Improving the hospital discharge process. Standardizing alcohol withdrawal management. Better triage of patients with non-traumatic headache. Just three of the quality challenges addressed by the most recent graduates of the UHF/Greater New York Hospital Association Clinical Quality Fellowship Program.
The fellowship program was established in 2009 to develop a new generation of quality improvement experts and leaders; 178 mid-career physicians and nurses have completed its training to date. Each intensive 15-month cycle includes learning retreats, webinars, mentoring, and—central to the experience—development and leadership of a major “capstone” project at each Fellow's home institution.
Four of those capstones, highlighted at the recent culminating dinner for the ninth class of Fellows, exemplify not only the diversity of Fellows' backgrounds and interests but also the wide range of challenges that today's quality leaders are tackling, from patient safety through improved clinical outcomes and more efficient delivery of services:
Elevating the quality discussion. Jean Hsieh, MD, MS, Icahn School of Medicine at Mount Sinai, used a checklist of quality issues, combined with nurse-driven prompting during rounds, to standardize and increase conversations about quality and safety concerns in her 10-bed Medical Progressive Care Unit, serving patients with complex medical needs.
Standardizing treatment protocols. Paul Huang, MD, Stamford Health, and his team developed a standardized treatment protocol for step-down unit patients with alcohol withdrawal symptoms—and found improvements in several outcome measures, including length of stay and benzodiazepine use.
Timelier hospital discharges. Kathleen Asas, MD, MPH, FAAP, Saint Barnabas Health Care System, developed a checklist to create a shared understanding by the medical team of the discharge planning process, build consensus on the timing of discharges, and improve workflow, coming close to her goal of discharging 30 percent of pediatric patients early in the day.
Triaging ED headache patients. David Koterwas, MS, NP, NYC Health + Hospitals Bellevue, used an algorithm to improve risk assignment of emergency department patients with non-traumatic acute headache; he will continue to work with hospital leadership on implementing the algorithm and other opportunities to train staff on evaluating and managing these headaches, with the aim of decreasing overutilization of CT scans.