A View from the Former Chair

The care, quality and safety of our patients are top priorities in the Department of Medicine. I’d like to share some of the excellent work being done in this area, led by Tom Gallagher, our Associate Chair for Patient Care Quality, Safety, and Value.

DOM Quality and Safety Taskforce

We recently launched a Quality and Safety taskforce to establish departmental goals in this area, and I would like to thank the members of this taskforce for their work.

Taskforce members: Tom Gallagher (Chair), Brad Anawalt, Ginny Broudy, Lindsay Collins, Steve Fihn, John Inadomi, Chris Kim, and Anneliese Schleyer.

Goals:

  1. Identify one or two department-wide quality/safety goals
  2. Support each division in identifying one division-specific quality/safety goal
  3. Recommend strategies for communicating within the department about these quality/safety goals, recognize high performers, and increase awareness of these issues across the department
  4. Recommend pilot projects on quality and safety for the department to support financially

DOM Quality and Safety Accelerator Grant Program

Regarding the last goal; I recently approved a plan to allocate $335,000 to advance quality and safety within the department. These funds came to the department because of the outstanding efforts of our faculty and trainees in patient care.

We used these funds to create a new program, the DOM Quality and Safety Accelerator Grant Program, to provide pilot funding and expert guidance for innovative projects that improve patient safety and quality of care.

Applications have been received and are currently under review for the first round of projects, which will start in January, 2017.

UW Medicine patient care quality improvement goals

Our goals are closely aligned with the overall UW Medicine patient care quality goals, which fall into several categories.

Involve patients and families

Involving a Patient-Family Advisory Council (PFAC) in clinical planning is important. Trish Kritek has been a leader in this effort.

Noise complaints

Patients complained about noise in the ICU, either in the rooms (roommate talking, beeping machines), or outside in the hallway talking.

PFAC played a valuable role in a multifaceted approach to quiet.

  • “A Quiet ICU” flyers were posted in the waiting room
  • Questions on the ICU survey were redesigned to focus on sources of noise
  • ICU liaisons encouraged quiet from staff and visitors

The result was a 22% increase on the satisfaction survey in response to the question: “During this hospital stay, how often was the area around your room quiet at night?”

Multiple person rooms

Multiple person rooms tend to inhibit sleep and add to frustration. PFAC input resulted in single occupancy ICU rooms at UWMC and an incorporated space for family to stay in the room.

Family presence during resuscitation (FPDR)

Family members who are present during resuscitation demonstrate less anxiety, depression and PTSD symptoms.

Increase patient satisfaction

The department is near (inpatient) or above (outpatient) established goals in patient satisfaction, although there are limited data available. The department has provided instructions on how to access patient satisfaction data and I encourage our faculty to take a look at these data.

Tom Gallagher and Cynthia Ferrucci will be leading a DOM Patient Experience Workgroup that will be assembling resources and best practices to enhance patient experience, including one-on-one coaching for interested faculty and other useful tools.

Expand patient access

Multiple clinics within the department are already meeting the UW Medicine-wide access goals. There is currently a 0-1 day wait for primary care, cardiology, oncology and women's health.

We are also expanding patient access through digital health.

Eliminate wasteful practices

Medicine residents identified 31 wasteful practices, from lab tests to imaging. The GME Choosing Wisely campaign has 16 programs participating and over 80 recommendations. At Harborview, CBC tests were decreased by >20 percent (per patient/per day) through the use of report cards and discussion.

DOM quality improvement initiatives

The department has implemented several other quality improvement initiatives across our divisions. The Center for Scholarship in Patient Care Quality and Safety is compiling a comprehensive list of all DOM QI initiatives and will post them on their website.

Here are some recent examples:

  • Decreased CHF 30-day readmission rate (Ted Gibbons)
  • Heart transplant utilization and heart failure length of stay (Kevin O’Brien)
  • Expanding patient access through digital health (DC Dugdale)
  • HIT test ordering (David Garcia, Paul Sutton, Andrew White)
  • Early vascular access for dialysis patients (Raj Mahrotra)
  • Improving access during seasonal peaks (Barak Gaster)
  • Telehealth, Project ECHO (John Scott)
  • HCV test and cure (Jeff Duchin)
  • Diabetes Health Improvement Project (Irl Hirsch, Savitha Subramanian)
  • Assessment of “Penicillin Allergy” (Matt Altman, Drew Ayar, Paul Pottinger)
  • Use of natural language word searches to identify inpatient risk of sepsis and respiratory failure (David Carlbom, Kristina Crothers)
  • Certificate program in Patient Safety and Quality (Tom Gallagher, Anneliese Schleyer)
  • Active inquiries into the practices of the ID consult service using queries of Amalga (Bob Harrington)
  • “The OPAT Bundle” (Shireesha Dhanireddy, Alison Beieler)
  • Hand Hygiene Standardization (John Lynch, Tim Dellit, others)

 

I am proud of our accomplishments and committed to achieving these goals. We have superb physicians, nurses and staff and I thank you all for your continued efforts in this area and your outstanding work caring for our patients.