JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Additionally, the CLER program includes focus areas on QI/PS, encouragingresidentparticipationinreportingandinvestigation of errors, unsafe conditions, and near misses, including involvement in interprofessional teams aimed at promoting safe care, improving systems, processes, and patient outcomes.5,6 The implementation of these requirements has been addressed by training programs in a variety of ways such as didactic training, assignment of residents to existing programmatic and discipline-specific QI and PS projects, fostering de novo QI and PS projects, creation of QI/PS training blocks, and intermittently dispersing QI and PS training throughout residency. Training programs have identified the need to incorporate a combination of didactic training and experiential learning in order to reinforce QI terms and methodologies. Various approaches to experiential learning exist but have included outlining general strategies for improving quality, discussing substantive topics such as medication safety, encouraging resident engagement with hospital QI activities and case studies such as root cause analyses, as well as attendance at committee meetings. Additionally, residents have worked closely with faculty mentors to design and implement an independent study project that affects practice at the institution.7 Overall residents have reported high levels of comfort by applying Practice Based Learning and Improvement (PBLI)-related knowledge and skills. Studies have concluded that a PBLI curriculum that is centered on practice-based quality improvement projects can fulfill the objectives of the ACGME competency while accomplishing sustained outcomes in quality improvement.8 In order to meaningfully address areas related to PS and QI in Section VI, the Learning andWorking Environment, we created a collaborative elective resident rotation called Enhancing Quality Improvement for Patients (EQuIP). The elective is set within our primary teaching site, University Medical Center New Orleans (UMCNO) and is unique for its interdisciplinary, multimodality and interprofessional structure.
specific committees, accreditation requirements and how these fit into the care that the residents and faculty are providing. Small-group sessions are held in the fields of QI/PS and include discussions about the completed modules as well as interactive reviews on the following topics: introduction to QI, PS, quality management and process improvement (PI), overview of UMCNO’s Safety, Quality and Risk department, overview of the ACGME CPR, and the CLER focus areas in PS and QI, education in QI methodology, utilization of publicly reported databases for QI and PS information and the hospital’s internal metric collection system and interprofessional oversightstructure called the Comprehensive Quality Management (CQM) committee. Experiential learning is achieved through: attendance and participation in hospital and medical staff committees, including the Comprehensive Quality Management committee; participation in currently operational PI workgroups and QI/ PS projects (including but not limited to Trauma, Code Blue, Critical Care Committee, etc); and by participation in root cause analyses and disclosure reporting events. Participation in the daily Quality Huddle is also facilitated; the quality huddle is an interdisciplinary team which works to improve communication and resolves issues before they impact patient flow and safety. A sample schedule from an EQuIP rotation can be seen in Figure 1.
Monday Sample Schedule for EQuIP Rotation Tuesday
Thursday
Wednesday
Friday
11/2 8:30 AM Quality Huddle 12:00 PM UMCNO Medicine Committee Meeting 2:00 PM Grievance Meeting 11/9 8:30 AM Quality Huddle 11:30 AM Stroke Committee 2:00 PM Grievance Committee
11/3 8:30 AM Quality Huddle 9:30 AM Required EQuIP Rotation Orientation
11/1 8:30 AM Quality Huddle 1:00 PM Patient Safety Rounds
11/6 8:30 AM Quality Huddle 1:00 PM Multidisciplinary Trauma Meeting
11/7 8:30 AM Quality Huddle 12:00 PM IM Case Conference 1:30 UMCNO Quality Didactic Lecture
11/8 7:00 AM Anesthesia/OR Committee 8:30 AM Quality Huddle 1:00 PM Medical Records Committee 1:00 PM Patient Safety Rounds 11/15 8:30 AM Quality Huddle 1:00 PM Patient Safety Rounds 11/22 8:30 AM Quality Huddle 9:00 AM Nurse Council Meeting
11/10 8:30 AM Quality Huddle
METHODS
11/13 8:30 AM Quality Huddle 1:00 PM Multidisciplinary Trauma Meeting 11/20 8:30 AM Quality Huddle 1:00 PM Multidisciplinary Trauma Meeting 11/27 8:30 AM Quality Huddle 10:00 AM Transfusion Review Committee
11/14 8:30 AM Quality Huddle
11/16 8:30 AM Quality Huddle 2:00 PM Grievance Committee
11/17 8:30 AM Quality Huddle 1:30 PM GME Didactic Lecture
The EQuIP rotation curriculumwas designed by the local subject matter experts involved with providing resident supervision. The rotation was designed as either a two week or a four week elective rotation, where funding is provided by the training program from already established hospital pay-lines. Daily rotational expectations are customized by the supervising experts basedon the rotators and their other care responsibilities (eg. continuity clinic, program didactics, call schedule). Each resident has access to a where a day-to-day calendar of events is kept updated. Multiple educational modalities are employed including self-directed learning, small-group didactics, and experiential active learning activities. Residents on the rotation complete six Institute for Healthcare Improvement (IHI) modules throughout the course of their rotation (either two weeks or four weeks). (QI 102, 103, 104; PS 101, 102, 201)9. They also participate in three didactic sessions covering quality improvement and patient safety concepts and methodologies, the relevance of QI/PS in graduate medical education, and clinical site specific
11/21 8:30 AM Quality Huddle 12:00 PM Pharmacy and Therapeutics Committee Meeting
11/24
11/25
11/28 8:30 AM Quality Huddle 10:00 AM Mock RCA 12:00 PM SHIP Conference
11/29 8:30 AM Quality Huddle
11/30 8:30 AM Quality Huddle
Figure 1: Sample Schedule for EQuIP Rotation
80 La State Med Soc VOL 170 MAY/JUNE 2018
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