Quality Improvement

Continuous quality improvement and improving patient safety are critical components to the mission of the Department of Medicine as well as the Internal Medicine Residency Program. Our program has developed a comprehensive quality improvement and patient safety curriculum for our trainees in order to prepare them for the changing landscape of health care. This includes:

  1. Teaching basic principles of continuous quality improvement (QI), individual performance improvement, patient safety and safety event analysis, team work and the culture of safety for residents;
  2. Participating in a shared quality improvement initiative across the residency program on an annual basis;
  3. Developing an infrastructure for residents to participate in, design and lead individual or team QI and patient safety projects;
  4. Providing a structured opportunity to review and improve individual and health system quality metrics;  
  5. Participating in local efforts to improve the value and quality of care we deliver to our patients.

Our Quality Improvement/Patient Safety Team

Associate Program Director of Quality Improvement and Patient Safety (APD QI/PS)
The quality improvement and patient safety efforts of the Internal Medicine Residency Program are overseen by the Associate Program Director for Quality Improvement and Patient Safety. This includes development of a curriculum that balances didactics with experiential activities. The APD for QI/PS helps to coordinate housestaff efforts around program and individual performance measures, mentors residents involved in QI and high value care efforts, develops educational content about safety event analysis and serves as a liaison between the Internal Medicine Residency Program and health system leadership to coordinate efforts in quality improvement and patient safety.

Alicia Clark, MD

Joel Boggan, MD, MPH 
Assistant Professor of Medicine
Division of General Internal Medicine

 
VA Medical Center Chief Resident for Quality and Safety (CRQS)
The VA CRQS works closely with the Durham VAMC Department of Medicine leadership as well as the Duke APD for QI/PS in organizing quality improvement initiatives (both in the inpatient and outpatient settings at the VA Medical Center and within Duke University Health Systems) and coordinating education activities as part of the program's comprehensive QI & PS curriculum. This includes supervising the Residency Program's Patient Safety and Quality Council by assisting with project design, implementation and data analysis. 

Aaron Mitchell, MD

Samuel Lindner, MD
Duke Medicine Residency Class of 2017

Medicine Residency Patient Safety & Quality Council (MR PSQC)

The Medicine Residency Patient Safety & Quality Council was formed to discuss program-wide project opportunities and residency program performance measures. The PSQC is a collection of medicine residents who have a specific interest in promoting quality improvement to our trainees.

The Council is led by our VA CRQS with faculty mentorship provided by the Associate Program Director for QI & PS as well as hospital medicine and ambulatory general internal medicine leadership. The Council’s specific goals include:

  • Creating a forum to discuss quality/safety issues seen by residents;
  • Aligning strategic priorities of health system and the department of medicine with those of residents to improve the care we deliver;
  • Initiating and implementing resident-led quality improvement projects;
  • Partnering with Duke medical student IHI scholars in learning about process improvement, team work and performance analysis;
  • Providing a means for residents to seek feedback on quality improvement/patient safety project ideas as well as to help them identify needed resources and mentorship;
  • Distributing information related to program performance on GME incentive program metrics;
  • Fostering a culture of safety and continuous process improvement.

During recent academic years, Medicine Residency Patient Safety & Quality Council program-wide project efforts have included:

  • Improving high value care delivery for inpatients by changing practicing around fever work ups and daily lab draws;
  • Changing paging culture by partnering with nursing champions and creating a shared agenda and using unit based competitions to implement templated communication tools;
  • Improving unit-based hand hygiene performance

Quality Improvement & Patient Safety Curriculum Overview

Our Internal Medicine Residency Program has a comprehensive curriculum for patient safety and quality improvement intended to prepare graduates for the changing landscape of health care and to arm them with the skills needed for continuous quality improvement and improving the safety of the care they deliver to patients. This curriculum balances didactic/knowledge building activities and experiential learning built into our pre-existing general medicine and ambulatory experiences to integrate the knowledge with application to patient care. As trainees progress through our program, they will be introduced to the core concepts as interns and begin to develop their own QI and PS skills in their second and third years of training.

During the intern year, interns engage in group-based learning activities and high value care topics during intern report.  Across all years, we have a bimonthly resident M&M series, in addition to a Quality Improvement/Patient Safety conference series.  Senior residents all participate in a Patient Safety Report that includes a structured safety event analysis using the Learning from Defects tool while on their Duke Gen Med rotation.  Additionally, each resident will participate in two years of experiential learning through quality improvement projects on general medicine topics as part of the Individual Performance Improvement Modules during the PGY-2 and PGY-3 years.  This experiences follows the Model for Improvement on a shared ambulatory goal/topic and allows residents to obtain real-time feedback on their performance relative to their peers.
  
Some of the unique features of our QI & PS Curriculum include:

  • Quality Improvement Lecture Series: conference didactics focusing on perspectives of key topics at both the local and national level;
  • Intern Report High Value Care Curriculum: report done as part of Duke General Medicine Intern Report series focusing on high-value care and projects;
  • GME Trainee Performance Incentive Program: system-wide program promoting residency program engagement in health system improvement by providing financial incentives to trainees based on performance on strategic priorities for the health system.  This has recently included metrics such as  patient satisfaction, hospital readmissions, ED to inpatient patient flow and safety reporting.
  • Individual Performance Improvement Modules: structured opportunity for second and third-year residents to implement the Model for Improvement and complete individual performance review with real-time peer performance feedback on a general medicine topic and creation of a SMART goal for personalized improvement and reassessment later in the academic year.  Previous projects have included appropriate application of USPSTF guideline-recommended screening, follow-up of ambulatory lab testing, goals of care discussion, and, for 2017-18, deprescribing of medications with the potential to lead to adverse effects.