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
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Relevant
Achievable
Measurable results
Improve quality
PQI project
 Most include six core competencies
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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%
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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?
Page
Call Reading Room
Phone Call
Ibox
Time Expectations for Trauma Reads
100
90
80
70
60
50
40
30
20
10
0
Immediate
5
10
15
20
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
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Practice for future MOC requirement
Improves patient care
Engages residents
Motivates faculty