1. TITLE OF PRESENTATION Subtitle of Presentation
Promoting Scholarship in
Quality Improvement and Patient Safety
TITLE OF PRESENTATION Subtitle of Presentation
Quality Improvement and Patient Safety Committee
Department of Medicine
Weill Cornell Medical College, New York
Jennifer I. Lee, MD
Robert J. Kim, MD
Tara Bishop, MD MPH
AAMC Learning Health System Research Awards Kick-off Meeting
Washington, DC
12 February 2015

2. About Weill Cornell Medical College
Affiliated with NewYork-Presbyterian Hospital and Methodist Hospital in Houston
Located in the heart of New York City
862 certified beds
Regional trauma and stroke center
Member of the NIH Clinical and Translational Science Award (CTSA) Consortium
Global presence in Qatar, Tanzania, Haiti, Brazil, Austria and Turkey
A little bit of background to give you a sense of our institution

3. Department of Medicine’s Quality Structure
Interinstitutional and interdisciplinary collaboration
Weill Cornell Medical Center (WCMC)/Physician Organization (PO)
New York-Presbyterian Hospital (NYP)
Division of Quality and Patient Safety
Division of Medical Nursing
Department of Social Work and Care Coordination

4. Quality and Professional Review Committee
Chief Quality Officer
(NYP)
Chairman,
Department of Medicine
(WCMC)
Quality and Patient Safety Officer
(DOM)
Quality and Performance Improvement
Committee of the Medical Board
Quality and Professional Review Committee Chair(s)
Quality and Patient Safety Committee
Division Representatives
Unit Medical Directors
Patient Care Directors/Care Coordinators
Division of Medical Nursing
Quality and Professional Review Committee
DOM Faculty
Associate Chief Quality Officer
(NYP/WCMC)
Director of QI Operations
Quality Improvement Project Award Fund

5. Quality Improvement and Patient Safety Committee (QIPS)
Formed in 2010
Interdisciplinary committee formed to support and promote the Department of Medicine’s (DoM) dedication to establishing a reliable, safe healthcare environment and providing high value, high quality care to our patients.

6. QIPS Committee Leadership
Dr. Augustine MK Choi Chairman of Medicine Dr. Jennifer I. Lee Quality and Patient Safety Officer and Co-chair Dr. Robert J. Kim Co-chair Dr. Tara Bishop Director of QI Operations Ed Perchik PA-C Performance Improvement Specialist (NYP) Mary Elizabeth Kelser, RN MBA Administrator

7. 2014-2015 QIPS Committee Members
Physician and nursing representation
12 divisions
Four principle medicine units
Two campuses (Weill Cornell, Lower Manhattan)
Residency and Physician Assistant Programs
While our committee is open to anyone within the department with a passion for quality and safety, we do have designated members which include physicians and nurses who represent the
12 main clinical divisions within our department
Four principle medicine units
Two campuses (Weill Cornell, Lower Manhattan)
Residency and Physician Assistant Programs

8. 2014-2015 QIPS Committee Members
Cardiology
Epidemiology
Kim, Robert
Calfee, David
Infectious Disease
Singh, Harjot
Endocrinology
Sinha, Naina
Gastroenterology/Hepatology
Kahaleh, Michel
Geriatric Medicine
Ramsaroop, Sharda
Hematology/Medical Oncology
Ruan, Jia 
Hospital Medicine
Lee, Jennifer
Nephrology & Hypertension
Chung, Miriam
Pulmonary & Critical Care Medicine
Rajwani, Kapil
Residency Training Program
Gingras, Laura
Weill Cornell Internal Medicine Associates
Eiss, Brian
Bishop, Tara
Womens Health: Iris Cantor Women's Health Center
NYP PI Specialist
Administrator
Leef-Jacobson, Elizabeth
Perchik, Ed
Kelser, Mary Elizabeth
Unit Medical Directors
5W – Majid, Adrian
5C—Martin, Paul
5N – Gupta, Renuka
11S—Singh, Anand
PA service
Tang, Chin
Reischer, Amy
Lower Manhattan
Crossman, Dan
Gupta, Alka
Patient Care Directors/Care Coordinators
5W – Motal, Julius / Maikoff, Megan
5N – Mohammed, Natalie
5C –Marianne Moore

9. QIPS Mission Leadership and Education
Create a Proactive Culture of Safety
Scholarship and Research
Leadership and Education
Become quality champions for our division, department and institution
Educate and mentor faculty, staff, patients and families to promote awareness of patient safety matters
Create a Proactive Culture of Safety
Focus beyond mandated quality measures, encouraging proactive, division-specific quality improvements
Redesign processes to support patient safety and mitigate risk to ensure consistent delivery of high quality patient care
Scholarship and Research
Pursue and promote scholarly activity in quality improvement by
Developing expertise with research methods outside of those used in traditional clinical research
Collaborating with experts within our institution
Department of Healthcare Policy and Research
WCMC’s IRB
Interdepartmental collaboration
Establishing the first promotions track for academic achievement in quality

10. DOM QI Project Awards Established in 2011
Funding for project proposals not traditionally recognized through other entities
Raise awareness and academic recognition for efforts in quality improvement and patient safety
Engagement of faculty and residents in quality improvement efforts and scholarship
For many of our faculty, the QI Project award represents a novel opportunity to obtain funding for those who have a research interest in QI but may not be on a traditional clinical research track
While gaining momentum there are still challenges in achieving scholarship in QI.
Not all quality improvement initiatives lead to research but we believe the former are no less important, can be very labor intensive and time consuming, and often remain unrecognized
The majority of proposals submitted every year are from junior faculty without previous research experience or training in QI science.
Many internal funding opportunities are offered as supplements to larger grants or awarded based on the project’s ability to receive outside funding when complete.
Focus for research funding often remains on the paradigm of traditional clinical and translational research methodologies which may not fit with quality improvement.
While organizations such as PCORI and AHRQ do provide awards for QI, the majority of the grassroots projects our residents and faculty design start smaller in scale and require assistance to develop and implement to reach the next level.
The QIPS QI project award recognizes these challenges and provides promising projects with potential for sustainability and dissemination the necessary funds and support required to ensure that the final outcome can meet the standards needed for success.

11. Project Funding Criteria
Interdisciplinary project leadership
Inter-institutional focus
High value care
Sustainability
Dissemination
Interdisciplinary project leadership and team members
Improvement focus relevant to both the department as well as the hospital to encourage inter-institutional collaboration
Improvement area that focuses on high value care;
High probability for sustainability and/or
High potential for dissemination.

12. Timeline Late Spring June July Request for Proposals Review Committee
QIPS committee members
NYP Quality and hospital leadership
Division of Medical Nursing
Award announcements
Funding period coincides with the academic calendar (July – June)

13. Mentorship Project-directed mentorship
Quality Improvement and research experts
Research assistant
Statistical support
Quarterly team meetings
Monitor progress
Discuss action items and deliverables
Discuss barriers and design potential solutions
While our Director of QI operations and research assistant have provided support to all winning projects in the past, this will be the first year that we will be implementing a formal mentor network for each awarded project team.
In addition to the research assistant who will assist in IRB preparations and logistical support, the mentor team will also include faculty with experience in QI methodology, research science, and statistics.
QIPS committee members and past awardees serve as part of this team.
There will also be a member from our hospital’s Division of Quality on each team to support project development and implementation in our efforts to ensure sustainability.
The goal of the mentor network is to assist the project team in the successful implementation of their project. Together, we will work to (1) ensure the validity and rigor of the project design and metrics; (2) identify and design strategies to overcome challenges encountered during the implementation process; (3) collaborate with key stakeholders to ensure sustainability; (4) promote QI scholarship through presentations and publications; (5) grow our mentor network through the training of each subsequent group of awardees.

14. QIPS QI Project Awards Poster Session
Highlighting of all funded projects
Publicized within the hospital, medical school and at local organizations
Annual event held on campus
2012: 13 submissions; 11 funded projects
2014: 18 submissions; 14 funded projects
2016: 23 submissions; 5 funded projects

15. DOM QI Project Awards Metrics
Sustainable changes in clinical policies or procedures
Scholarship
Did the project lead to changes in clinical policies or procedures so that it is sustainable?
Did the project lead to a scholarly product, defined as a presentation at a national meeting and/or publication in the peer-reviewed literature?

16. Innovative Changes in Clinical Practice
CLINICAL GUIDELINES
High impact fracture protocol on the Medical Orthopedic Trauma Service (MOTS)
Echocardiography in Patients with Moderate or Severe Aortic Stenosis or Mitral Regurgitation
Clinical Dashboard for Weill Cornell Internal Medicine Associates (WCIMA)
Testing an Insulin Titration Algorithm to Combat Clinical Inertia and Improve Inpatient Glycemic Control
Evaluating Adherence to Clinical Guidelines For Thrombophilia Screening
Eva Flores, MD
Marie Finn, RN
Mohammed Mehdi Premjee
Robert J. Kim, MD
Fran Ganz-Lord, MD
Naina Sinha Gregory, MD
Jane Seley DNP, MPH
Maria Teresa De Sancho MD et al
These slides do not list all the funded projects but provides a glimpse into the areas in which the projects focused and the interdisciplinary nature of the project teams.
Projects ranged from educational to IT interventions focusing on the
implementation of and improving adherence to clinical guidelines
reduction of hospital acquired conditions and infections
Improvements to clinical practice relevant to our clinical setting
Improvement in care transitions

17. Innovative Changes in Clinical Practice
HAI
Protocol for Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults
A Standardized Approach to the Education and Assessment of Central Venous Catheter Placement
PROCESS IMPROVEMENT
Accuracy of Attending of Record Designations
Use of a Universal Database to Record Procedures and Track Bronchoscopy Complications
Mary R. Mulcare, MD
Jaime Lynn Hayes, RN, BSN, et al
Kirana Gudi MD, et al
Jennifer I. Lee MD
Glenna Friedman
Dana Zappetti, MD
Riya George, BS

18. Innovative Changes in Clinical Practice
Peter A. D. Steel MA MBBS, et al
Elizabeth Alexander MD, et al
Kathryn Arbour MD, et al
Saraswati Iobst MD
Carol DeJesus LCSW CCM, et al
CARE TRANSITIONS
Emergency Department Low Risk Chest Pain Follow-up Project
Improving the Transition from Inpatient to OPAT Care in the ID Fellowsʼ Clinic
Improving Patient Safety by Implementing a Multidisciplinary Discharge “Time-Out”
The CARE Project

19. National Poster/Oral Presentations
Society of Hospital Medicine Annual Meeting. Las Vegas, NV. March 2014
CORD Academic Assembly New Orleans, LA. March 2014
Society of General Internal Medicine Annual Scientific Meeting, San Diego, April 2014
Improving Hepatitis C Screening Rates in a Resident Clinic (Maday Gonzalez MD et al) Characteristics of Medicine Inpatients who Engage the Discharge Appeals Process (Ernie Esquivel MD et al) Protocol for Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults (Mary Mulcare MD et al) The CARE Project (Sara Iobst MD et al)

20. National Poster/Oral Presentations
Improving Utilization of Interpreter Services by Admitting Medicine Housestaff (Jamie Mullally MD et al) Testing an Insulin Titration Algorithm to Combat Clinical Inertia and Improve Inpatient Glycemic Control (Jane Seley DNP et al) Evaluating Adherence to Clinical Guidelines For Thrombophilia Screening (Maria De Sancho MD et al.)
2014 AAMC Education and Science Meeting. Rosemont, IL. June 2014
American Diabetes Association 74th Scientific Session. San Francisco, CA. June 2014.
56th American Society of Hematology Annual Meeting and Exposition. San Francisco, CA. December 2014

21. Publications In Progress:
Testing an Insulin Titration Algorithm to Combat Clinical Inertia and Improve Inpatient Glycemic Control (Jane Seley DNP et al)
Evaluating Adherence to Clinical Guidelines For Thrombophilia Screening (Maria De Sancho MD et al.)
Protocol for Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults (Mary Mulcare MD et al)
Improving the Transition from Inpatient to Outpatient Parenteral Antibiotics Therapy Care in the Infectious Disease Fellowsʼ Clinic (Elizabeth Alexander MD et al)
Emergency Department Low Risk Chest Pain Follow-up Project (Peter Steel MD et al)
The CARE Project: A Multi-disciplinary Approach to Improve the Care of Hospital Super-Utilizers (Kelly Berchou MD et al)
Characteristics of Medicine Inpatients who Engage the Discharge Appeals Process (Ernie Esquivel MD et al)

22. Challenges Alignment with organizational goals
Achieving sustainability
Biostatistics support
As you can see, our organizational structure is complex and the relationship between the hospital and college continues to evolve. Maintaining close working connections and continuing to collaborate in our QI efforts has been difficult at times to maintain but continues to develop as the importance of interdisciplinary and interinstitutional teamwork remain as a top priority.
We continue to emphasize the identification and early involvement of key stakeholders in project planning and implementation to increase sustainability of QI efforts. This year we have invited several members of nursing and hospital leadership to participate in the proposal review process to improve alignment in our goals. They will also take part in the mentoring of projects to ensure continued involvement throughout the improvement process.
One of the barriers to publication of QI projects has been the lack of rigor in the design of metrics and data collection. Collaboration with the Department of Healthcare Policy and Research allows for early biostatistics support to increase the likelihood for publication in peer reviewed journals.

23. Future Directions
Expand committee membership to include IT and other disciplines
Faculty development
Quality University
DoM Faculty Development Program
Mentorship Training

24. Thank you!
Jennifer I. Lee, MD FACP