TF-12 Teaching Residents About Continuous Quality Improvement

Abstract

Almost 2 decades ago, the Institute of Medicine released the report “To Err is Human” stating that at least 44,000 people died from preventable medical errors in hospitals, equating to between $17 billion and $29 billion in estimated financial costs. This provocative report called on the health care industry to create systems to address issues of patient safety. In training our current generation of physicians, it is important to not only train them to be remarkable clinicians, but also to be able to address issues of patient quality and safety. In line with this, emergency medicine residents ought to participate “in performance improvement to optimize patient safety” and achieve the graduation target of participating “in an institutional process improvement plan to optimize [emergency department] practice and patient safety” as stated in the Emergency Medicine Milestone Project. The primary goal is to equip residents with the tools necessary to engage in continuous quality improvement (CQI) as a way to address patient quality and safety initiatives. The objectives to reach this goal include: (1) Define basic terminology used in the patient safety and quality environment; (2) Explain the Model for Improvement and the steps in the Plan-Do-Study-Act (PDSA) cycle; (3) Create Aim-Measure-Change statements for a patient quality or safety case. The online module consists of the following sections: (1) Pre-test as outlined in the evaluation plan; (2) Why care about quality improvement; (3) What is CQI; (4) Model for Improvement; (5) Fishbone diagram for identifying cause and effect; (6) PDSA cycle; (7) Interpreting data with a run chart; (8) Post-test as outlined in the evaluation plan. Much of the material is curated from the Institute for Healthcare Improvement Open School. Both the pre-test and post-test will include 3 parts: (1) Survey with questions on the learner’s comfort level with approaching and starting a CQI project; (2) Quiz on basic terms used in patient quality and safety; (3) Case-based quiz asking learners to write statements addressing the aim, identifying a measure, and creating a recommendation of a change for the presented case, which will be graded using the Quality Improvement Knowledge Application Tool Revised scoring system. This asynchronous training module is an interactive computer-aided instruction created to help residents achieve a foundation of knowledge to be able to develop and implement a CQI project.