Patient Safety and Quality Improvement Program

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University Hospitals Quality Institute

The hospital’s Quality Institute, located within the University Hospitals campus, has a staff of twenty-four (not including risk management and infection control). Their multidisciplinary approach to process improvement has lends itself to participation in resident education.

Resident EQUIPS

In 2009, the Internal Medicine Residency Program and the University Hospitals Cleveland Medical Center Quality Institute collaborated to create a curriculum for a four-week externship (Resident EQUIPS – Externship in Quality Improvement and Patient Safety) for PGY3 residents. This 28-day immersion experience includes high-yield quality didactics from various quality institute staff, including the Chief Quality Officer,  William Annable, MD. The externs also review and present cases for the Department of Medicine Quality Assurance committees and perform audits on inpatient wards focused on regulatory agency safety standards. Each week, the residents meet with representatives of the patient advocacy office to review and discuss all active patient grievances that are submitted. The residents participate in a multidisciplinary leadership committee to review incident reports and determine if further action is warranted. They also meet with representatives from quality, risk management and legal (where they participate in case reviews), infection control, utilization review, and coding. The goal is for residents to gain a deeper and more nuanced understanding of patient safety and quality issues in a large teaching hospital and embrace the concept of continuous quality improvement to apply to their practice.

PGY3 Quality Improvement Project

Each PGY3 resident has the opportunity to participate in a quality improvement project in a small group setting. Throughout the course of residency, residents are able to identify key quality issues. A quality institute representative is assigned to each project to act as a mentor and facilitator with the Patient Safety Chief providing additional oversight. Under their guidance, residents are expected to work on the project throughout the course of the academic year and are presented at the annual Department of Medicine Research Day. Examples include improving resuscitation processes, ICU and outside hospital transfer processes, electronic discharge processes, and noninvasive mechanical ventilation availability.

PGY1 Quality Curriculum

During the first year of Internal Medicine Residency, the residents participate in a two-week Clinical Skills block. The curriculum was re-designed to include a focus on quality and patient safety in addition to procedural training, teaching skills, physical exam skills, resuscitation and other small group learning exercises. With six months of PGY1 clinical experience, the interns are familiar with many of the quality issues discussed. Interns meet with the Quality Institute, risk management and the legal department staff and share patient cases highlighting quality issues. This experience enhances the learner’s ability to grasp the concepts and apply them to their practice.