Quality improvement and safety curriculum for hematology/oncology fellows at Columbia University.

Abstract

247 Background: It is imperative to provide Hem/Onc fellows with experiential training in quality improvement (QI) and patient safety methodology. Our objective was to design a curriculum that would provide experience in designing, implementing, and analyzing a QI/safety project with the ultimate aim of engagement in QI/safety efforts throughout their careers. Methods: The curriculum focused on experiential learning and was led by a faculty member with QI/safety methodology training who provided didactics and supervisory support of the projects. Fellows worked in groups (3-5 fellows) to implement a project. Plan-Do-Study-Act (PDSA) methodology was introduced early in the academic year and workshops continued over a one-year time period. At the year end, projects were presented at an institution-wide symposium. Two cohorts (2015-2016, 2017-2018) have completed the curriculum. Results: Program efficacy was measured in several ways. The QIKAT-R tool was administered prior to the curriculum in August 2015 (n = 12) and at completion June 2016 (n = 14). At baseline, the mean score was 3.97 (out of 9) which improved to 7.57 at completion. Comfort level with QI also increased by 42.9%. Annual ACGME survey questions pertaining to an institutional culture of patient safety increased from 88% (2015) to 100% (2016 and 2018) and participation in QI increased from 53% (2015) to 95% (2106) to 100% (2018). Further, fellows (n = 33) successfully completed nine projects which included: improvement of fertility preservation, improvement in the adequacy of bone marrow aspirates performed by fellows, increasing genetic counseling referrals in select patients with colorectal cancer, improvement in smoking cessation counseling, increasing timely chemotherapy order entry, and reduction of unnecessary heparin induced thrombocytopenia antibody testing. The curriculum is currently being adapted to other fellowship programs at Columbia. Conclusions: Our curriculum is an effective method to teach fellows at Columbia University Medical Center a skill set necessary to conduct successful QI/safety projects. PDSA methodology of small cycles of change can be used life-long to continuously assess and improve care quality and safety.