PL-2 Quality Improvement Projects
The projects should focus on quality and provision of care in the continuity
clinics or wards using the “plan, do, study, act” philosophy. It should include
the quality triad of structure, process and outcome. There are various factors
that can affect patient care and you need to determine whether they are
structural, procedural or outcome oriented and whether or not they can be
altered to improve patient care. Your project can link to advocacy projects,
senior year Grand Rounds or possibly a rigorous research project.
Competency and Licensure Objectives
Medical Knowledge
Demonstrate an investigatory and analytic thinking approach to clinical
situations.
Practice Based Learning and Improvement (PBLI)
Analyze practice experience and perform practice based improvement
activities using a systemic methodology.
Systems Based Practice (SBP)
Understand how your patient care and other professional practices affect
other health care professionals, the health care organization and the larger
society and how these elements of the system affect their own practice.
American Board of Pediatrics
Starting in 2010, the American Board of Pediatrics will require evidence of
quality improvement as part of the maintenance of certification process. While
their methods are still uncertain, and may currently be limited to online
simulations, it is possible that this project can serve as this evidence, or at least
groundwork for future projects.
The Project Objectives
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Appropriately identify a clinical issue for which clinical practices vary.
Analyze the performance gaps found in the continuity clinic or wards and
recognize their possible impact on patient care.
Define a problem.
Identify structure, process and outcome components appropriate to the
clinic or wards and the associated patient population.
Ensure the structure, process and outcome components chosen are
measurable and clearly linked to patient care.
Understand how each quality measure identified affects patient care.
TIMELINE
What is due?
1. Identify mentor
2. Project description
3. Initial aim statement
4. Timeline
Submit on project description worksheet via email
to Drs. Black and Thompson
1. Pre-implementation data findings
2. SMART aim statement
3. Key Drivers
4. Design Change(s)/Interventions(s)
5. Measure(s)
Submit on project description worksheet via email
to Drs. Black and Thompson
Implementation*
Completion of project
Presentations or Poster session
Date**
9/1/10
12/15/10
Preferably during
your Advocacy,
Development or Elective
months
No later than 2 weeks
before your presentation
June 2011, dates TBD
Please note:
*Implementation may be an ongoing process, however if you plan to survey or institute
something new in the outpatient clinic it is highly recommended that you do so during
your Advocacy, Development and/or Elective months.
**dates listed are deadlines, we are happy to receive information anytime before those
dates!
METHODS
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Identify a mentor for your project. Good mentors are usually a
continuity clinic supervisor, an advisor, or a sub-specialist within
the field of study.
Identify a need for improvement
Identify a source of information (chart review, patients, fellow
residents)
Establish outcomes of interest
Decide if IRB approval is needed or desired (see LT)
Establish methods of assessment (refer back to QI presentation
done by Dr. Black. May be chart reviews, surveys, focus groups,
secondary data analyses)
Create a timeline for implementation
RESOURCES
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www.thci.org
http://www.qualitytools.ahrq.gov/
http://www.ahrq.gov/chtoolbx/uses.htm#quality
http://www.aap.org/visit/qualitymeasure.htm
www.ncqa.org
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http://www.mmc.org/mmc_bush/Clin_train.htm
http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/evbased/
www.aap.org/evalresources
Your mentors
Drs. Black and Thompson
Methodologist (very helpful!): Dr. Erik Black
(erikwblack@gmail.com)
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FORMAL PRESENTATION OF YOUR PROJECT
(2 options)
1. Platform presentation during noon conference
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Utilize the power point template
State the problem that you identified in our system
List the objectives of your project
Briefly describe your project
Discuss the markers by which you assessed your project
Discuss your outcomes
Keep your presentations to 10 minutes (15 minutes max with
questions.)
A reminder…this is not the time to just give a lecture on a medical
issue. For instance, a resident created an order set for community
acquired pneumonia. She discussed some of the details of the antibiotics, VS,
parameters, etc… however, the meat of her discussion centered around why she
created this order set and what she achieved.
2. Poster presentation (one noon conference in June will be set aside for
poster presentations)
o A template for a poster can be provided upon request
o Speak to Drs. Black or Thompson about where to print (the
architectural lab printing only costs $8!!!)
o Please remember if you plan to present your project and findings
at a meeting outside of the residency (e.g., PAS) then you need to
seek IRB approval first. Again, Drs. Black and Thompson can help
with this.
QI Project Description Worksheet
Name:
Title of Project:
Due by September 1, 2010
1. Mentor:
2. Project description (brief paragraph providing general idea of project):
3. Initial Aim Statement (can be less specific than SMART Aim statement):
4. Timeline (pre-implementation data gathering, implementation, postimplementation data gathering):
Due by December 15, 2010
1. Pre-implementation data findings:
2. SMART Aim statement (specific, measurable, action-oriented,
realistic/relevant, timely):
3. Key Drivers (should be stated in the affirmative and list all key drivers even
if you are not going to target them for change):
4. Design Change(s)/Intervention(s):
5. Measure(s):
Due by June 1, 2011
1. Project is complete.
2. Preparing for platform presentation or poster presentation to be given that
month.
3. Project Description Worksheet, presentation, and evaluation of project will
be placed in your electronic portfolio.
PROJECTS TO CONSIDER
(with potential mentors)
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Increasing the usage of guidelines and order sets (Dr. Udassi or Black)
Translation of the newborn pamphlet into Spanish (Dr. Kelly)
Well-child check and Fitness Clinics: screening, feeding, obesity (Dr.
Dumont-Driscoll)
Automatically faxed discharge summaries from wards to PCP (Dr. Lossius)
Communication and understanding all the members of the medical team
on the inpatient unit (Dr. Lawrence)
Patient and family stress related to hospitalization (Dr. Lawrence with
child life)
Pain management for routine hospital procedures (Drs. Lawrence and
Udassi)
Create informational website for Gen Peds and clinics (Dr. Kelly)
30mo WCC form (Dr. Kelly)
Improved use of Asthma Action plan for inpatient hospitalized asthma
exacerbation (Dr. Black or pulmonary faculty)
Contact precaution order and use, with appropriate step for patients
admitted and treated with presumed MRSA infection and use of droplet
precautions for pt with Bronchiolitis-awareness of the sensitivity of the
RSV and flu rapid test (Dr. Udassi)
Anti-microbial sheet formulation and use, to limit the overuse of
antibiotic and contributing to rise of resistant strains ( Dr. Udassi)
Education and Cost effects of ordering labs/studies not urgently requiredie inpatient vs outpatient workup. (Dr. Udassi)
Utilizing the appropriate procedure for removing ”mislabeled drug
allergies” (Dr. Huang)
Pain-free or less pain in primary care (Dr. Thompson)
PAST PROJECTS
Outpatient Clinic:
 Guideline for AOM and PE tube referral
 Spanish questionnaire:TB and lead poisoning
 Nutritional counseling and nutritional supplements
 Car seat education and use
 Screening for post-partum depression*
 Sports physical screening
 Translation services
 STD education
 Instituting use of BMI calculator
 Smoking cessation
 Asthma: effective instruction for medication usage
 Injury prevention
 Postcard reminder system: flu shots and Synagis
 Consistent STD, HPV, and pap smear screening policies
 Standardized ADHD follow-up visits
 Counseling on sun protection
 Screening tool for sleep issues during the well-child visit
 Fire arm safety and gun lock distribution during the well-child visit
 Improving provider and parental education of cold and cough therapy in children
and infants
 Screening tool for autism at the 18 month and 24 month well-child visit
 UF Outpatient Pediatric Clinic Informational On-hold Message
 Positive Developmental Screening: Where do we go from there?
 Improving the compliance rate of Developmental screening using ASQ at the 18
month well child visit by implementation of Electronic Medical Records at CMS
 TV/Internet Usuage Evaluation during the well child check
 Modified Guidelines in the Outpatient management of Cardiomyopathy at the
Congenital Heart Center Clinic
Newborn nursery:
 SIDS education
 Discharge education brochure: “Head to toe Newborn/Infant survival guide”
 “Babies don’t come with instructions: A parent’s guide to their newborn”
 Discharge instruction form (English and Spanish versions)
 Chorioamnionitis/Suspect Sepsis order set
 Newborn Nursery admission order revision and improving use of the
hypoglycemia algorithm
 Newborn nursery follow-up physician list
 Newborn Nursery Physician Worksheet
 Preventing Smoking in Mothers of Newborns
 Hyperbilirubinemia Protocol for the Shands UF Newborn Nursery
 Newborn Nursery “Smart List”
ED/PAH:
 Standardized guidelines and forms (AGH ED): fever less than 90 days, fever in
the immunocompromised patient, shortness of breath, general pediatric illness
 Improving documentation in the AGH ED through use of a Pediatric Shortness of
Breath standardized form
 Standardized guidelines and forms (UF ED): appropriate antibiotic therapy of
STI’s, sexual assault, asthma, 1st afebrile/unprovoked seizure
 Improvement in PAH handout
 Utilizing Poseidon to fax electronic ER charts to the PCPs' offices
 PAH phone call computer entry system
Inpatient:
 Order sets: community acquired pneumonia, cellulitis, asthma, ALTE, croup,
bronchiolitis, failure to thrive, bowel disimpaction/GI cleanout
 Respiratory flow sheet revision
 Decreasing medication errors related to incorrect weight entry
 Revision of code blue documentation sheet
 Creating and modeling safe sleep environments for hospitalized infants and
children
 Pancreatic Insufficiency in CF Population- Treatment and Care
 Admission Order Set for Patients with Fever and Neutropenia
 Physician Trading Card Project
 Pediatric Blood Draw Optimization with Causal/Cost Analysis
 Children’s Hospital Video Orientation
ICU:
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Management algorithms for use by outside facilities for common newborn
diagnoses transported to Shands
NICU quick reference guide
NICU-specific discharge instruction sheet
Sedation and analgesia protocol in mechanically ventilated patients in the PICU
New standardized progress note for the PICU
Residents
 Intern survival guide
 Reducing Unnecessary Paging During Residents’ Protected Time