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Trainees Take the Lead in Quality Solutions

Eighteen “learners” presented quality improvement projects on April 6. From left, front, Veena Dhillon, Megan Shepherd, Paula Kent, Meghan Arnold, Mrinalini Gadkari; back, Nailya Muganlinskaya, Shari Lawson, Siew Lee Cheng, Runjhun Nanchal, Stacy Sanders, Rusty Schlessman, Jordan Winter, Peter Herrick-Stare, Elizabeth Vogel-Rogers, Katherine Thompson, Bolanle Asuni, Michael Awad. Absent: Joshua Sterns. (Photo credit: John Christofersen.)
Why does it take so long to discharge a patient? The delays, according to medical resident Michael Awad, nurse Nailya Muganlinskaya, and Megan Shepherd, an administrative fellow, boil down to poor communication between doctor and nurse. Using Halsted 5 as their laboratory, these three settled on an intervention that would be cost effective, require the least amount of effort, and yet produce the highest impact: text pagers.

“During rounding, at the instant the decision is made to discharge the patient, the physician sends a text page directly to the nurse, removing the gap in communication,” said Awad, presenting his team’s findings before a panel of JHM leaders on April 6.

Awad’s team was one of six to present projects designed to jumpstart quality improvement in patient care. Each team consisted of a resident, graduate nursing student and administrative fellow.

Their projects were part of Achieving Competency Today (ACT). Funded by the Robert Wood Johnson Foundation in collaboration with the Association of American Medical Colleges and the American Association of Colleges of Nursing, ACT advances the notion that the learners in America’s teaching hospitals—those on the frontlines of care—can improve quality.

Johns Hopkins was one of 12 health systems nationwide selected to receive the grants. “Each grantee partnered with residency and graduate nursing programs to assess the feasibility of bringing together learners in teams to advance both the science of quality and improve patient care,” said Judy Reitz, who as senior hospital executive responsible for quality improvement served as principle investigator.

Each team took on a problem at the front and center of clinical care: discharge delays (two projects), inadequate coordination of care, surgical site infections, day-of-surgery cancellations and crowding in the ED. Each team was supported by several faculty.

On Jan. 10, the teams started in on a four-week course, a Web-based curriculum that taught them about the organization, design and financing of health care. Using tools like fishbone diagrams and “2 x 2 tables,” they developed their quality improvement plans, aiming for low-effort, high-yield solutions.

The work was intense and time-consuming “but absolutely worth it,” said Paula Kent, School of Nursing graduate student. Her group looked at reducing surgical site infections with pre- and intra-operative warming to better manage hypothermia. “In a four-week period, we came up with a quality improvement plan that’s strong and easy to implement.”

So, now that the projects are complete, can these trainees, as ACT suggests, really be agents of change? If the enthusiastic response on the part of senior management on April 6 is any indication, they certainly can. Many expressed interest in following up with the teams to pursue their proposals. According to Reitz, all the plans will be pursued. “We can rest assured that all of this good work will continue to mature.”

On April 12, the evaluation panel announced the teams that received the highest ratings. One was the group that looked at reducing surgical-site infections; the other a team that explored improving coordination of care through better communication during patient transfer. These teams will go to Boston June 15 to present at the final meeting of the ACT grantees. Johns Hopkins will continue to participate in the next round of ACT grants.

—Anne Bennett Swingle




Johns Hopkins Medicine

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