Quality Is a Verb in Residency

For the past three years our Internal Medicine residents have worked in teams on quality improvement (QI) projects in their continuity clinics. This work has led to sustainable improvements like new staffing models or the ability of patients to list a resident as their primary care physician at Iowa River Landing (IRL). A computerized patient record system (CPRS) orientation booklet was developed for residents as a QI project as was the introduction at the VA Medical Center of an electronic after-visit summary form. Some projects have achieved clinically important outcomes as well, such as the establishment of a process for “deprescribing” proton pump inhibitors. Many resident teams (14 to date) have presented their work at the University of Iowa Health Care’s Quality and Safety Symposium (QSS). Seven teams were chosen for oral presentations at Midwest Society of General Internal Medicine (SGIM) in 2017. Four teams have presented their QI projects as posters at national SGIM in the past two years.

Krista Johnson, MD, MME, Clinical Associate Professor in General Internal Medicine, is the Educational Director for Safety and Quality in the Internal Medicine Residency Program. “None of this would have been possible,” Dr. Johnson says, “without the faculty mentors who volunteered their time and expertise to guide the resident QI teams. These mentors either work with our residents in their continuity clinics or were our past and current VA Chief Residents in Quality and Safety. We would like to acknowledge these mentors for their guidance and encouragement.”

Faculty Mentors for Resident Quality Improvement Teams

Beck,GwenGwen Beck, MD
IRL

Mentor: 3 years
Past project: Modified the resident schedule template
Team presentation: UIHC QSS 2017
Current project: Improve colorectal cancer


BieberDaleDale Bieber, MD, MS
IRL

Mentor: 1 year
Current project: Improve resident clinic flow at IRL


Leslie Brettel, MD
VA

Mentor: 2 years
Past project: Proton pump inhibitor deprescribing
Team presentations: UIHC QSS 2017; Midwest Regional SGIM 2017 (won best oral presentation); National SGIM 2018
Current project: Improve abdominal aortic aneurysm (AAA) screening


DavisRebeccaRebecca Davis, MD
IRL

Mentor: 2 years
Past project: Implement the new staffing model for faculty and resident
Team presentations: UIHC QSS 2017; Midwest SGIM 2017 (oral presentation); National SGIM in 2018
Current project: Prescribe metformin for patients with pre-diabetes


DirksenRachaelRachael Dirksen, MD
IRL

Mentor: 3 years
Past projects: 1. Identified residents as their patients’ primary care physician in EPIC; 2. Improve test result communication and documentation
Team presentations: UIHC QSS 2016, 2017; Midwest Regional SGIM 2017 (oral presentation); National SGIM 2018
Current project: Improve the process of obtaining outside medical records for new patients


FiordellisiWendyWendy Fiordellisi, MD
IRL

Mentor: 3 years
Past projects: 1. Improve the triage process at IRL Medicine clinic; 2. Improve hypertension control in patients with diabetes
Team presentation: UIHC QSS 2016
Current project: Improve resident clinic flow at IRL


Goerdt,ChristopherChris Goerdt, MD, MPH
IRL

Mentor: 2 years
Past project: Proton pump inhibitor deprescribing
Team presentation: UIHC QSS 2017
Current project: Improve dual-energy X-ray absorptiometry (DEXA) screening


Grippen Goddard~AmandaAmanda Grippen-Goddard, MD
VA

Mentor: 1 year
Current project: Improve congestive heart failure (CHF) admissions


HoffmanRichardRich Hoffman, MD, MPH
VA

Mentor: 3 years
Past projects: 1. Created a healthcare maintenance template; 2. Improve Prevnar and Pneumovax vaccination rates
Team presentation: UIHC QSS 2016
Current project: Improve CHF admissions


Iverson,WilliamWilliam Iverson, MD
VA

Mentor: 3 years
Past projects: 1. Creation of a CPRS orientation booklet; 2. Improve prescribing of statins in patients with diabetes
Team presentations: UIHC QSS 2016, 2017; National SGIM 2018
Current project: Improve management of COPD


Johnson~KristaKrista Johnson, MD, MME
VA and IRL

Mentor: 3 years
Past projects: 1. Improve adherence to opioid prescribing guidelines (VA); 2. Improve atrial fibrillation documentation (VA); 3. Implement the new staffing model for faculty and residents (IRL)
Team presentations: UIHC QSS 2016 (VA); UIHC QSS 2017 (VA and IRL); Midwest SGIM 2017 (oral presentation, VA and IRL); National SGIM 2018 (IRL)
Current projects: Improve colorectal cancer screening (VA); Prescribe metformin for patients with pre-diabetes (IRL)


kuehncarlyCarly Kuehn, MD
VA

Mentor: 2 years
Past project: Proton pump inhibitor deprescribing
Team Presentations: UIHC QSS 2017; Midwest Regional SGIM 2017 (won best oral presentation); National SGIM 2018
Current project: Improve AAA screening


SmockJustinJustin Smock, MD
VA

Mentor: 3 years
Past projects: 1. Improve test result follow-up; 2. Improve follow-up of positive depression screens
Team presentations: UIHC QSS 2016, 2017; Regional SGIM 2017 (oral presentation)
Current project: Improve hypertension control


Szot,JosephJoseph Szot, MD
VA

Mentor: 2 years
Past projects: 1. Improve adherence to opioid prescribing guidelines; 2. Improve atrial fibrillation documentation
Team presentations: UIHC QSS 2016, 2017; Midwest SGIM 2017 (oral presentation)


VillalvazoYolandaYolanda Villalvazo, MD, MPH
VA

Mentor: 1 year
Current project: Improve colorectal cancer screening


White~KatherineKatie White, MD
IRL

Mentor: 3 years
Past projects: 1. Developed a new staffing model for residents and faculty; 2. Improve test result communication and documentation
Team presentations: UIHC QSS 2017; Midwest SGIM 2017 (oral presentation); National SGIM 2018
Current project: Improve the process of obtaining outside medical records for new patients


WiblinToddTodd Wiblin, MD, MS
IRL

Mentor: 3 years
Past project: Increase the number of new patient appointments in interns’ clinics
Team presentation: UIHC QSS 2017
Current project: Improve colorectal cancer screening at IRL


Wickersham~AlexisAlexis Wickersham, MD
VA

Former resident and former VA Chief Resident of Quality and Safety
Mentor: 1 year
Past project: Implementation of electronic After Visit Summary
Team presentation: UIHC QSS 2016

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