1. Enhancing Quality Improvement for Patients (EQuIP) Equipping Louisiana with a Quality Future.

2. What Is EQuIP and Why Do We Do It? School-wide initiative Engage residents and fellows in systems-based quality improvement and patient safety (QI/PS) projects. Neither fully top-down nor fully bottom-up. Next Accreditation System: CLER Visits – Reviews the integration of GME and clinical facilities in: Quality improvement Patient safety initiatives Supervision Fatigue management and mitigation Transitions in care Resident duty hours Professionalism http://www.acgme-nas.org/cler.html

3. Quality Improvement & Patient Safety at LSUSOM Faculty DevelopmentResidentsStudents Teaching Hospital(s) Program Directors and Coordinators EQuIP DIO EQuIP Office EQuIP Steering Committee Program Directors and Coordinators Science and Practice of Medicine Curriculum

4. 1. Establish a sense of urgency 2. Form a powerful guiding coalition 3. Create a vision 4. Communicate the Vision 5. Empower others to act 6. Plan and create short- term wins 7. Improve continue changing the process 8. Institutionalize new approaches Adapted from JP Kotter, “Leading Change: Why Transformation Efforts Fail,” Harvard Business Review 1:1 (2007). EQuIP Steering Committee EQuIP Operations Committee

5. Tasks Teaching Hospital(s) & Clinical Sites EQuIP Operations Committee EQuIP Steering Committee Ongoing QI/PS projects at ILH Incorporate residents into ongoing initiatives Report outcomes as already scheduled Provide professional development for SOM faculty Match residents and fellows to ILH QI/PS committees Establish timelines for reporting and oversee day-to-day operations Solicit applications for new initiatives from programs and residents Review applications for new EQuIP projects Overcome roadblocks in meaningful resident participation Help to bring projects not making meaningful progress into compliance Serve as champions for program compliance with EQuIP curriculum

6. Welcome to the Matrix See legend aboveDepts and CURRENT PROJECTS /PROGRAMS/ COMMITTEES at ILPH ILPH point person Allergy & Immunology Anesthesiology Dermatology Emergency Medicine Emergency Medicine- Undersea & Hyperbaric Medicine Family Medicine Bogalusa Family Medicine Kenner Family Medicine Lake Charles Internal Medicine / Dermatology Internal Medicine / Emergency Medicine Internal Medicine / Pediatrics Internal Medicine - Cardiovascular Disease Internal Medicine -Endocrinology Internal Medicine - Gastroenterology Internal Medicine -Geriatric Medicine Internal Medicine -Hematology and Oncology Internal Medicine - Infectious Disease Internal Medicine Internal Medicine - Interventional Cardiology Internal Medicine - Nephrology Internal Medicine - Pulmonary Disease & Critical Care Internal Medicine - Rheumatology Child Neurology Clinical Neurophysiology Neurology Neurosurgery Obstetrics and Gynecology Ophthalmology - Retina Ophthalmology Orthopaedic Surgery Pediatric Orthopaedics Otolaryngology Pathology Pediatrics Cardiology Pediatrics Endocrinology Pediatrics Gastroenterology Pediatrics Hematology/ Oncology Pediatrics Neonatal/ Perinatal Pediatrics Nephrology Pediatrics Physical Medicine & Rehabilitation- Pain Medicine Physical Medicine & Rehabilitation Plastic Surgery Child Psychiatry Psychiatry Radiology Diagnostic Surgery Critical Care Surgery Vascular Surgery Urology Female Pelvic Reconstruction All Ambulatory Services Council Breast Program Weight Mgt Prog Cancer Care Comm Telemed Pgm GI Oncology Pgm: Thoracic Oncology 1-6 Anesthesia/OR Surgery Dashboard OR Booking 1,2,3 Critical Care GWTG-R Rapid Response Cardiopulmonary Arrest 1,5 Emergency & Disaster Mgm. 1,5, Ethics Health Literacy and Patient Education 1-6 Infection Control Pgms CUSP 1,5,6 Medical Admn and Leadership Medical Staff Credentialing 1-4,7 Nursing Dept Leadership Med-Surg Units Patient Satisfaction 1,3,5 Pain Management 1,5 Palliative Care Svs 1,2,3 Pathology & Sub-Groups Performance Measures Critical values 1-4 Performance Mgm Measures Quality Management: SCIP Quality Management: Stroke pgm Quality Management:: CAP Community Acquired Pneumonia Patient Advocate: NPSG Patient Satisfaction Quality Management: STEMI PCI Hypothermia Quality Management: Heart Failure 1-4 Pharmacy & Therapeutics 1,7 Population Health Management Community Med Prog. 2,3,4,7 Radiology Timely GFR lab prior to contrast studies All Throughput Access to Primary Care 5-Jan Trauma Services 1,5 Wound Care and Regen Med Pgm 1,3,5 Transition of Care Inititiatives Residency and Fellowship Programs Hospital Committees

7. EQuIP Steering Committee EQuIP Operations Committee and Staff Residents and Fellows Teaching Hospitals and Other clinical sites Program Directors & Coordinators

9. Participation in Hospital Committees Approximately 150 residents and fellows Part of committees at 4 clinical sites – e.g. infection control; ethics; Population Health/Disease Management programs; etc. Challenges: Committee meeting times

10. Participation in Independent QI Projects Approximately 125 individual and group projects – Conducted by and with ~ 465 house officers – Data collection and intervention at ~ 15 clinical sites (hospitals and clinics) – General Surgery residents in class-based projects to ensure continuity Challenges: Ensuring value/feasibility of individual projects

11. Nurse Manager of Quality Management at ILH collects current PI programs, committees, and projects. Listing is maintained on a drive shared between the QM and EQuIP offices. LSU Residency Program Director and/or residents request participation in ILH committee/project from the EQuIP office. EQuIP coordinator sends an email to the physician leads (CC to core group liaison, Dr. Zee Ali, and Patrick Reed) as an introduction and for approval of the resident assignment. Lead Approval Resident given dates, time location, and instructions as appropriate from the project lead. YES Return to the beginning for a new project NO Ms. Harkin will keep EQuIP workbook updated with resident assignments. When the EQuIP office notices an individual or group project requiring significant institutional resources,the EQuIP director or coordinator will (1) forward that project's details to ILH leadership to solicit approval and (2) referred residents/faculty to the LSUHSC IRB and to the ILH Research Review Committee for evaluation.

12. EQuIP Project Database

14. Evaluation of Resident Participation

15. Next Steps Quality Improvement Day (May 14, 2013). Evaluate resident performance on hospital committees (Spring 2013). Gather preliminary results of EQuIP projects (Summer 2013). Roll out QI/PS curriculum to faculty and hospital personnel (TBD). More robust project review mechanism ( AY 2013-2014).

16. Questions? Murtuza (Zee) Ali, MD mali@lsuhsc.edu