Quality Improvement, Patient Safety and High Value Care

The program offers several opportunities to participate in QI, patient safety and high value care.

  1. Population Health half days: at both the VA PRIME and PHHS PCIM - small PDSA cycles of improvement and aim to address population health. We will aim to address smoking, vaccination rates, and are in the process of creating practical projects for your area of interest (cirrhosis alcohol abstinence if hepatology is your focus). The bare minimum is to ensure empty inbaskets/ BPAs for your entire patient panel at PCIM and PRIME. 
  2.  Formal QI courses are available through UTSW including the CSE (clinical safety and effectiveness) course. This is a 6-month course with 7-8 full day classes and guidance while completing QI project.
    1. More info:
  3. Presenting at Monthly patient safety conferences (traditionally, M&Ms). These will include a mixture of patient safety, high value care and traditional M&Ms. If you would like to do your resident update talk as an M&M, please let the Chiefs know
  4. Hospitalist Rotation: 1 of your 2 weeks of hospitalist time can be used for QI time
  5. Elective time: It is possible to schedule 2- or 4- weeks of your elective as dedicated QI time. Please contact for ideas/ details/ opportunities.
  6. Improving the EMR is an easy way to contribute to QI. If you see something, say something. There are numerous committees at Parkland that can help.
    • For example: in the past, ordering 2 sets of blood cultures in EPIC would fire an alert of ‘duplicate order’. It took years for someone to point this out to the IT department, and we were able to fix this very quickly, saving our employees from losing valuable time and calm. We look forward to hearing your ideas.
  7. QI Projects: Depending on career/ fellowship interest, we can do wonderful inpatient QI projects also.
    • Eg- GI – reducing C. diff testing on patients taking laxatives
    • Eg- Rheumatology- reducing concurrent ANA and sub-serology testing at the same time.
    • Eg- Hematology- reducing unnecessary thrombophilia testing inpatient.
  8. Writing JAMA Internal Medicine Teachable Moments is a bonus. We see overuse/ underuse everyday and getting a publication in a high-impact journal never hurts. Our residents have had a fair amount of success with this section over the past years. These are short (800 word) write-ups describing a real case with a discussion. See here for instructions.
  9. Excellent online resources:

Examples of successful QI projects from prior years:

ProjectResidentsMentorLocationDescription
Get With the Guidelines mineralocorticoid receptor antagonist (MRA) Prescription Spencer Carter Dr. Sandeep Das NPH - PCIM Improving prescription of MRA for guideline appropriate CHF patients in primary care clinics
Octreotide utilization review Tiffany Lee and Jake Hutto, Arjun Gupta Dr. Deepak Agrawal NPH Octreotide has many indications with variable quality of evidence for appropriate use. We aim to improve evidence based use.
ICU Delirium - Sedation & Analgesia Fernando Woll (pulm fellow), Mark Cooper (GI fellow) Drs. Leveno and Chen NPH We are evaluating hourly variation in sedatives and analgesic to reveal patterns of use associated with prolonged vent time.
Chalk Talks Nick Brownell and company   ALL Responding to resident call for more materials to teach medical students, Nick produced a series of chalk talks addressing common shelf topics.
Improve naltrexone prescription for alcohol use disorders Nimish Shah, Neil Keshvani Dr. Anil Makam NPH- wards Naltrexone is severely underutilized for rx of alcohol use disorders 
Improving measurement and reporting of respiratory rate by techs/ RNs Neil Keshvani, Nimish Shah Dr. Anil Makam NPH- wards Respiratory rate is hardly ever correctly recorded outside the ICU and may misguide management of patients.
VA Safety Committee (Review of safety reports at the VA) Nimish Shah, Neil Keshvani Dr. Tyler Miller, Arjun VA Review all safety posts at VA, RCA/ analyze these and improve patient safety at VA, with Diane Lyle.
Improve Sepsis guidelines adherence   Dr. Carol Croft CUH Sepsis is the main priority for CUH this year, assess and address barriers to appropriate care.
'Man vs Machine'   Dr. Anil Makam, Dr. Oanh Nguyen NPH- wards and CCU Compare physician-assessed risk of re-admission to the readmission risk calculated by existing EHR models.
 Reducing time to chemotherapy from admission at Parkland 14-400 Arjun Gupta Dr. Navid Sadeghi NPH14-400 Time to chemo for scheduled pre-admits is an unacceptable 6 hours leading to increased length of stay. We aim to reduce it to 4 hours.
Reducing unnecessary labs through the Lab Committee

Arjun Gupta, Neil Keshvani

 

Jessica Barnes

 

 

Nivedita Arora

 

Dr. Brett Moran/ Dr. Nainesh Shah

 

Dr. Deepak Agrawal

 

Dr. Nagalla/ Dr. Sarode

NPH

 

 

 

 

 

CUH

Great place to run ideas by, and to optimize lab use.

Eg- create q48h labs, show turnaround time for send-out labs when ordering labs.

Evaluating need for some labs (amylase, FOBT inpatient, urine eosinophils removed) - stool WBC under consideration

 

Folate, SPEP

PCIM Committee Tri Le Dr. Salahuddin Kazi 7th floor old Parkland  Meetings in G5.240 q2 months. 
Goal is to improve PCIM functioning and experience for patients and providers.
Improving vascular access (PICC vs midline)   Dr. Kavita Bhavan/  Dr. Deepak Agrawal NPH New order set for vascular access (PICC/ midline together) starting at NPH. 
 Optimizing cardiology admission order sets Anurag Mehta  Dr. Sandeep Das NPH/ CUH  Involve end-users of cardiology admission order sets (residents) in their review and revision to optimize their structure and function
Reduce inappropriate lab tests at the VA Arjun Gupta Dr. Tyler Miller/ Dr. Robin Amirkhan (pathology) VA Coming up with novel solutions to reduce inappropriate lab tests at the VA.
Facilitating image sharing during patient transfers through process assessment and identification of quality indicators Roshni Patel Dr. Gary Reed, Dr. Deepak Agrawal CUH

Improving quality of patient care, reducing,healthcare costs, and reducing reimaging 

Reduce hospital-acquired anemia by using pedi-tubes for routine blood draws within the ICU.

Brandon Jakubowski Dr. Matt Leveno NPH >50% of a phlebotomy sample is discarded --> pedi-tubes can reduce hospital acquired anemia
Transitioning chemotherapy to outpatient setting Neil Keshvani Dr. Navid Sadeghi NPH Transitioning multiple day chemo regimens from inpatient to outpatient setting
Reducing inappropriate rasburicase use Komal Patel Dr. Navid Sadeghi NPH Making sure that an expensive medication (rasburicase) is not used inappropriately
         
Previous Resident QI Projects (MyUTSW)