DOM ANNUAL SHARK TANK COMPETITION
DOM QUALITY & PATIENT SAFETY PROGRAM
The DOM Annual Shark Tank Competition was started in 2016 to identify quality improvement projects led by DOM faculty and trainees that promote high value care (HVC). High value care is evidence-based, clinical practices that improve patient outcomes and potentially reduce the costs of healthcare.
For each competition, we select 4-5 finalists to share their “pitch” with our esteemed panel of sharks. The sharks, a group of quality leaders from UCH and affiliated hospitals, choose the winning project to receive DOM QPS support for one year. This support includes:
AY2021-2022 SHARK TANK PITCHES
SHARK TANK WINNERS
2019-2020 SHARK TANK WINNER – KAREN MOULTON, MD (CARDIOLOGY)
HF RADAR: Reduced Admission and Decompensation and Augmented Recovery for Heart Failure Patients
The project aims to enroll HF patients in a dashboard that will improve the rate of achieving optimal medication therapy (OMT) for HF patients, reduce the rate of HF admissions by 15%, and improve the rate of LV function recovery that may avoid the need for ICD placement. Furthermore, the project will provide feedback and self-evaluation of high value care for future general cardiologists.
The team has built a patient list for baseline data collection and developed a process map for enrollments. To date, only a few patients have been enrolled in the protocol for optimal therapy. They developed dedicated schedule openings for these new patients in their clinic schedules. COVID has played a roll in the delay of the project as well as a hospital process to automatically schedule discharge patients in a RPV and missing the fellows clinic appointments. Additionally, the dedicated schedule openings are filled by patients w/out new heart failure making it difficult to schedule the target patients. The team continues to work on enrollment process and volume.
2018-2019 SHARK TANK WINNER – ARUN KANNAPPAN, MD (PULMONARY SCIENCE & CRITICAL CARE)
ICU Liberation with Epic Partnership
The goal of this project was to create standardized protocols (i.e., ABCDEF Bundle) to improve care for ICU patients. The outcomes of interest for the intervention included: reduction of ICU days, reduction of ventilator-associated complications and reduction in neurocognitive and psychiatric morbidity.
The project team created a novel Epic order set and collaborated with the DOM QPS team to develop a Power BI dashboard. The new order set and Power BI reporting tool went live in July 2019. This allowed unit/manager level documentation of metrics including delirium days, spontaneous breathing trials (SBT), spontaneous awakening trials (SAT), central line days, ventilator days, time to extubation and ICU length of stay. The project team continues to work on developing weekly and monthly reports and are continuing education efforts in the MICU. Roll-out to other ICUs occurring through 2021.
2017-2018 SHARK TANK WINNER – CARMEN LEWIS, MD (INTERNAL MEDICINE)
Tobacco Cessation – Beyond the AVS
The goal of this project was to deliver high value care in the Department of Medicine specialty ambulatory setting by implementing proven clinical architecture for tobacco cessation from Lowry General Internal Medicine Practice. This clinical architecture will help ensure tobacco use is reliably assessed and documented and quit rates are measured.
The team developed a workflow document in Epic for MA’s and providers and developed training tools for education. They developed auditing and feedback reports along with care management tools. Rolled project out to Lowry, Stapleton, Lone Tree, AMC and the WISH clinic. The clinical architecture did not promote a specific tobacco intervention, rather provided timely data within the workflow so that any tobacco intervention could occur.
2016-2017 SHARK TANK WINNER – ERIN BRENDENBERG, MD (HOSPITAL MEDICINE)
Line Placement Appropriateness Guide: Reducing Line Placement
The goal of the project is to ensure appropriate central line use within the University of Colorado Hospital, ultimately to reduce CLABSI rates and central line associated VTE’s relative to peer institutions. The team has focused on appropriate use of multi-lumen PICC lines as higher risk for CLABSI and VTE compared to midlines and single lumen PICC lines. The team chose to use education plus an EHR forcing function to help providers select the safer line when possible and only use the multi-lumen PICCs when indicated. Their goal was to decrease inappropriate PICC lines placed by 25% by June 2017.
The team implemented an educational intervention for providers and nurses to assess competency and fill education gaps. The team also redesigned the Epic order set to provide more guidance on appropriate use and to promote midlines and single-lumen PICC. Additional interventions included a reorganization of PICC team to consolidate multiple IV access teams and to improve the PICC protocols. Team was able to reduce CLABSI from 2.2% to 1.6% and DVT went from 4% to 4.2%. Estimated cost savings were over $200,000, decreased cost per line by $190 with a return on investment of 4.3.