JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Rotating residents are required to both perform a gap analysis as well as design a viable QI/PS project, then successfully present both to key stakeholders from administrative, nursing and physician groups. The presentation must demonstrate understanding of the core elements and tools (root cause analysis, flow charts, control charts, etc.), a succinct description of the project including scope; the case for change; objective, quantifiable performance measures; any pilot data, and goals to be achieved (future state). Residents must be able to identify potential barriers; and are asked to submit a draft timeline for completion of the project. (In accordance with the LSUHNO IRB Policies and Procedures Guidebook, the authors of this brief report deem this study exempt pursuant IRB policy number 5.20). Resident supervision is assigned depending on the activity but is consistently provided by QI/PS content experts among the faculty physicians, staff nurses or pharmacists, and hospital leadership personnel from the Quality and Risk departments. The effectiveness of the EQuIP rotation in meeting its learning objectives is analyzed by comparison of pre- and post- rotation testing of 100% of participants; as well as by rotation effectiveness survey. Pre- and post-test questions were written by staff and faculty leadership involved with the EQuIP rotation. The pre-rotation exam is given on day one and the post-rotation exam is given on the final day of the rotation block. Questions are structured to determine knowledge of: core concepts of QI/PS processes; specific tools to devise an action plan; core principles of value based care; process for reviewing the qualification of a practitioner; and specific phases of a process improvement project. The rotation effectiveness survey asks aboutresidents’ perceived enhanced knowledge in QI/PS and the degree of value obtained during EQuIP in preparing for future medical practice. Residents are asked to grade each item across a five-point scale (‘1’equates to strong disagreement with attainment of knowledge; ‘5’ equates to ‘strong agreement’ with attainment of knowledge of skills). Finally, organizational impact of the rotation is also measured by monitoring the number of projects that have arisen from EQuIP. Project aims are archived and maintained in a searchable database of all resident-led projects, accessible to all residents and care providers. Projects can be searched by key word, by major heading or by project lead. Data is updated annually and progress in each project is assessed and reviewed.
improvement in rotating residents’ knowledge of principles and processes of QI/PS/QM/PI (Table 2).
Comparison of Pre- and Post-rotation Test Scores
Pre-Test Score (%)
Post-Test Score (%)
Average Score
80.00
61.11
Standard Deviation
18.75
20.58
Two tailed T-test P value
0.0009
Table 2: Comparison of Pre- and Post-rotation Test Scores
On the effectiveness survey, rotating residents rated every item at a score of ‘4’ or higher, with an average rating of 4.35 (Table 3).
Resident Ratings on Post-Rotation E ectiveness Survey, based on a 1 (Strongly Disagree) to 5 (Strongly Agree) Likert scale.
Survey Question
Rating Average
Upon completion of this rotation, you are able to explain the structure of the UMCNO EQuIP Rotation.
4.46
4.38
At the end of this rotation, you are conversant in the principles of basic methodologies and processes used in QI/PS. (For example, RCA, PDCA, PDSA, etc.)
4.00
At the end of this rotation, you can explain the UMCNO quality and safety management/improvement structure, policies and processes including RCA and PI Team initiatives.
4.31
At the end of this rotation, you feel comfortable discussing regulatory standards for quality and safety, including The Joint Commission National Patient Safety Goals.
4.38
At the end of this rotation, you are able to identify UMCNO's central priorities for quality and safety.
4.54
During this rotation, you experienced meaningful participation in one or more of the following: UMCNO committee meetings, RCA's, Process Improvement Teams, CLER tracers and/or event investigations occurring in the clinical setting.
4.54
At the end of this rotation, you can explain how this rotation fits into the ACGME competencies and milestones - and the rationale behind these connections.
4.15
At the end of this rotation, you have thoughtfully considered the intent and impact of the CLER program.
At the end of this rotation, you understand the EQuIP program - goals, resources, requirements and place in the GME structure.
4.54
At the end of this rotation, you understand the proper processes and methodologies to formulate an EQuIP project.
4.46
RESULTS
At the end of this rotation, you are conversant in your specialty-specific quality improvement and patient safety focus areas, indicators and benchmarks.
4.15
Between 2014 and 2016, 41 residents from five medical specialties rotated on EQuIP. This included residents from pathology (15), radiology (9), internal medicine (9), emergency medicine (7), and neurosurgery (1). Taken as a percentage of the total resident complement, this equates to roughly 10% of all rotating residents, and residents ranged from second- to fourth- year of residency. This academic year, awareness of the rotation has grown and trainees from Nephrology, Pulmonary/Critical Care, and Plastic Surgery are also expected to participate. The pre- and post-rotation test results demonstrated significant
Upon completion of this rotation, you understand the importance of measurement in the outcome of patient care.
4.62
Upon completion of this rotation, you are able to describe epidemiological and system-based risk factors and prevention strategies associated with medical error.
4.08
Upon completion of this rotation, you are able to communicate effectively with multidisciplinary teams regarding PS and QI issues and topics.
4.31
Table 3: Resident Ratings on Post-Rotation Effectiveness Survey, based on a 1 (Strongly Disagree) to 5 (Strongly Agree) Likert scale.
J La State Med Soc VOL 170 MAY/JUNE 2018 81
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