CAMC residents benefit from participating in quality and safety projects
As a teaching institution, CAMC strives to provide many educational experiences for its students. Each year, CAMC welcomes more than 175 medical residents, interns and fellows to its campuses.
Heather Tarantino, MD, FACP, clerkship director and assistant professor for WVU School of Medicine-Charleston Division, is dedicated to making sure these residents get the best training possible during their time at CAMC, and said it's about more than just basic patient care.
"We want to teach them when they walk in the door," Tarantino said. "New doctors are held to the same standards as a doctor that's been in practice for 30 years."
There are a number of quality improvement initiatives in place at CAMC to ensure health care providers are working as efficiently and safely as possible. While these initiatives are a regular part of the day-to-day for many, educators are working to specifically include residents.
In 2010, Tarantino initiated a pilot project to introduce internal medicine residents to quality improvement programs.
Working with educators and quality improvement and patient safety professionals, Tarantino formed the internal medicine Quality Improvement and Patient Safety committee (QIPS) to develop a learning curriculum and to integrate CAMC's existing performance improvement structure into the resident training process.
Seeing the need for more integration with all residents, CAMC has taken steps to develop a QIPS committee in all residency specialties. A QIPS Advisory Council of educators and team leaders, chaired by Tarantino, is promoting learning and involvement in quality and patient safety initiatives in all residency programs, and is working to develop curriculum at the institutional level that provides these opportunities.
Quality improvement projects focus on integrating quality and patient safety issues into the daily experience and language of the residency training experience as residents are engaged in identifying areas for improvement, evaluating outcomes data and looking at ways to improve patient care and efficiency. The QIPS Council, under Tarantino's leadership, has worked to engage residents in interprofessional teams and forums, which can also involve residents in quality improvement.
Second year internal medicine resident Moniba Nazeef, MD, is grateful to have the experience.
"As young physicians, these projects have helped us learn a lot about systems-based practices and to look for problems that potentially lead to inconsistencies and inefficiencies," she said. "We get an insight into the importance of time and cost effectiveness as well as overall patient satisfaction, which are things we do not learn a lot in medical school. Understanding these issues leads to brainstorming and discussions of identifying where these problems lie and how they can be approached to come up with practices for improvement and follow-ups to maintain consistency."
The main goals in all the quality improvement projects are to improve patient care, better prepare residents to enter a regular practice, as well as improve communication among all health care providers.
The internal medicine department worked on several different projects, including improving outcomes for cardiac and pneumonia patients, as well as overall patient satisfaction.
The QIPS committee educated residents and implemented new discharge instructions for heart failure patients hospital wide, bringing the process compliance to 100 percent.
In the outpatient care center, Tarantino and her residents changed the call back process, and the department decreased the time it took to call patients back by 60 percent.
This year, internal medicine won a CAMC quality award for best innovation for their work.
Residents in the surgery department found that the transfer of information from the surgical/trauma intensive care unit (STICU) to a step-down unit or different floor was not unified, causing a lot more work for the unit receiving the new patient. The nature of the resident program limits the number of hours a resident can work, meaning several different residents will be working with each patient. Resident Adam Ubert, MD, created a form that standardized the process, providing the unit receiving the patient with a summary of the injuries or procedures, required follow-up care and any other pertinent information.
The initiative was overseen by Richard K. Umstot Jr., MD, attending physician in the STICU. The surgical care improvement project (SCIP) is a national initiative that outlines specific protocol for every surgical procedure, such as giving certain antibiotics, taking steps to prevent deep vein thrombosis (a blood clot in the vein), and other preventative measures after a patient has been under anesthesia. The team was invited to speak at a national teleconference about the hand-off improvement and improvement in patient outcomes.
Jamie Jeffrey, MD, oversees the resident quality improvement projects at CAMC Women and Children's Hospital. The residents are working on several projects, including improving asthma patient care and bronchiolitis treatment.
Pediatrics is working on a way to improve outcomes for asthma patients. If a child with asthma is admitted to the hospital, he or she is given a specific treatment plan to treat the symptoms. The residents found a need for more education at discharge for a home management plan, which would include a daily treatment recommendation, a reminder to get a flu shot and getting information to school nurses so they will be able to take an active role in the child's treatment.
Bronchiolitis is the number one admitting diagnosis for infants. There is a national guideline for the care and treatment of a patient afflicted, and the residents have worked on developing a specific order set for these patients, including working closely with respiratory to expedite healing.
"The institution is very engaged in involving these residents, and the residents have been great," said Joan Phillips, MD, clinical director of pediatrics at CAMC Women and Children's Hospital.
Thirty-eight students from the University of Charleston's School of Pharmacy and 40 third-year medical students from the West Virginia School of Osteopathic Medicine participated in an Interprofessional Collaboration Education Day in November at CAMC's Simulation Center at General Hospital.
Students rotated through different simulations like diagnosing patients (actors provided with a list of symptoms and medical history) and life-threatening situations on simulation dummies.
Students also had the chance to work in teams to come up with treatment plans for simulated patients. The collaboration between the pharmacy and medical students helped them gain a better idea of how they will interact in a hospital setting, each providing their own expertise to ensure the best patient outcomes possible.