As part of the Essential Hospitals Engagement Network (EHEN), the UT Health Northeast is working to reduce eight hospital-acquired conditions by 40 percent and preventable readmissions by 20 percent by the end of 2014. Recognizing that resident physician buy-in is critical to the project’s success, UT Health Northeast launched an initiative that aims to directly integrate residents into the improvement process. While still in the early stages of deployment, UT Health Northeast already has observed an increase in resident engagement in quality improvement activities.
The EHEN is one of 26 hospital engagement networks funded by the Centers for Medicare & Medicaid Services through the Partnership for Patients, a national effort to improve the quality, safety and affordability of health care.
The UT Health Northeast resident quality improvement program – launched in August 2012 – includes both didactic and hands-on learning. Residents are trained in improvement strategies during regular educational sessions and participate in quality improvement activities outside of their rotations when they are off duty.
To maintain resident engagement among the 24 students enrolled in the program, UT Health Northeast divided them into three groups based on which hospital-acquired conditions the residents were interested in addressing:
- Hospital readmissions
- Infections, including surgical site infections, central line–associated bloodstream infections, catheter-associated urinary tract infections (CAUTIs) and ventilator-associated pneumonia
- Harm, including hospital-acquired pressure ulcers, venous thromboembolism (blood clots), falls and adverse drug events
For example, some residents have been involved in developing and piloting a standardized order set form that aims to prevent CAUTIs. The order set triggers the residents and nurses to evaluate the patient’s continued need for a catheter on a daily basis. If the inpatient services residents do not renew the order each day, nurses are empowered to remove the urinary catheter.
“It’s important to involve residents in improvement processes because it is going to be part of their everyday practice once they become practicing attending physicians, especially with implementation of the Affordable Care Act and upcoming reimbursement changes,” says Ryan Menard, MD, assistant professor of family medicine at UT Health Northeast. Menard notes that the initiative also satisfies the Accreditation Council for Graduate Medical Education protocol, which requires residents to participate in scholarly activities.
Although the program has only been in place for roughly three months, UT Health Northeast already is seeing a positive impact. “This initiative has made our residents more aware of making sure that we have better patient outcomes,” Menard says. “It also has made them aware of avoiding unnecessary tasks and unnecessary testing, and being more cost effective in what we do.”
In addition to boosting residents’ interest in quality improvement, the program also has encouraged teamwork among nurses and residents. “Nurses work more closely with the residents than with the attending physicians and they have been very open and receptive,” Menard says. “Nurses are not afraid to approach residents with a problem.”
Because of its success so far, UT Health Northeast now is looking to boost resident involvement in other hospitalwide projects, including the inpatient roll out of a new electronic health record system. The hospital also plans to use the program in its recruitment efforts. “We hope to publicize the initiative to increase interest and enrollment in our MD/MBA combined program this application year,” Menard says.
For more information about UT Health Northeast’s residency program, please contact:
Ryan Menard, MD
Assistant Professor of Family Medicine
UT Health Northeast