As frontline care givers, resident physicians are in a unique position to identify – and correct – unsafe and inefficient practices that lead to less than optimal care, drive up healthcare costs and, in some cases, result in tragic and preventable medical errors.
In the past year, the CIR Policy and Education Initiative (CIR PEI) has sponsored four What’s Your QI QI? conferences, attracting residents and faculty from throughout the New York area.
“As physicians on the frontline, we know our patients and we want the best for them. That’s why we’re leading quality improvement and patient safety endeavors in our hospitals,” said Dr. David Eshak, an internal medicine resident at Jacobi Medical Center in the Bronx and a CIR regional vice president.
How to be Scholarly in Quality Improvement: November 23, 2013
Co-sponsored by the Albert Einstein College of Medicine, the first conference in the series focused on publishing QI projects and attracted more than 120 attendees. Dr. Greg Ogrinc of Dartmouth Medical School led a hands-on workshop on how to plan conduct and publish QI projects using the SQUIRE (Standards for Quality Improvement reporting Excellence) Guidelines. Dr. Karyn Baum, from the University of Minnesota, focused on where and how to get published including how to build a career in QI.
Unlike other types of research, Dr. Ogrinc pointed out, “QI is not the same as drugs, tests, clinical procedures. [It] is performance change, driven by experiential learning, is context-dependent and problems can occur at various organization levels.” Residents especially experience challenges in conducting their research and finding opportunities for publishing. Rejection, rewriting, working as team, communication and developing a plan for publication are all keys to successfully getting published during residency. Dr. Baum’s tips on finding out where and how to get published include:
- Attending QI meetings/conferences (such as AAMC Integrating Quality, Academy of Healthcare Improvement)
- Paying attention to departmental/specialty conferences focused on research
- Familiarizing yourself with journals that publish QI
- Using your published posters as a springboard
- Familiarizing yourself with journal submission guidelines
How to Provide Cost Conscious Care: January 18, 2014
The Costs of Care team, ABIM Foundation, Albert Einstein College of Medicine, and CIR PEI teamed up for an exciting training focused on providing cost-effective care to patients. To open the conference, Daniel Wolfson of the ABIM foundation asked the room of more than 100 residents and faculty to stand if they had seen a patient harmed by unnecessary care; only one person in the room remained seated.
Mr. Wolfson suggested that when it comes to tests, attendings should ask their residents, “Why do you need this test?” as opposed to asking “why didn’t you take these tests?” Of the $700 billion a year wasted on healthcare in the U.S., unnecessary treatment accounts for about 30 percent of that cost—or $200 billion.
The Costs of Care team highlighted the importance of understanding the impacts of cost on patients and how financial difficulties are often mistaken for “patient non-compliance.” Dr. Vineet Arora, Director of Education, Costs of Care, and an expert in clinical behavioral change, suggested that simply asking patients if they have difficulty paying for their medications is a simple way to determine a course of action in treatment. The team included several tools for practicing medicine with more value. Cost-saving strategies included:
- Generics (prescribing generic drugs when available)
- Ordering medications in bulk
- Therapeutic alternatives (whenever possible such as yoga instead of physical therapy)
- Medication Review (to ensure all medications are actually necessary)
- Discount drugs
- Splitting pills (consumer report has created a list on medications that are safe to split)
The Costs of Care team also provided participants with the “COST” tool to help physicians determine barriers in their home institutions in order to begin to change the culture of their programs to include more cost-consciousness.
The final workshop in the series will take place on April 26. How to be a Lead Agent of Change: From Bedside to Transformative Care will teach caregivers effective communications skill to overcome the barriers to patient safety and transparency.