1. Lisa Knight, MD 07-31-2014 Introduction to Quality Improvement (QI)

2. Lecture Objectives Be familiar with our Pediatric Residency QI curriculum and important deadlines Identify areas of healthcare where QI can be helpful Take the Pre-Program QI Self-Assessment Test

3. Why Teach Quality Improvement? Professional duty of physicians to provide high quality of care Residency Review Committee (RRC) requires it ACGME Core Competencies Practice-Based Learning and Improvement Systems-Based Practice ABP Maintenance of Certification (MOC) Requirement Pay for Performance

4. ACGME Competencies Patient Care Medical Knowledge Interpersonal and Communication Skills Professionalism Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care Systems-Based Practice as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value http://www.acgme.org/acWebsite/home/home.asp

5. Pediatric Residency Review Committee The Pediatric Residency Review Committee (RRC) requires that all residents: Learn QI methods Participate in a QI project "residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-assessment and life-long learning. Residents are expected to develop skills and habits to be able to systematically analyze their practice using QI methods, and implement changes with the goal of practice improvement; residents are expected to participate in a QI project."

6. Goals of our QI Curriculum Learn how to assess the quality of care that you provide in both the inpatient and outpatient setting Learn how to identify, develop, and implement small changes to improve the quality of care in those settings

7. July Aug Sept Oct Nov Dec Jan Feb March April May June Intro to QI Lecture Complete QI Survey QI Lecture Project Planning Documents Due QI Lecture 1.AIM Statement 2.PDSA Cycle 3.Faculty Mentor 4.Baseline Data Collection Important Dates for PGY-1s: 1.Project Planning Documents due by end of day on Friday, Jan 30, 2015 a.Project Planning Document a.AIM statement b.Faculty Mentor c.Project Measures d.What you are going to change to make the system better b.Introduction section of your QI paper with baseline data information 2.Next QI Lecture 1.Thursday, September 18, 2014 from 12:15p to 1:15p PGY-1 QI Curriculum Overview 1.Review PDSA cycle 2.SQUIRE Guidelines Project Implementation

9. PGY-2 QI Curriculum Overview July Aug Sept Oct Nov Dec Jan Feb March April May June QI Lecture Project Implementation and collection of post-intervention data Complete data collection by March 31st Complete QI Survey Poster Workshop Poster Presentation at SCAAP Meeting Important Dates for PGY-2s: 1.Complete data collection by March 31, 2015 2. QI Project Write-up Due to me by end of day on Friday, May 8, 2015 3. QI Lectures in 2015 a.How to do a QI Write-Up in Feb 2015 (Date TBA) b.Poster Workshop in April 2015 (date TBA) 4. 3 rd Annual Pediatric QI Presentation Day – Friday, June 19, 2015 5. SCAAP Annual Meeting Poster Presentations in July 2015 (Date TBA) Pediatric QI Presentation Day QI Write-up Due

10. Go for low-hanging fruit When selecting a QI topic… Make sure your project is something that you can complete by March 31 st of your second year Make sure you collect some form of baseline data on what you plan to change

11. Consider these areas when choosing a topic Near misses, adverse events, complaints  Create a checklist to decrease the number of times each patient’s central line is accessed by staff on the Heme-Onc floor to decrease CLABSI Repeated mistakes  Making clear “if, then” statements on resident check-out sheets A process that adds excessive costs to the patient or facility  Poor compliance with asthma controller medication Process that adds excessive time to care  Delay in starting surgery in the OR Variations in care  Transition of DKA patients from insulin gtt to SC injections Process or equipment/supplies that can be changed  Equipment to increase mobility of patients who are on contact precautions Ensure that Organizational support and participation will be provided for this improvement process

12. http://pediatrics.med.sc.edu/qi/qi.asp USC Pediatric Residency QI Website

13. Test Time!