[caption id="attachment_9806" align="alignright" width="200"]
Ryan Schulteis, MD, is chief resident for quality improvement and patient care at the Durham VA Medical Center.[/caption]
[dropcap]S[/dropcap]ix months into his term as the Durham VA Medical Center’s inaugural chief resident of quality improvement and patient safety, Ryan Schulteis, MD, has a long list of projects he hopes will make a difference in patient care.
Dr. Schulteis is one in a network of about 20 chief residents across the country who are focusing on quality improvement and patient safety at VA hospitals.
He's working with David Simel, MD, professor of medicine (General Internal Medicine) and vice-chair for Veterans Affairs in the Department of Medicine. Simel said the VA started the chief residencies in quality improvement and patient safety three years ago in order to emphasize the importance of these issues to the VA and to help meet an Accreditation Council for Graduate Medical Education requirement for resident training in these areas.
The idea was simple: “Create a curriculum for the chief residents to learn how to do quality and patient safety work, and (the chief residents) would then, in turn, deliver that curriculum to trainees who were rotating through the VA,” Simel said.
Having a chief resident focused on quality improvement and patient safety benefits the Durham VA and Duke Hospital, Simel said.
“We truly believe improving quality decreases cost and improves patient outcomes,” he said.
At the beginning of their term, chief residents of quality improvement and patient safety undergo training provided by the VA. Schulteis also began an internal curriculum last January, meeting with a group led by Simel. Schulteis currently attends monthly videoconference meetings with chief residents at other VAs to get feedback on projects and help solve problems. He notes that all of the chief residents are trained to protect the privacy of VA patients.
Schulteis then works with Duke internal medicine residents, who are often the first in the hospital to identify and encounter quality and patient safety issues and are the first who could potentially help implement change, Simel said.
Schulteis said because of his relationship with Duke residents he feels well-positioned to meet the duel mission of improving the quality of care delivered to veterans on a daily basis and training residents in quality improvement.
“I have a unique understanding of what the residents are able to do to help me accomplish the mission of improving the quality of care delivered at the Durham VA Medical Center,” he said.
Schulteis said that working with residents leads to improved patient care at the VA, but also to residents being able to show that their involvement has led to the improvement in the quality of care they have delivered and of their own practice patterns.
Building a foundation
[caption id="attachment_9808" align="alignright" width="300"]
Durham VA Medical Center[/caption]
Schulteis has started 15 quality improvement projects, collecting background data, developing and initiating ideas for change for each project, and developing process and outcome measures that will indicate if a change is successful.
Some examples include improving the administration of Vancomycin for patients with bloodstream infection, creating a default removal time for Foley catheters (unless otherwise overridden) to prevent catheter-associated UTIs and improving communication around patient transfers.
Among the projects is a safety consultation program for residents with patient safety concerns, modeled after a project idea from Schulteis’ counterpart at the Atlanta VA Medical Center. That project, says Schulteis, engages Duke residents in quality improvement through a process they are already comfortable with: asking for a consultation.
“Within the first month of its existence, we had six consults that we participated in,” Schulteis said. “We’ve encouraged the residents to request consultations not just when they feel something unsafe is going on but, for example, when they are not sure how to explain to patients what the chance of side effects are for a certain medication.”
As a result, Schulteis has six new quality improvement projects that are being led by the residents who requested consultations, giving them an opportunity to apply quality improvement and patient safety tools.
Schulteis has put into motion another project that will improve the flow through the Duke Emergency Department and general medicine service for patients with chest pain or a concern for coronary artery disease.
“What we’ve been trying to do is to look -- from a systems perspective -- at the flow of patients with chest pain through the Emergency Department to the general medicine ward and ultimately to the cardiology service, where they receive diagnostic testing,” he said. “We’ve looked at limiting the steps, reducing the length of stay, improving the quality of the outcomes of these patients. One thing we’ve identified for improvement is the laboratory testing patients receive in the Emergency Room.”
Schulteis looked to the literature to find how to best manage the laboratory testing of these patients and found a recent article by Kristin Newby, MD, professor of medicine (Cardiology), that has helped him design a better way to implement the testing process. He is analyzing data gathered at the Durham VA over the last five years in order to model what would happen if all patients with chest pain undergo standardized laboratory testing.
“Our models suggest that we would be able to improve patient flow and reduce length of stay, without changing outcomes for the worse,” he said. “The next step that we’re going to be doing in the next few months is to implement these changes and see what happens.”
Continual change
Schulteis says he will spend the second half of his term, from January to July 2013, implementing changes he’s identified for each project and measuring success. Measuring success in quality improvement is different than the typical research model.
“One of the principles of quality improvement is it’s an ongoing process, it’s continual: implement the change, collect the data, implement the next change that either builds upon the first or corrects the mistakes of the first,” he said.
Schulteis also plans to provide feedback for residents. One of his projects will generate scorecards that will show residents how they performed during a rotation at the VA and their goal for the second half of the year will be to make improvements.
“We all know they are doing wonderful work,” Schulteis said. “This just gives them a concrete goal and basically allows them to focus their energy toward systematic improvement.”
Simel said it has been great to see Schulteis get others involved and excited about quality improvement.
“I think the interesting thing that he’s done is improve communication,” Simel said. “When our residents identify problems that they think can be better, they understand that they have a place to go to discuss them and that we can work on them.”
In July, Joel Boggan, MD, senior assistant resident in Medicine and Pediatrics, will take over as chief resident for quality improvement and patient safety. Boggan began the internal curriculum on quality improvement last month and said he is looking forward to continuing Schulteis’ work, especially projects involving infectious disease complications, hand offs and getting individual feedback to residents.
Like Schulteis, his knowledge of Duke and good relationship with residents will be assets in this new role, he says.
Schulteis said he will continue to focus on improving the quality of patient care after his term as chief resident is over, and he hopes he will be able to serve as a mentor to Boggan. He said he feels the role of the chief resident is unique because it has strengthened relationships between Duke and the Durham VA as well as between Duke, the VA network and affiliated universities.
“I am excited and grateful for the support that the Department of Medicine has provided for this position,” he said. “I am excited that they will continue to support this position in the future because, although I feel like we’ve made tremendous progress in six months, the story won’t end in six months for a lot of these projects. Thankfully, we have a successor who will bring his own ideas to the table and also help provide closure and continue the process of improvement for things that we’ve already initiated.”
Learn more about Schulteis in his Meet the Chief profile.
Ryan Schulteis, MD, is chief resident for quality improvement and patient care at the Durham VA Medical Center.[/caption]
[dropcap]S[/dropcap]ix months into his term as the Durham VA Medical Center’s inaugural chief resident of quality improvement and patient safety, Ryan Schulteis, MD, has a long list of projects he hopes will make a difference in patient care.
Dr. Schulteis is one in a network of about 20 chief residents across the country who are focusing on quality improvement and patient safety at VA hospitals.
He's working with David Simel, MD, professor of medicine (General Internal Medicine) and vice-chair for Veterans Affairs in the Department of Medicine. Simel said the VA started the chief residencies in quality improvement and patient safety three years ago in order to emphasize the importance of these issues to the VA and to help meet an Accreditation Council for Graduate Medical Education requirement for resident training in these areas.
The idea was simple: “Create a curriculum for the chief residents to learn how to do quality and patient safety work, and (the chief residents) would then, in turn, deliver that curriculum to trainees who were rotating through the VA,” Simel said.
Having a chief resident focused on quality improvement and patient safety benefits the Durham VA and Duke Hospital, Simel said.
“We truly believe improving quality decreases cost and improves patient outcomes,” he said.
At the beginning of their term, chief residents of quality improvement and patient safety undergo training provided by the VA. Schulteis also began an internal curriculum last January, meeting with a group led by Simel. Schulteis currently attends monthly videoconference meetings with chief residents at other VAs to get feedback on projects and help solve problems. He notes that all of the chief residents are trained to protect the privacy of VA patients.
Schulteis then works with Duke internal medicine residents, who are often the first in the hospital to identify and encounter quality and patient safety issues and are the first who could potentially help implement change, Simel said.
Schulteis said because of his relationship with Duke residents he feels well-positioned to meet the duel mission of improving the quality of care delivered to veterans on a daily basis and training residents in quality improvement.
“I have a unique understanding of what the residents are able to do to help me accomplish the mission of improving the quality of care delivered at the Durham VA Medical Center,” he said.
Schulteis said that working with residents leads to improved patient care at the VA, but also to residents being able to show that their involvement has led to the improvement in the quality of care they have delivered and of their own practice patterns.
Building a foundation
[caption id="attachment_9808" align="alignright" width="300"]
Durham VA Medical Center[/caption]
Schulteis has started 15 quality improvement projects, collecting background data, developing and initiating ideas for change for each project, and developing process and outcome measures that will indicate if a change is successful.
Some examples include improving the administration of Vancomycin for patients with bloodstream infection, creating a default removal time for Foley catheters (unless otherwise overridden) to prevent catheter-associated UTIs and improving communication around patient transfers.
Among the projects is a safety consultation program for residents with patient safety concerns, modeled after a project idea from Schulteis’ counterpart at the Atlanta VA Medical Center. That project, says Schulteis, engages Duke residents in quality improvement through a process they are already comfortable with: asking for a consultation.
“Within the first month of its existence, we had six consults that we participated in,” Schulteis said. “We’ve encouraged the residents to request consultations not just when they feel something unsafe is going on but, for example, when they are not sure how to explain to patients what the chance of side effects are for a certain medication.”
As a result, Schulteis has six new quality improvement projects that are being led by the residents who requested consultations, giving them an opportunity to apply quality improvement and patient safety tools.
Schulteis has put into motion another project that will improve the flow through the Duke Emergency Department and general medicine service for patients with chest pain or a concern for coronary artery disease.
“What we’ve been trying to do is to look -- from a systems perspective -- at the flow of patients with chest pain through the Emergency Department to the general medicine ward and ultimately to the cardiology service, where they receive diagnostic testing,” he said. “We’ve looked at limiting the steps, reducing the length of stay, improving the quality of the outcomes of these patients. One thing we’ve identified for improvement is the laboratory testing patients receive in the Emergency Room.”
Schulteis looked to the literature to find how to best manage the laboratory testing of these patients and found a recent article by Kristin Newby, MD, professor of medicine (Cardiology), that has helped him design a better way to implement the testing process. He is analyzing data gathered at the Durham VA over the last five years in order to model what would happen if all patients with chest pain undergo standardized laboratory testing.
“Our models suggest that we would be able to improve patient flow and reduce length of stay, without changing outcomes for the worse,” he said. “The next step that we’re going to be doing in the next few months is to implement these changes and see what happens.”
Continual change
Schulteis says he will spend the second half of his term, from January to July 2013, implementing changes he’s identified for each project and measuring success. Measuring success in quality improvement is different than the typical research model.
“One of the principles of quality improvement is it’s an ongoing process, it’s continual: implement the change, collect the data, implement the next change that either builds upon the first or corrects the mistakes of the first,” he said.
Schulteis also plans to provide feedback for residents. One of his projects will generate scorecards that will show residents how they performed during a rotation at the VA and their goal for the second half of the year will be to make improvements.
“We all know they are doing wonderful work,” Schulteis said. “This just gives them a concrete goal and basically allows them to focus their energy toward systematic improvement.”
Simel said it has been great to see Schulteis get others involved and excited about quality improvement.
“I think the interesting thing that he’s done is improve communication,” Simel said. “When our residents identify problems that they think can be better, they understand that they have a place to go to discuss them and that we can work on them.”
In July, Joel Boggan, MD, senior assistant resident in Medicine and Pediatrics, will take over as chief resident for quality improvement and patient safety. Boggan began the internal curriculum on quality improvement last month and said he is looking forward to continuing Schulteis’ work, especially projects involving infectious disease complications, hand offs and getting individual feedback to residents.
Like Schulteis, his knowledge of Duke and good relationship with residents will be assets in this new role, he says.
Schulteis said he will continue to focus on improving the quality of patient care after his term as chief resident is over, and he hopes he will be able to serve as a mentor to Boggan. He said he feels the role of the chief resident is unique because it has strengthened relationships between Duke and the Durham VA as well as between Duke, the VA network and affiliated universities.
“I am excited and grateful for the support that the Department of Medicine has provided for this position,” he said. “I am excited that they will continue to support this position in the future because, although I feel like we’ve made tremendous progress in six months, the story won’t end in six months for a lot of these projects. Thankfully, we have a successor who will bring his own ideas to the table and also help provide closure and continue the process of improvement for things that we’ve already initiated.”
Learn more about Schulteis in his Meet the Chief profile.