Practice Quality Improvement: A Resident

PerspectiveMadelene Lewis, MD

Radiology Resident, PGY-4

Medical University of South Carolina

What is PQI?Practice quality improvement

Why PQI?American Board of Specialties

response to public concerns Promotes continuous quality

improvement and lifelong learningPart of Maintenance of Certification

(MOC)

PQI Projects

Project with potential to improve the quality of practice and enhance the quality of care

Should beRelevantAchievableMeasurable results Improve quality

PQI project

Most include six core competenciesKnowledgePatient careCommunication skillsProfessionalismPractice based learning and improvementSystems based practice

Resident Learning Portfolios

ACGME now requires

Based on 6 core competencies

PQI projects address practice based learning and improvement “Systematically analyze practice using quality

improvement methods and implement changes with the goal of practice improvement”

PQI and Residents

Now a resident requirement

Projects can be local, institutional, or society based

Why PQI in residency?

Opportunity to become familiar with PQI

Proactive environment

Develop tools to resolve problems

Improves patient outcomes

Increases resident engagement and satisfaction

Involves faculty and other team members

Resident Support

Effective quality improvement curricula

Departmental role models and mentors

Infrastructure embeds quality improvement in daily practice

Increase appeal to residents and faculty

How to do a PQI project?

Select Project: Identify an existing or potential issue

Collect Data

Review and analyze data

Develop improvement plan

Incorporate proposed solution

Reassess to determine success

Identify and institute additional strategies or changes

Examples of project types in radiology

Patient safety

Accuracy of interpretation

Report turnaround time

Practice guidelines and technical standards

Referring physician surveys

PQI Project Example from RadiologyStep 1

Identify ProblemPoor and inconsistent communication between the

radiology residents and trauma team after hours

PQI Project Example from RadiologyStep 2

Collect DataElectronic survey sent out to all radiology and

surgery residents regarding radiology communication on trauma patients

1. How do the radiology residents currently communicate preliminary trauma reads after hours? 

direct phone call 50.0%

Pager 30.0%

Ibox 30.0%

you must call the reading room 90.0%

2. How do you think radiology residents should communicate preliminary reads on trauma victims after hours?

Direct phone call 40.0%

Pager 30.0%

Ibox 10.0%

I prefer to call the reading room 40.0%

3. How quickly do you expect a preliminary read on trauma victims after hours? 

Immediately 20.0%

25 minutes 0.0%

10 minutes 30.0%

15 minutes 50.0%

20 minutes 0.0%

30 minutes 0.0%

PQI Project Example from RadiologyStep 3

Review and Analyze Data

PageCall Reading RoomPhone CallIbox

How Trauma Residents Prefer to Communicate?

Time Expectations for Trauma Reads

01020304050

60708090

100

Immediate 5 10 15 20

PQI Project Example from RadiologyStep 4

Develop and implement planMeeting with faculty and resident representatives

from trauma and radiology to discuss survey resultsDeveloped new procedure for communication Policy presented at resident QA conference and

monthly trauma meeting

PQI Project Example from RadiologyStep 5

Reassess and make additional changes as neededPlan to re-survey radiology and surgery residents 2

months after the new policy is implemented

Conclusion

PQI projects are important to residentsPractice for future MOC requirement Improves patient careEngages residentsMotivates faculty