Implementation of a Quality Improvement Elective Rotation for Internal Medicine Residents

From the 2021 HVPAA National Conference

Kathryn Zaffiri (Lehigh Valley Health Network), Amy Slenker

Objectives

  • Enhance medical resident’s understanding and appreciation for healthcare quality improvement
  • Increase the number of meaningful quality improvement projects being completed by residents

Background

Quality Improvement (QI) in the healthcare setting is becoming more widespread among hospital systems and academic institutions. At Lehigh Valley Health Network, very few residents participated in a formal QI project during their training. Additionally, residents lacked any protected time for QI education and focused project efforts.

Methods

A quality improvement educational elective rotation was created for Internal Medicine residents. This virtual rotation is non-clinical protected time and is one week in duration. The 3 main components to the rotation include: education, observation, and application. The residents are provided educational PowerPoint presentations that give an overview of QI in healthcare, QI tools, resources, and steps on how to best design and implement a QI project. Residents are invited to any hospital or departmental quality meetings for the week. Finally, the residents are expected to come up with a QI project idea and begin working on a comprehensive project proposal document. Check-in meetings throughout the week help keep the resident on task.

Results

During the first academic year of implementation, 18 internal medicine residents completed the rotation (PGY1= 2, PGY2= 9, PGY3= 7). A few noteworthy project topics include: Decrease in Inappropriate IgE Food Allergy Testing, Appropriate Use of Ethics vs Risk Management Consults, Reducing Unnecessary Procalcitonin Ordering, and Decreasing Inappropriate Heparin-Induced Thrombocytopenia Testing. We obtained qualitative feedback from many of the residents who completed the rotation. Notable quotes include: “The Quality Improvement elective rotation allowed me to make significant progress on my QI project that I had been working on since my intern year of residency”, “…I learned more about healthcare QI which influenced my decision to find a fellowship program where I could continue to be involved in QI projects.”, and “Since we have very little protected administrative time the QI week was great to have that dedicated time to get work done on a project.”

Conclusions

The development of this elective rotation curriculum has been monumental in the quality improvement efforts among the residents. Providing guidance, education, and designated time for work on these projects has enabled many meaningful QI ideas to be turned into interventions. We have received support from the residency’s leadership team to work towards making this a required rotation.

Clinical Implications

The residents who complete this rotation will have a stronger understanding of healthcare QI. This rotation will provide an insight into how quality and patient safety is best addressed. The residents will be able to better identify opportunities for improvement in their clinical work environment and create meaningful interventions that deliver efficient and effective patient care.

Click here to register for the 2022 Architecture of High Value Health Care National Conference!

What are academic medical centers across the country doing to improve healthcare value?

Value improvement guides: Published reviews in JAMA Internal Medicine coauthored by experienced faculty from multiple leading medical centers, with safety outcomes data and an implementation blue print.

Review article detailing 25 labs to refine for high value quality improvement | July 2020

MAVEN campaign: Free 4 year high value care curriculum online.

Join the Alliance! Membership is free with institutional approval and commitment to improving value in your medical center.

Learn more about HVPAA on Health Affairs Blog