Enhancing Patient Safety and Quality Improvement in ECU Internal Medicine Residency

ECU Quality Improvement and Patient Safety (QIPS) Curriculum

Vision Make QIPS an integral part of the ECU Internal Medicine Residency experience

Objectives Equip residents with basic knowledge and tools of QIPS to deliver safe, effective, patient centered, timely, efficient, and equitable care Promote culture of safety in the program and institution and carry these principles forward in their careers Meet ACGME requirements for Practice-Based Learning and Improvement (PBLI), and Systems-Based Practice (SBP) Engage faculty and residents in QIPS related work

Timeline 2021-2022 Academic Year 7/29: Intro to QIPS curriculum, QI intake form 8/27: Patient safety, Mock RCA, Intro to M&M 1/28/22: Presentation to QIPS panel 9/27, 9/28, 9/29: PGY2 QI workshop 7/30, 8/6, 8/13: PGY3 QI workshop 9/9: First M&M Nov, March, June: Meeting with QIPS chief and faculty 5/27/22: End of the year QIPS symposium presentation

Curriculum Overview Requirements PGY-1 PGY-2 PGY-3 + - - IHI introductory course + + + Safety event reporting + - - Learning from defect presentation +/- + + QI project + + + Mock RCA - - + M&M report

Curriculum Structure Lectures Workshops QI project Safety experiences

Lectures Lectures on important patient safety and quality improvement topics will be scheduled during morning conference and Friday conference didactic sessions. Lectures will be delivered by experienced QIPS leaders from the residency program and the teaching hospital. Topics in QIPS Patient Safety Quality Improvement High reliable organization principles Principles of Patient Safety Error Reporting Root Cause Analysis Introduction to the QI QI Vs research Starting a QI Project: Defining a Problem, Organizing a Team Creating a Problem Statement or SMART aim Stakeholder Analysis, fish bone Measuring for Improvement, Developing Countermeasures Pilot and Implementation Planning

QI Workshop Residents will be trained on the practical application of QI principles and methodologies at 3-day long QI workshop Annual QI workshop will be delivered for PGY-2 residents by the director of the hospitalist team during Directors block (block 4) For 2021inaugural year, additional QI workshop will be conducted for PGY-3 residents during block 2

QI Workshop contd. Residents are required to fill out the QI interest intake form. They will be grouped into teams depending on their interests. Each team will consist of 4-5 residents, ideally comprised of different PGY levels to make sure the continuation of the project over the years. Interprofessional collaboration and participation is highly encouraged. Resident QI teams will be paired with mentors who are experienced faculty and QI leaders from the health system depending on their expertise and/or mutual interests Resident teams will brainstorm project ideas during QI workshop and formulate the aim statement and measures for their proposed projects

QI Project Residents are required to do at least one longitudinal mentored QI project during PGY-2 and/or -3 year. Resident QI teams will meet with their assigned mentors monthly Each team is expected to file a project progress report with QIPS chief resident and faculty every 3 months to monitor the progress. These reports will be shared with faculty for semi-annual evaluation.

QI Project contd. Resident QI teams will present their ongoing projects to QI expert panel on the last Friday of January to get feedbacks Annual ECU QIPS symposium will be held on the last Friday of May where all resident QI teams will present their projects. Top three projects will be chosen for Grand Round Presentation. Publication and presentation at local and national QI conferences are highly encouraged but not required.

Patient Safety Experiences Academic Year PGY 1 Patient safety activities Complete basic IHI certificate at orientation Report >= 2 SI (note the reference number and log in at NI) Present >= 2 learning from defect presentations to attending or senior resident during morning round or morning conference (event report) and log in at NI PGY 2 Participate at mock RCA Institutional Committee participation PGY 3 Present >= 1 Morbidity and Mortality report (2 residents per report) on selected Thu at morning conference.

Institutional Committees at Teaching Hospital Vidant Health Patient Safety Performance Improvement meetings (review of safety events, RCAs, etc.) Hospital Patient Safety Quality Improvement Committee

Patient Safety Recognition Safety activity Basic IHI SI LFD Mock RCA Institutional committee M and M Points 5 5 5 5 10 10 Patient safety silver (30 points) and gold (50 points) For PGY 1- expectation 25 points For PGY 2 - expectation 35 points For PGY 3- expectation 45 points Safety ambassador of month

Accountability PBLI and SBP are integral part of ACGME core competencies. Residents across ACGME are expected to get training and participate in these activities and gain basic knowledge. If resident is not meeting milestone in QIPS activities (Practice- Based Learning and Improvement (PBLI), Systems-Based Practice (SBP)), resident will have a formal first warning meeting with QIPS chief. If the resident continues to be deficient in these milestones, this will be brought up to the attention of IM faculty leadership during CCC and may affect their promotion to subsequent year and graduation.