Practice Quality Improvement: A Resident Perspective Madelene Lewis, MD Radiology Resident, PGY-4 Medical University of South Carolina

What is PQI? Practice quality improvement Why PQI? American Board of Specialties response to public concerns Promotes continuous quality improvement and lifelong learning Part of Maintenance of Certification (MOC)

PQI Projects Project with potential to improve the quality of practice and enhance the quality of care Should be Relevant Achievable Measurable results Improve quality

PQI project Most include six core competencies Knowledge Patient care Communication skills Professionalism Practice based learning and improvement Systems based practice

Resident Learning Portfolios ACGME now requires Based on 6 core competencies PQI projects address practice based learning and improvement “Systematically analyze practice using quality improvement methods and implement changes with the goal of practice improvement”

PQI and Residents Now a resident requirement Projects can be local, institutional, or society based

Why PQI in residency? Opportunity to become familiar with PQI Proactive environment Develop tools to resolve problems Improves patient outcomes Increases resident engagement and satisfaction Involves faculty and other team members

Resident Support Effective quality improvement curricula Departmental role models and mentors Infrastructure embeds quality improvement in daily practice Increase appeal to residents and faculty

How to do a PQI project? Select Project: Identify an existing or potential issue Collect Data Review and analyze data Develop improvement plan Incorporate proposed solution Reassess to determine success Identify and institute additional strategies or changes

Examples of project types in radiology Patient safety Accuracy of interpretation Report turnaround time Practice guidelines and technical standards Referring physician surveys

PQI Project Example from Radiology Step 1 Identify Problem Poor and inconsistent communication between the radiology residents and trauma team after hours

PQI Project Example from Radiology Step 2 Collect Data Electronic survey sent out to all radiology and surgery residents regarding radiology communication on trauma patients

1. How do the radiology residents currently communicate preliminary trauma reads after hours? direct phone call 50.0% Pager 30.0% Ibox 30.0% you must call the reading room 90.0% 2. How do you think radiology residents should communicate preliminary reads on trauma victims after hours? Direct phone call 40.0% Pager 30.0% Ibox 10.0% I prefer to call the reading room 40.0% 3. How quickly do you expect a preliminary read on trauma victims after hours? Immediately 20.0% 25 minutes 0.0% 10 minutes 30.0% 15 minutes 50.0% 20 minutes 0.0% 30 minutes 0.0%

PQI Project Example from Radiology Step 3 Review and Analyze Data

How Trauma Residents Prefer to Communicate?

Time Expectations for Trauma Reads

PQI Project Example from Radiology Step 4 Develop and implement plan Meeting with faculty and resident representatives from trauma and radiology to discuss survey results Developed new procedure for communication Policy presented at resident QA conference and monthly trauma meeting

PQI Project Example from Radiology Step 5 Reassess and make additional changes as needed Plan to re-survey radiology and surgery residents 2 months after the new policy is implemented

Conclusion PQI projects are important to residents Practice for future MOC requirement Improves patient care Engages residents Motivates faculty