.  AHRQ WebM&M is highly recommended.

http://www.ahrq.gov/professionals/quality-patient-safety/index.html

American College of Physicians

Excellent collection of resources.

http://www.acponline.org/running_practice/quality_improvement/

Institute for Healthcare Improvement

Excellent courses.  Second link is required prior to the start of residency.

http://www.ihi.org/patientsafety

http://app.ihi.org/lms/onlinelearning.aspx

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