Residency Training: Quality improvement projects in neurology residency and fellowship

Abstract

Objective: Teaching quality improvement (QI) is a priority for residency and fellowship training programs. However, many medical trainees have had little exposure to QI methods. The purpose of this study is to review a rigorous and simple QI methodology (define, measure, analyze, improve, and control [DMAIC]) and demonstrate its use in a fellow-driven QI project aimed at reducing the number of delayed and canceled muscle biopsies at our institution.Methods: DMAIC was utilized. The project aim was to reduce the number of delayed muscle biopsies to 10% or less within 24 months. Baseline data were collected for 12 months. These data were analyzed to identify root causes for muscle biopsy delays and cancellations. Interventions were developed to address the most common root causes. Performance was then remeasured for 9 months.Results: Baseline data were collected on 97 of 120 muscle biopsies during 2013. Twenty biopsies (20.6%) were delayed. The most common causes were scheduling too many tests on the same day and lack of fasting. Interventions aimed at patient education and biopsy scheduling were implemented. The effect was to reduce the number of delayed biopsies to 6.6% (6/91) over the next 9 months.Conclusions: Familiarity with QI methodologies such as DMAIC is helpful to ensure valid results and conclusions. Utilizing DMAIC, we were able to implement simple changes and significantly reduce the number of delayed muscle biopsies at our institution. Teaching quality improvement (QI) is a priority for residency and fellowship training programs, partially stemming from mandates for formal QI education from organizations like the Accreditation Council for Graduate Medical Education.1 Learning these competencies is of practical utility, as the American Board of Medical Specialties includes reporting on quality of care as part of their maintenance of certification program.2 Within neurology, this may be via adherence to evidence-based quality guidelines published by the American Academy of Neurology or others. 3One of the most meaningful ways residents and fellows can participate in QI is to start a QI project. QI projects provide an opportunity for trainees to identify and correct gaps in the quality of care provided to patients, and gain a better understanding of how patient care relates to the health care system as a whole. QI projects may have the added benefit of improving the efficiency and quality of the academic teaching environment. 4 The range of potential projects is broad because QI and patient safety span all areas of clinical practice. One way to conceptualize different areas of focus is to consider the 6 aims of improvement outlined by the Institute of Medicine.5 High-quality care should be safe (avoiding patient harm), effective (providing care based on scientific knowledge), patient-centered (providing care that respects patient preferences and values), timely (reducing harmful delays), efficient (avoiding waste), and equitable (care independent of personal characteristics like socioeconomic s...

Quality and Safety in Healthcare, Part XCIV

“…2 In another study using the DMAIC methodology of Six Sigma, the percentage of delayed muscle biopsies was reduced from 20.6% to 6.6%. 27…”

Quality and Safety in Healthcare, Part XCII

“…The training, skill proficiency, and error rates of workers performing aspects of a process often are part of the process of gathering information regarding what to measure for this step 14 . Multiple measurements can be made in three different categories: inputs to the process such as resources, steps within the process itself, and performance of the outcome(s) from the process 15 . One of the tools used in the measure part of DMAIC is the SIPOC diagram.…”

“…14 Multiple measurements can be made in three different categories: inputs to the process such as resources, steps within the process itself, and performance of the outcome(s) from the process. 15 One of the tools used in the measure part of DMAIC is the SIPOC diagram. The initials in the acronym SIPOC stand for the details regarding suppliers, inputs, process, outputs, and customer (s) regarding a given process.…”

Pitfalls and Rewards for Implementing Ocular Motor Testing in Acute Vestibular Syndrome

“…To address known challenges in diagnosing AVS patients 2 , we launched an institutional Quality Improvement (QI) initiative, using the DMAIC methodology (Define, Measure, Analyze, Improve, Control) 8 .…”