Pediatric quality-improvement efforts advance resident education, patient care
From screening new mothers for post-partum depression to ensuring that children receive regular dental health check-ups, quality-improvement efforts by residents at UC Davis Children's Hospital have been highly effective at improving both resident education and patient outcomes, a study by pediatric medical education faculty has found.
Over a three-year period and working in teams, residents and faculty were able to apply quality-improvement (QI) principles to design and successfully implement a wide range of projects that resulted in significant improvements in patient care on a range of measures.
The research, "Improving pediatric health-care delivery by engaging residents in team-based quality-improvement projects," is published online in the American Journal of Medical Quality.
"Our trainees and clinical faculty do what they do because they want to make a difference in the lives of children and their families," said Ulfat Shaikh, professor of general pediatrics and director of Healthcare Quality Integration at UC Davis. "But the hard reality is that millions of patients all over the United States experience harm, delays, ineffective treatments, disparities and high costs when they deal with the health-care system."
"Our pediatric trainees are demonstrating that engaging frontline clinicians and trainees in leading quality improvement can help organizations do a better job taking care of their patients," she said.
The study was conducted to analyze best practices for fulfilling Accreditation Council for Graduate Medical Education requirements for residency programs to "ensure that residents are integrated and actively participate in interdisciplinary clinical quality-improvement and patient safety programs."
The researchers found that a focused curriculum was effective, within the constraints of resident work hours, based on three years of education and refinement. In addition to Shaikh, the study's other authors are Joanne Natale, professor of critical-care medicine in the Department of Pediatrics; Su-Ting T. Li, associate professor and residency program director in the Department of Pediatrics; and statistician Jasmine Nettiksimmons.
At the outset of the study, the faculty curriculum development team examined residents' experiences with QI programs through use of a Web-based assessment tool. Only 11 percent of trainees stated they had experience with quality improvement.
To address this gap in experience, the quality-improvement development team developed an approach that included:
• Didactic training on key quality-improvement concepts
• Working in interprofessional teams
• Faculty and peer mentoring
• Selecting topics aligned with institutional priorities
• Designing and implementing QI projects
• Disseminating QI projects to leadership
At the conclusion of the three-year period, the residents had successfully been engaged in applying QI methodology to identify gaps in clinical practice and designing projects to improve the quality of care delivered. The highest level of comfort with applying key QI concepts was experienced by residents in their first year of exposure to QI curricula. During the last year of the curriculum, senior residents mentored interns during their second and third years of QI curricula exposure.
The QI projects included:
• Increasing documentation of primary-care provider contact information on admission to the pediatric ward
• Reducing wait time for language interpretation services in the pediatric clinic
• Increasing implementation of the vitamin D recommendations of the American Academy of Pediatrics
• Improving screening new mothers for postpartum depression in the pediatric clinic
• Increasing the number of children who receive home-management care plans at hospital discharge
• Increasing the rate of administration of human papilloma virus (HPV) vaccine in the pediatric clinic
• Increasing developmental screening in the hospital-based pediatric teaching clinic
• Increasing developmental screening in a community clinic serving the underserved
• Improving patient flow in the pediatric clinic by reducing lead time (total length of time spent by patients in the clinic)
"Given the importance of equipping future physicians with QI skills, curricula such as the one we described can be feasible and effective. Because residents play major roles in clinical care within academic health centers, education in QI focused on redesigning care delivery systems may help them understand and support these systems while in residency and beyond," the study says.