PL-2 Quality Improvement Project
PL-2 Quality Improvement Projects
The projects should focus on quality and provision of care in the continuity clinics or wards using the “plan, do, study, act” philosophy. It should include the quality triad of structure, process and outcome. There are various factors that can affect patient care and you need to determine whether they are structural, procedural or outcome oriented and whether or not they can be altered to improve patient care. Your project can link to advocacy projects, senior year Grand Rounds or possibly a rigorous research project.
Competency and Licensure Objectives
Medical Knowledge
Demonstrate an investigatory and analytic thinking approach to clinical situations.
Practice Based Learning and Improvement (PBLI)
Analyze practice experience and perform practice based improvement activities using a systemic methodology.
Systems Based Practice (SBP)
Understand how your patient care and other professional practices affect other health care professionals, the health care organization and the larger society and how these elements of the system affect their own practice.
American Board of Pediatrics
Starting in 2010, the American Board of Pediatrics will require evidence of quality improvement as part of the maintenance of certification process. While their methods are still uncertain, and may currently be limited to online simulations, it is possible that this project can serve as this evidence, or at least groundwork for future projects.
The Project Objectives
□ Appropriately identify a clinical issue for which clinical practices vary.
□ Analyze the performance gaps found in the continuity clinic or wards and recognize their possible impact on patient care.
□ Define a problem.
□ Identify structure, process and outcome components appropriate to the clinic or wards and the associated patient population.
□ Ensure the structure, process and outcome components chosen are measurable and clearly linked to patient care.
□ Understand how each quality measure identified affects patient care.
TIMELINE
|What is due? |Date** |
|Identify mentor |9/1/10 |
|Project description | |
|Initial aim statement | |
|Timeline | |
| | |
|Submit on project description worksheet via email to Drs. Black and Thompson | |
|Pre-implementation data findings |12/15/10 |
|SMART aim statement | |
|Key Drivers | |
|Design Change(s)/Interventions(s) | |
|Measure(s) | |
| | |
|Submit on project description worksheet via email to Drs. Black and Thompson | |
|Implementation* |Preferably during |
| |your Advocacy, |
| |Development or Elective months |
|Completion of project |No later than 2 weeks before your presentation |
|Presentations or Poster session |June 2011, dates TBD |
Please note:
*Implementation may be an ongoing process, however if you plan to survey or institute something new in the outpatient clinic it is highly recommended that you do so during your Advocacy, Development and/or Elective months.
**dates listed are deadlines, we are happy to receive information anytime before those dates!
Methods
- Identify a mentor for your project. Good mentors are usually a continuity clinic supervisor, an advisor, or a sub-specialist within the field of study.
- Identify a need for improvement
- Identify a source of information (chart review, patients, fellow residents)
- Establish outcomes of interest
- Decide if IRB approval is needed or desired (see LT)
- Establish methods of assessment (refer back to QI presentation done by Dr. Black. May be chart reviews, surveys, focus groups, secondary data analyses)
- Create a timeline for implementation
RESOURCES
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• evalresources
• Your mentors
• Drs. Black and Thompson
• Methodologist (very helpful!): Dr. Erik Black (erikwblack@)
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FORMAL PRESENTATION OF YOUR PROJECT
(2 options)
1. Platform presentation during noon conference
o Utilize the power point template
o State the problem that you identified in our system
o List the objectives of your project
o Briefly describe your project
o Discuss the markers by which you assessed your project
o Discuss your outcomes
o Keep your presentations to 10 minutes (15 minutes max with
questions.)
A reminder…this is not the time to just give a lecture on a medical
issue. For instance, a resident created an order set for community
acquired pneumonia. She discussed some of the details of the antibiotics, VS, parameters, etc… however, the meat of her discussion centered around why she created this order set and what she achieved.
2. Poster presentation (one noon conference in June will be set aside for poster presentations)
o A template for a poster can be provided upon request
o Speak to Drs. Black or Thompson about where to print (the architectural lab printing only costs $8!!!)
o Please remember if you plan to present your project and findings at a meeting outside of the residency (e.g., PAS) then you need to seek IRB approval first. Again, Drs. Black and Thompson can help with this.
QI Project Description Worksheet
Name:
Title of Project:
Due by September 1, 2010
1. Mentor:
2. Project description (brief paragraph providing general idea of project):
3. Initial Aim Statement (can be less specific than SMART Aim statement):
4. Timeline (pre-implementation data gathering, implementation, post-implementation data gathering):
Due by December 15, 2010
1. Pre-implementation data findings:
2. SMART Aim statement (specific, measurable, action-oriented, realistic/relevant, timely):
3. Key Drivers (should be stated in the affirmative and list all key drivers even if you are not going to target them for change):
4. Design Change(s)/Intervention(s):
5. Measure(s):
Due by June 1, 2011
1. Project is complete.
2. Preparing for platform presentation or poster presentation to be given that month.
3. Project Description Worksheet, presentation, and evaluation of project will be placed in your electronic portfolio.
PROJECTS TO CONSIDER
(with potential mentors)
• Increasing the usage of guidelines and order sets (Dr. Udassi or Black)
• Translation of the newborn pamphlet into Spanish (Dr. Kelly)
• Well-child check and Fitness Clinics: screening, feeding, obesity (Dr. Dumont-Driscoll)
• Automatically faxed discharge summaries from wards to PCP (Dr. Lossius)
• Communication and understanding all the members of the medical team on the inpatient unit (Dr. Lawrence)
• Patient and family stress related to hospitalization (Dr. Lawrence with child life)
• Pain management for routine hospital procedures (Drs. Lawrence and Udassi)
• Create informational website for Gen Peds and clinics (Dr. Kelly)
• 30mo WCC form (Dr. Kelly)
• Improved use of Asthma Action plan for inpatient hospitalized asthma exacerbation (Dr. Black or pulmonary faculty)
• Contact precaution order and use, with appropriate step for patients admitted and treated with presumed MRSA infection and use of droplet precautions for pt with Bronchiolitis-awareness of the sensitivity of the RSV and flu rapid test (Dr. Udassi)
• Anti-microbial sheet formulation and use, to limit the overuse of antibiotic and contributing to rise of resistant strains ( Dr. Udassi)
• Education and Cost effects of ordering labs/studies not urgently required- ie inpatient vs outpatient workup. (Dr. Udassi)
• Utilizing the appropriate procedure for removing ”mislabeled drug allergies” (Dr. Huang)
• Pain-free or less pain in primary care (Dr. Thompson)
PAST PROJECTS
Outpatient Clinic:
|Guideline for AOM and PE tube referral |
|Spanish questionnaire:TB and lead poisoning |
|Nutritional counseling and nutritional supplements |
|Car seat education and use |
|Screening for post-partum depression* |
|Sports physical screening |
|Translation services |
|STD education |
|Instituting use of BMI calculator |
|Smoking cessation |
|Asthma: effective instruction for medication usage |
|Injury prevention |
|Postcard reminder system: flu shots and Synagis |
|Consistent STD, HPV, and pap smear screening policies |
|Standardized ADHD follow-up visits |
|Counseling on sun protection |
|Screening tool for sleep issues during the well-child visit |
|Fire arm safety and gun lock distribution during the well-child visit |
|Improving provider and parental education of cold and cough therapy in children and infants |
|Screening tool for autism at the 18 month and 24 month well-child visit |
|UF Outpatient Pediatric Clinic Informational On-hold Message |
|Positive Developmental Screening: Where do we go from there? |
|Improving the compliance rate of Developmental screening using ASQ at the 18 month well child visit by implementation of Electronic Medical |
|Records at CMS |
|TV/Internet Usuage Evaluation during the well child check |
|Modified Guidelines in the Outpatient management of Cardiomyopathy at the Congenital Heart Center Clinic |
| |
|Newborn nursery: |
|SIDS education |
|Discharge education brochure: “Head to toe Newborn/Infant survival guide” |
|“Babies don’t come with instructions: A parent’s guide to their newborn” |
|Discharge instruction form (English and Spanish versions) |
|Chorioamnionitis/Suspect Sepsis order set |
|Newborn Nursery admission order revision and improving use of the hypoglycemia algorithm |
|Newborn nursery follow-up physician list |
|Newborn Nursery Physician Worksheet |
|Preventing Smoking in Mothers of Newborns |
|Hyperbilirubinemia Protocol for the Shands UF Newborn Nursery |
|Newborn Nursery “Smart List” |
| |
| |
|ED/PAH: |
|Standardized guidelines and forms (AGH ED): fever less than 90 days, fever in the immunocompromised patient, shortness of breath, general |
|pediatric illness |
|Improving documentation in the AGH ED through use of a Pediatric Shortness of Breath standardized form |
|Standardized guidelines and forms (UF ED): appropriate antibiotic therapy of STI’s, sexual assault, asthma, 1st afebrile/unprovoked seizure |
|Improvement in PAH handout |
|Utilizing Poseidon to fax electronic ER charts to the PCPs' offices |
|PAH phone call computer entry system |
| |
|Inpatient: |
|Order sets: community acquired pneumonia, cellulitis, asthma, ALTE, croup, bronchiolitis, failure to thrive, bowel disimpaction/GI cleanout |
|Respiratory flow sheet revision |
|Decreasing medication errors related to incorrect weight entry |
|Revision of code blue documentation sheet |
|Creating and modeling safe sleep environments for hospitalized infants and children |
|Pancreatic Insufficiency in CF Population- Treatment and Care |
|Admission Order Set for Patients with Fever and Neutropenia |
|Physician Trading Card Project |
|Pediatric Blood Draw Optimization with Causal/Cost Analysis |
|Children’s Hospital Video Orientation |
| |
|ICU: |
|Management algorithms for use by outside facilities for common newborn diagnoses transported to Shands |
|NICU quick reference guide |
|NICU-specific discharge instruction sheet |
|Sedation and analgesia protocol in mechanically ventilated patients in the PICU |
|New standardized progress note for the PICU |
| |
|Residents |
|Intern survival guide |
|Reducing Unnecessary Paging During Residents’ Protected Time |
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