Quality improvement and patient safety (QIPS)
Course Director: Ulfat Shaikh, M.D., M.P.H.
Our innovative Pediatric Quality Improvement and Patient Safety (QIPS) curriculum prepares residents to be leaders in quality improvement and patient safety in their future practices. Residents are initially introduced to QIPS concepts through didactics and web-based curricula. Then, working in teams, residents design and implement a QIPS project to improve clinical outcomes, safety, or patient satisfaction. Previous projects have led to permanent systems-changes that have improved patient care.
Pediatrics residents share continuous quality improvement projects
June 16, 2010
Two Department of Pediatrics residents, Courtney LaCaze and Josephine Lau, on June 4 gave invited presentations of UC Davis continuous-quality-improvement projects (CQI) at the statewide California Health Care Safety Net Institute Summit on Quality Improvement in Graduate Medical Education, held in San Francisco.
LaCaze gave an oral presentation on "Establishing postpartum depression screening in an outpatient pediatric continuity clinic." Lau's poster presentation was on "Improving efficiency of clinic visits using interpreters: A continuous-quality-improvement project to shorten interpreter wait time in the pediatric residents' clinic." The event was held at the University of California, San Francisco, Mission Bay campus.
Both presentations were the result of CQI projects undertaken in the general pediatrics and pediatric urgent-care continuity clinics, which are staffed by residents. The year-long projects, which started in July 2009, were assigned by Assistant Professor Ulfat Shaikh and Associate Professor Joanne Natale, and included the department's 36 residents working together in teams.
"I am so proud of the fabulous projects that our residents designed and completed," Shaikh said. "Their enthusiasm and dedication to making a difference in the lives of their patients was evident by their hard work and the difference that their projects made. The pediatric quality improvement and patient safety training program at UC Davis helped our residents increase their ability to apply quality improvement methods to real-life clinical problems, and to develop their leadership skills and ability to work effectively within a team. These skills will be valuable in helping residents deliver better and safer patient care in their future careers."
LaCaze said she and her colleagues chose a project on postpartum depression, which affects up to 25 percent of new mothers, because it can have significant adverse effects on child development. Postpartum depression is diagnosed during a child's first year of life and has numerous symptoms, among them anxiety, fatigue and sadness. LaCaze and team members Marc Ikeda, Gia Oh, Jean Pierce, Patty Ku, Mark Ratanasen and Carrie Gardner determined the extent to which post-partum depression was being assessed in the clinic. Their faculty mentor was Assistant Professor Erik Fernandez y Garcia.
"We looked at our patients' charts and found we really weren't screening systematically," LaCaze said. "It's important for pediatricians to screen for postpartum depression because they see parents so frequently in clinic during the baby's first year of life -- much more often than the mother sees her own physician."
After determining that mothers are more apt to acknowledge symptoms of depression in writing than during a face-to-face interview, LaCaze and her team developed and deployed a patient-health questionnaire for postpartum depression. It was a resounding success. Within six months, 50 percent of mothers were being screened for postpartum depression on the resident group's work day, up from 21 percent. LaCaze said 100 percent of mothers who were surveyed said they found the screenings helpful.
"Now we have this screening tool. We will be implementing it in all of the pediatrics clinics throughout the week, beginning in September," LaCaze said. "So just as we make sure that children go home in car seats and have smoke alarms in the home, we will ensure that their mothers are screened for depression and referred for treatment when appropriate."
LaCaze also said that the nursing staff in the clinic has been extremely supportive of their efforts, because at-risk mothers will receive increased follow-up care that will require more frequent appointments.
"The CQI program really worked," she said.
Lau's poster described her team's efforts to foster direct communication between residents and medical interpreters to shorten wait time. Her poster described how the improved communication with the Medical Interpretation Services department resulted in reducing wait times for medical interpretation services in clinic. Other participants in Lau's project included Andrea Bataan, Brian Gablehouse, Jacob Henderson, Amanda Kostyk, Yvonne Lee and Jennifer Singler. Associate Professor Joanne Natale mentored the residents.