Enhancing Quality Improvement for Patients (EQuIP)

Equipping Louisiana with a Quality Future.

What Is EQuIP and Why Do We Do It?

• School-wide initiative• Engage residents and fellows in systems-based quality

improvement and patient safety (QI/PS) projects.• Neither fully top-down nor fully bottom-up.

• Next Accreditation System: CLER Visits– Reviews the integration of GME and clinical facilities in:

• Quality improvement • Patient safety initiatives• Supervision• Fatigue management and mitigation• Transitions in care• Resident duty hours• Professionalism http://www.acgme-nas.org/cler.html

Quality Improvement & Patient Safety at LSUSOM

Faculty Development Residents Students

Teaching Hospital(s)

Program Directors and Coordinators

EQuIP

DIO

EQuIP Office

EQuIP Steering Committee

Program Directors and Coordinators

Science and Practice of Medicine Curriculum

1. Establish a sense of urgency

2. Form a powerful guiding coalition

3. Create a vision

4. Communicate the Vision

5. Empower others to act

6. Plan and create short-term wins

7. Improve continue changing the process

8. Institutionalize new approaches

Adapted from JP Kotter, “Leading Change: Why Transformation Efforts Fail,” Harvard Business Review 1:1 (2007).

EQuIP Steering Committee

EQuIP Operations Committee

Tasks

Teaching Hospital(s) & Clinical Sites

EQuIP Operations Committee

EQuIP Steering Committee

Ongoing QI/PS projects at ILH

Incorporate residents into ongoing initiatives

Report outcomes as already scheduled

Provide professional development for SOM

faculty

Match residents and fellows to ILH QI/PS

committees

Establish timelines for reporting and oversee day-to-day operations

Solicit applications for new initiatives from

programs and residents

Review applications for new EQuIP projects

Overcome roadblocks in meaningful resident

participationHelp to bring projects not

making meaningful progress into compliance

Serve as champions for program compliance

with EQuIP curriculum

Welcome to the Matrix

See legend above

Depts and CURRENT PROJECTS /PROGRAMS/ COMMITTEES at ILPH

ILPH point person

Allergy & Immunology

Anesthesiolog

y

Dermatolog

y Emergency Medicine

Emergency Medicine-

Undersea & Hyperbaric Medicine

Family Medicine Bogalusa

Family Medicine Kenner

Family Medicine

Lake Charles

Internal Medicine / Dermatolog

y

Internal Medicine / Emergency Medicine

Internal Medicine / Pediatrics

Internal Medicine -

Cardiovascular Disease

Internal Medicine -

Endocrinology

Internal Medicine - Gastroenter

ology

Internal Medicine -Geriatric Medicine

Internal Medicine -

Hematology and

Oncology

Internal Medicine - Infectious

Disease Internal Medicine

Internal Medicine -

Interventional

Cardiology

Internal Medicine - Nephrology

Internal Medicine - Pulmonary Disease &

Critical Care

Internal Medicine -

Rheumatology

Child Neurology

Clinical Neurophysi

ology Neurology

Neurosurger

y

Obstetrics and

Gynecology

Ophthalmology - Retina

Ophthalmol

ogy

Orthopaedic

Surgery

Pediatric Orthopaedic

s

Otolaryngol

ogy Pathology Pediatrics Cardiology

Pediatrics Endocrinolo

gy

Pediatrics Gastroenter

ology

Pediatrics Hematology/ Oncology

Pediatrics Neonatal/ Perinatal

Pediatrics Nephrology Pediatrics

Physical Medicine & Rehabilitati

on- Pain Medicine

Physical Medicine & Rehabilitati

on Plastic Surgery

Child Psychiatry Psychiatry

Radiology Diagnostic

Surgery Critical

Care Surgery Vascular Surgery

Urology Female Pelvic

Reconstruction

                                                                                                      

AllAmbulatory Services Council

                                                                                                   

 

Breast Program

                                                                                                   

 

Weight Mgt Prog

                                                                                                   

 

Cancer Care Comm

                                                                                                   

 

Telemed Pgm

                                                                                                   

 

GI Oncology Pgm:

                                                                                                   

 

Thoracic Oncology

                                                                                                   

1-6Anesthesia/OR

                                                                                                   

 Surgery Dashboard

                                                                                                   

 OR Booking

                                                                                                   

1,2,3Critical Care

                                                                                                   

 

GWTG-R Rapid Response

Cardiopulmonary Arrest

                                                                                                   

1,5Emergency & Disaster Mgm .

                                                                                                     

1,5,Ethics

                                                                                                   

 

Health Literacy and Patient Education

                                                                                                   

1-6Infection Control Pgms

                                                                                                   

 CUSP

                                                                                                   

1,5,6Medical Admn and Leadership

                                                                                                   

 

Medical StaffCredentialing

                                                                                                   

1-4,7Nursing Dept Leadership

                                                                                                   

 

Med-Surg UnitsPatient Satisfaction

                                                                                                   

1,3,5Pain Management

                                                                                                   

1,5Palliative Care Svs

                                                                                                   

1,2,3Pathology & Sub-Groups

                                                                                                   

 Performance Measures

                                                                                                   

 Critical values

                                                                                                   

1-4Performance Mgm Measures

                                                                                                   

 Quality Management: SCIP

                                                                                                   

 Quality Management: Stroke pgm

                                                                                                   

 

Quality Management:: CAPCommunity Acquired Pneumonia

                                                                                                   

 

Patient Advocate: NPSG Patient Satisfaction

                                                                                                   

 

Quality Management: STEMI PCI

Hypothermia

                                                                                                   

 Quality Management: Heart Failure

                                                                                                   

1-4Pharmacy & Therapeutics

                                                                                                   

1,7Population Health Management

                                                                                                   

 Community Med Prog.

                                                                                                   

2,3,4,7Radiology

                                                                                                   

 

Timely GFR labprior to contrast studies

                                                                                                   

AllThroughput

                                                                                                   

 Access to Primary Care

                                                                                                   

5-Jan

Trauma Services

                                                                                                   

1,5

Wound Care and Regen Med Pgm

                                                                                                   

1,3,5

Transition of Care Inititiatives

                                                                                                   

Residency and Fellowship Programs

Hos

pita

l Com

mitt

ees

EQuIP Steering Committee

EQuIPOperations

Committee and Staff

Residents and Fellows

Teaching Hospitals and Other clinical

sites

Program Directors & Coordinators

Participation in Hospital Committees

• Approximately 150 residents and fellows• Part of committees at 4 clinical sites– e.g. infection control; ethics; Population

Health/Disease Management programs; etc.

Challenges:• Committee meeting times

Participation in Independent QI Projects

• Approximately 125 individual and group projects– Conducted by and with ~ 465 house officers– Data collection and intervention at ~ 15 clinical sites

(hospitals and clinics)– General Surgery residents in class-based projects to

ensure continuity

Challenges: • Ensuring value/feasibility of individual projects

Nurse Manager of Quality Management at ILH collects current PI programs, committees, and projects. Listing is

maintained on a drive shared between the QM and EQuIP offices.

LSU Residency Program Director and/or residents request participation in ILH committee/project from

the EQuIP office.

EQuIP coordinator sends an email to the physician leads (CC to core group liaison, Dr. Zee Ali, and Patrick Reed) as an

introduction and for approval of the resident assignment.

Lead Approval

Resident given dates, time location, and instructions as

appropriate from the project lead.

YES

Return to the beginning for a new project

NO

Ms. Harkin will keep EQuIP workbook updated with resident

assignments.

When the EQuIP office notices an individual or group project requiring significant institutional resources ,the EQuIP director

or coordinator will (1) forward that project's details to ILH leadership to solicit approval and (2) referred residents/faculty

to the LSUHSC IRB and to theILH Research Review Committee for evaluation.

EQuIP Project Database

EQuIP Project Database

Evaluation of Resident Participation

Next Steps

• Quality Improvement Day (May 14, 2013).• Evaluate resident performance on hospital

committees (Spring 2013).• Gather preliminary results of EQuIP projects

(Summer 2013).• Roll out QI/PS curriculum to faculty and hospital

personnel (TBD).• More robust project review mechanism ( AY

2013-2014).

Questions?

Murtuza (Zee) Ali, MDmali@lsuhsc.edu