IHQSE faculty members, Drs. Emily Gottenborg, Jeff Glasheen, and Tyler Anstett, along with IHQSE alumna Dr. Julia Limes, published the first program evaluation of a residency training program focused on Hospital Medicine. The paper describes the University of Colorado’s experience of training over a hundred hospitalist residents over 15 years. Notably, the program found that graduates were highly likely to choose careers in hospital medicine with over 80% holding quality, safety and operational leadership roles.
Dr. Moksha Patel, IHQSE Lead Physician Informaticist, authored a perspective piece, looking at ways to reimagine the way we measure hospital-provider productivity. This paper focuses on the limitations of traditional measures of hospital-provider value, such as clinical productivity and emphasizes the patient, employee, and institutional outcomes such as quality, safety and experience.
Despite decades of effort to drive quality improvement, many health care organizations still struggle to optimize their performance on quality metrics. The advent of publicly reported quality rankings and ratings allows for greater visibility of overall organizational performance but has not provided a roadmap for sustained improvement in these assessments. In 2012, the Institute for Health care Quality, Safety, and Efficiency was launched, which is an integrated set of quality and safety training programs, with a focus on leadership development and support of performance improvement through data analytics and intensive coaching. After 10 years, the IHQSE has trained nearly 2000 individuals and has been associated with significant improvement in organization-level quality rankings and ratings, offering a framework for organizations seeking systematic, long-term improvement.
Standardizing the transfer criteria and implementation of a transfer-readiness assessment reduced the time-to-transfer decision out of the PICU from 14.4 hours to 7.8 hours and increased the proportion of patients transferred on >/6Lpm of HHF oxygen in children with viral bronchiolitis. No increase in PICU readmissions or use of rapid response team was found.
IHQSE leader Dr. Tyler Anstett and colleagues report on how a systems-based M&M conference with key stakeholders present resulted in significant improvements in completion time of ‘routine’ (18-minute reduction) and ‘now’ (8-minute reduction) ordered inpatient electrocardiograms. This is the first study to show a positive impact on a process following a systems-based case review conference.
Alumni of IHQSE’s Certificate Training Program publish outcomes resulting from a series of interventions aimed at improving adherence with recommended well-child checks and continuity of care with the same provider in the first year of a child’s life. Using the medical home concept as a guide, this team’s program showed increased adherence with first five visits in the first year of life from 25% to 78% with sustained improvement in subsequent years.
IHQSE Faculty, Dr. Sarah Tevis and team, published findings of a study which assessed opioid prescribing preferences for acute postoperative pain. Surgical residents reported that faculty preferences for opioid prescribing are a significant driver in their prescribing practices, inadvertently resulting in variability from established prescribing guidelines. Surgeons were surveyed about their preferences for prescribing opioids; those responses were then compared with actual prescribing practices and prescribing guidelines determined by the Opioid Prescribing Engagement Network. Results of the survey suggest that there is a disconnect in communication between residents and faculty as well as opportunity for enhanced education on prescribing guidelines.
IHQSE Faculty, Dr. Sarah Tevis, co-authored a study showing that lumpectomy patients who received a perioperative opioid-sparing multimodal analgesia protocol reported significantly lower postoperative pain and were able to be discharged without an opioid prescription. This publication in Annals of Surgical Oncology showed the reduction of excess opioids available for diversion--made possible by implementing opioid-sparing multimodal analgesia.
Working with a team of clinicians and informaticists, IHQSE Director Dr. Jeff Glasheen helped create and implement an EHR-driven tool that accurately predicts inpatient mortality. The tool, using real-time data from Epic, provides a highly predictive mortality score that is updated every 15 minutes across a 12-hospital health system. Tested on over 80,000 patients, the tool was developed to aid decision making in scarce resource situations, such as COVID-19 ventilator shortages.
IHQSE Faculty member, Emily Gottenborg, MD, and her colleague, Amy Yu, MD, are first authors on an article about the pandemic's impact on personal and professional activities of healthcare providers. They suggest solutions to help mitigate the impact, such as continuing alternate and flexible work schedules, developing flexible promotion timelines, investing in family support mechanisms, creating social support networks, and addressing gender pay disparities.