Carolinas HealthCare System
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Quality Improvement

Our residents receive longitudinal training in quality improvement throughout their residency. As a part of our quality improvement curriculum, residents learn to evaluate their own practice and examine patient care in a systems-based manner. Our curriculum features a “Quality Improvement Week” during which local and visiting speakers introduce and reinforce concepts of quality improvement and patient safety. Our novel curriculum has been presented on a national scale to other medical educators at the Association of Internal Medicine Program Director’s meeting and the AAMC Southern Group of Educational Affairs meeting.

Residents are divided into quality improvement teams each year. Each team is mentored by a faculty attending with experience in quality and patient safety. In addition, each team receives assistance from a quality improvement coach. Each QI team identifies a clinical problem, conducts a root cause analysis, defines an Aim statement, and implements small-scale interventions through multiple PDSA cycles with the goal of improving care.

Each group has the opportunity to present their findings to the entire department at our Annual Resident QI Project Presentation Day. Each year, the faculty vote and present an award for the top overall quality improvement project.

In addition, our residents have presented their QI work at the state, regional, and national level.

Recent resident-led QI projects include:

2015

  • Targeting the Use of High Risk Medications in the Elderly at Myers Park Internal Medicine Clinic
  • Not Your Typical Smear Campaign: Improving Cervical Cancer Screening at Myers Park Internal Medicine Clinic (Winner of the departmental top overall QI project award)
  • Improving Colon Cancer Screening at Myers Park Internal Medicine Clinic
  • Improving the accuracy of COPD diagnosis through increasing the use of PFTs

2014

  • A Multidisciplinary Effort to Improve Utilization of Resources for Patients with Morbid Obesity in the Primary Care Clinic (Winner of the Most Impactful Project Award at the CHS Senior Resident Leadership Seminar)
  • I3POP Collaborative: Improving Diabetic Care in the MPIM Clinic by Increasing Screening for Diabetic Retinopathy (Poster presentation at the North Carolina ACP meeting)
  • Improving Physician-Nurse Bedside Rounding and Communication
  • Improving Colon Cancer Screening In the Ambulatory Setting
  • Don’t Have A Heart Attack: Effective Interventions for Timely Results
  • Reducing Hospital Readmissions (Winner of the departmental top overall QI project award)

2013

  • I3POP Collaborative: Improving Diabetic Neuropathy Screening at Myers Park Clinic (Winner of the Interdisciplinary Teamwork Award at the CHS Senior Resident Leadership Seminar)
  • Improving Cost-Conscious Patient Care Amongst Resident Physicians
  • Improving the Hospital Discharge Process with the Goal of Reducing 30-day Re-admissions (Winner of a Bronze Award at the CHS Quality & Sharing Day)
  • Improving Primary Care Physician Notification of a Patient’s Admission (Winner of the departmental top overall QI project award)

2012

  • Reducing Inappropriate PPI Use in the Hospital (Winner of the departmental top overall QI project award)
  • Improving BP Measurement and Management at Myers Park Clinic
  • Improving Smoking Cessation Counseling at Myers Park Clinic (Poster presentation at the North Carolina ACP meeting)
  • Improving Influenza Vaccination Rates at Myers Park Clinic

2011

  • Starting the Discussion: Talking About End-of-Life Care in the Clinic
  • Reducing Lab Response Time Amongst Resident Physicians
  • Improving Clinical Performance Feedback to Medical Students
  • Improving Obesity Recognition and Counseling at Myers Park Clinic
  • Increasing Use of Framingham Risk Scoring and Global Risk Assessment at Myers Park Clinic

Regarding evaluation of their own practice, our residents are provided “report cards” on their care of patients in their practice panel with diabetes, asthma, heart failure, and coronary artery disease. These reports are reviewed semi-annually with ambulatory faculty mentors. Following this review, the resident develops an action plan for patients at highest risk for poor health outcomes in his/her practice panel.

Finally, there are a number of system-wide quality initiatives in which our residents have opportunities to participate. Recently, our hospital was certified as a “Magnet Organization.” This recognition is reserved for fewer than 7 percent of hospitals in the United States who have achieved the highest levels of quality, safety, and efficiency.

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