Pediatric 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 improving health care delivery 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. Past projects have led to permanent systems-changes that have improved patient care.
Pediatrics residents share continuous quality improvement projects
Lee's presentation was on “Improving asthma care in a pediatric teaching clinic.” The event was held at the Sunset Center in Carmel.
The presentation was the result of a CQI project undertaken in the general pediatrics and pediatric urgent-care continuity clinics, which are staffed by residents. Similar year-long projects, which started in July 2009, have improved clinical care in a variety of areas, including clinical efficiency, guideline implementation, depression screening, developmental screening, dental health assessment, and immunization.
"I am so proud of the fabulous projects that our residents design and implement, “Shaikh said. "Their enthusiasm and dedication to making a difference in the lives of their patients is evident by their hard work and the difference that their projects make. The pediatric quality improvement and patient safety training program at UC Davis helps 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."
Lee and Department of Pediatrics associate clinical professor Albina Gogo chose to work on outpatient asthma because it is one of the most common pediatric chronic diseases, and early intervention can prevent hospitalizations and emergency department visits. There was also an opportunity for improvement as resident approach to pediatric asthma management varied significantly.
Lee and her team decided to focus on three areas for improvement: the electronic medical record used in clinic, resident education and clinic practice. They created electronic medical record modifications such as creating a standardized asthma action plan, medication order templates, history-taking templates and a reminder to record Childhood Asthma Control Test score, provide asthma action plans and influenza vaccines.
Additionally, they gave a presentation to all residents on how to interpret pulmonary function testing, summarized and made the national asthma care guidelines easily accessible, and met with residents to review the individual and group performance. Finally, they educated the clinic's nurses and medical assistants regarding their various interventions and enlisted their help.
"Over the 12 months of our study, residents had statistically significant improvements in recommending and administering the influenza vaccine in age appropriate patients during winter months, in using a standardized instrument to assess level of control, in prescribing medications per the national asthma care guidelines and in providing written asthma action plans," Lee said.
Shaikh leads successful discharge transitions project
When a patient is discharged from UC Davis Children’s Hospital, residents are required to complete a timely and clearly communicated discharge summary. Communication deficits at hospital discharge are common and contribute to poor care coordination, adverse events, unplanned readmissions, decreased patient satisfaction and higher costs of care.
In June 2012, Shaikh and Department of Pediatrics residents implemented a quality improvement (QI) project for discharge transitions. Shaikh and her team began by presenting monthly educational sessions on QI methodology, where residents and attending pediatricians discovered and eliminated root causes affecting timeliness of discharge summaries. Residents shared strategies for well-written and succinct discharge summaries.
Attending pediatricians and residents worked together to develop a structured discharge summary template, which was integrated into the hospital’s electronic health record, and a checklist for the residents’ handbook and website.
The QI intervention conducted over 1 academic year demonstrated improvements in the timeliness of completion and the quality of discharge summaries. The proportion of summaries completed by residents and then reviewed by attending pediatricians within 24 hours of discharge increased from 38 percent to 73 percent.