Continuous quality improvement (CQI) has become an increasingly important part of the health care industry, both in patient care and in education. A recent national policy statement from the Institute of Medicine urges physicians to take the lead in improving the quality of the U.S. health care system. Resident participation in CQI is required by the ACGME under the competency of “practice-based learning and improvement”. In addition, the American Board of Pediatrics requires a Quality Improvement project for recertification. Given this new emphasis, we have developed a robust QI program that spans all three years of residency.
By the completion of residency, our residents should be able to demonstrate the knowledge and skills necessary to effectively participate in a CQI effort and demonstrate an appreciation for the need to improve quality in health care. This program utilizes the following components:
Online Training Modules
Several on-line training modules, ranging from the basics of CQI to a more “graduate” level, are available by iPad or other internet-connected devices.
Interactive Discussion Session
This workshop occurs at the end of intern year, and includes a review of the residency CQI program. It allows for an interactive discussion of QI concepts and brainstorming to generate ideas for potential QI projects.
Residents are required to participate in a CQI project. These projects are collaborative and interdisciplinary in nature. They build teamwork skills and foster a sense of inquiry and personal responsibility for overall healthcare for our patient population. Residents can do short (a few months) or long-term projects in groups with other residents, faculty, hospitals, etc. All residents must complete a project by the end of their third year. Graduating seniors must present their projects in poster or oral format during an annual scholarly projects forum their senior year. Projects may also be presented at a regional pediatrics conference in the spring of each year. Many may rise to the level of publication in peer-reviewed journals.
Recent Resident QI Projects
In the Spring of 2013, a Pediatric Grand Rounds Lecture was devoted to resident projects. Residents presented five diverse presentations:
· “Food Insecurity and Children” and “Patient Centered Medical Home: Patient Satisfaction Survey” both presented by Dr. Catherine Baker
· “Pilot Study: Understanding Parental Perceptions of Children’s Body Image, Health, and Dietary Intake in Panama” presented by Drs. Katherine Byra and Matias Jasin
· “Improving Compliance with ACGME Resident Duty Hour Rules” presented by Dr. Cary Aungst
· “Addressing Infantile Pertussis” presented by Drs. Deanna Barry
· “Patient Centered Medical Home: Patient Satisfaction Survey” by Dr. Melanie Youschak and Dr. Catherine Baker.
At the Annual Lewis Barness Fellows Forum in April 2013, pediatric residents presented their QI projects and other research projects during a poster presentation:
· “ Effect of utilization of post-call badges on improvement in timely departure of post-call residents” by Drs. Cary Aungst, Catherine Kubiak, and Kelly Montgomery
· “Impact of a community coalition addressing food insecurity in children” by Dr. Mary Baker
· “Effect of implementation of a tier system on pain control in the CVICU” by Dr. Krystle Balduzzi
· “Addressing infantile pertussis: The effect of adding Tdap immunization status questions to well visit chart templates and providing informational handouts to families” by Drs. Deanna Barry, Haley Howard, and Kelly Driver
· “Implementation of a Spanish language training curriculum in a pediatric residency program” Drs. Pilar Brinez, Juan Luna, Vanessa Perez, and Yolanda Suarez
· “Knowledge, attitudes, and practices related to obesity in Panama” by Drs. Katherine Byra, Matias Jasin, Vanessa Perez, Christina Dornschuld, and Kim Chau
· “Enhancing quality of care for ADHD patients” by Dr. Mary Chrisochos
· “Feasibility and safety of rapid refeeding of hospitalized anorexic patients” by Drs. Stacey Keller and Fateema Turay
· “Resident education in the NICU” by Drs. Richard Lion and Haley Howard
· “Effects of implementation of a hypertonic saline protocol for RSV bronchiolitis” Dr. Scott McKinley
· “Implementation of a specific care template for children in foster care” by Dr. Dayna Moore
· “Update and revision of the newborn manual for pediatric residents” by Dr. Mindy Murphy
· “Improving conscious sedation and pain management for abscess incision and drainage” by Dr. Erika Pasciuta
· “Cardiac screening prior to cardiothoracic surgery in neonates” by Drs. Anthony Sochet and Katherine Braley
· “Implementation of a medical home project” by Drs. Melanie Youschak and Mary Baker