Intrathecal baclofen (ITB) pump complications may result in poor therapeutic effect, withdrawal, hospitalization, or reoperation. Do you have concerns about ITB pump management in your practice? This project will walk you through the plan-do-study-act cycle to make an incremental improvement in baclofen pump management in your pactice.

Catheter associated urinary tract infections (CAUTIs) are one of the most common complications associated with hospital admission. CAUTIs can result in patient morbidity and mortality, extended hospital stays, and increased health care costs. Third-party agencies use this factor as a publicly reported quality indicator. Is your facility’s CAUTI rate higher than expected or desired? This project will walk you through the plan-do-study-act cycle to make an incremental improvement.

Choose one of those minor annoyances, inefficiencies, or persistent issues in your practice, your education work, your administrative role, or your research that could use a little attention. This form will help you apply the plan-do-study-act cycle to any problem--big or small--to help you make an incremental improvement.

Physician burnout is a national problem amongst practitioners due to the ever-changing face of health care: EMR burdens, decreased reimbursements, increased requirements and policing of documentation, insurance denials, loss of autonomy, etc.  Some departments have addressed burnout and promoted wellness of physicians in their departments and others have not. Are you concerned about burnout of physicians in your department? This project will help you apply the plan-do-study-act cycle to issues of physician burnout to help you make an incremental change to benefit physicians.

Encouraging and including participation and contributions from diverse individuals is critical to the future of medicine and our civil society. As has become increasingly obvious, there are many opportunities for improvement in this important area of concern. This project will help you apply the plan-do-study-act improvement cycle to areas such as staff and resident diversity, unconscious bias in payer and insurance considerations, holiday considerations, patient satisfaction measures, or your own idea for making a small improvement in this vital area.

Literature suggests that tracking the functional status of patients with spine-related pain improves outcomes. Does your practice consistently obtain a functional status measure in this patient group? Is the functional status measure result communicated and utilized effectively amongst your team? Is there room for improvement? This project will walk you through the improvement steps to make a small change and measure its effectiveness.

Effective communication is important in almost every area of a physician’s professional work. Could your communication skills be improved in some specific area? Do trainees describe you as too abrupt/directive/distant? Do patients wish for more diagnosis specific education from you? Do your written communications elicit negative feedback?  Do patients complain that your office does not communicate well about next appointments or some other aspect of care? Using the plan-do-study-act cycle, this project will help you apply quantifiable measures to what can feel like a fuzzy area.

Proper use of personal protective equipment (PPE) in health care settings has always been important for patient and provider safety, but PPE has gained increased attention in the era of COVID-19. Guidelines for appropriate use are available through many institutions and the CDC. Is there concern in your work area that PPE is not being used optimally? This project will help you measure the current state, make a small change, and measure your results.

Are longer-than-optimal patient wait times a persistent problem in your practice? This measure often lowers patient satisfaction scores, and you could potentially make a real difference to your patients by implementing simple changes to improve wait times. This project will help you set your goal, investigate the root cause, establish measures, make a change, and measure your improvement.

Research has demonstrated that pre-procedure timeouts decrease procedure-related errors. How consistent is your practice in performing pre-procedure timeouts? This project will walk you through the plan-do-study-act cycle to make an improvement related to timeouts.

Literature indicates safety gaps exist when patients are discharged from the hospital. Analyze with your care team and then describe the current method of discharging patients at your facility. Are there any potential safety issues you could address? This project will guide you through identifying the problem, measuring it, making a change, and re-measuring to assess results.

Physicians considering prescribing opioids or renewing prescriptions for opioids may not be aware that patients are obtaining opioids from multiple providers or being prescribed other substances that may increase risk of opioids (e.g., benzodiazepines). These are both important safety concerns. To reduce these risks, the Centers for Disease Control recommends that physicians consider checking their state’s Physician Drug Monitoring Program (PDMP) prior to every opioid prescription and, for patients on ongoing opioid treatment, check the PDMP at least every 3 months (https://www.cdc.gov/drugoverdose/pdmp/providers.html). Are you routinely aware of your state’s PDMP information for a patient when you prescribe and renew prescriptions for opioids? (PDMPs exist in all states except Missouri, and in the District of Columbia and Guam http://www.fsmb.org/siteassets/advocacy/key-issues/prescription-drug-monitoring-programs-by-state.pdf.)

This project will help you assess how often you're checking the PDMP and make a plan for improving.

The Physical Activity Guidelines for Americans, 2nd edition, U.S. Department of Health and Human Services, 2018, https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf suggests 3 hours of activity daily (combined light, moderate, and vigorous) in children ages 3 through 5, and at least 60 minutes of daily physical activity for children and adolescents ages 6 through 17. In addition, the prevalence of obesity has increased dramatically in school-aged children. Children and adolescents with disabilities should meet the same guidelines whenever possible.  Do you address the issues of physical activity and obesity with your patients?

This project will help you identify any gaps that exist in your consultations with patients, then use the plan-do-study-act framework to make an improvement.

Patient falls during an admission to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) can cause significant morbidity and possibly even mortality. Additionally, third party agencies use this factor as a publicly reported quality indicator.  Is your facility’s fall rate higher than expected or desired?

This project will help you measure your existing state, set a goal, make a change, and measure your results.

Acute care transfers (ACT) from inpatient rehabilitation facilities (IRF) cause interruption of functional progress, are related to negative overall outcomes, and are increasingly viewed by external parties as an indicator of IRF quality. Is your facility’s acute care transfer rate higher than expected or desired?

This project will help you identify where you could make improvements, then use the plan-do-study-act framework to implement a change and measure the results.

Multiple factors (e.g. impaired cognition and/or sensation, decreased strength and mobility, poor nutritional status, incontinence, etc.) that are commonly present in patients admitted to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) can greatly increase the risk that those patients will develop pressure injuries. Prevention of pressure injuries is vitally important for these patients because once pressure injuries develop, they can lead to significant morbidity. Additionally, third party agencies use this factor as a publicly reported quality indicator. Is your facility’s pressure injury rate higher than expected or desired?

This project will help you define the problem, set a goal, make a change, and measure results.

Literature suggests that early identification of opioid abuse potential improves the outcome of patients with painful medical conditions. Identify whether your practice uses the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) or a similar tool. Is it administered consistently? Are the results of the screener used effectively to manage a patient’s risk of opioid misuse?

This project will help you determine where you can make an improvement with the use of opioid assessment screener in your practice.

Research demonstrates that standard management protocols for anticoagulation therapy reduce errors and improve outcomes, including diet and drug interaction education. Describe your practice’s current protocols for anticoagulation diet and drug interaction education, then determine if there is room for improvement in the current protocol or protocol implementation.

This project will help you implement the plan-do-study-act cycle to anticoagulation therapy education for patients with the goal of making a difference in the care you provide this population.

Some practice areas were already starting to embrace telemedicine, but the COVID 19 pandemic substantially accelerated the widespread development and use of telemedicine. Although future regulations related to telehealth are uncertain, many physicians developed processes and procedures in order to care for their patients who were unable or unwilling to leave their homes. Were you one of these physicians? A problem statement should be clear and pertain to your practice. Possible examples might include:

-  No infrastructure to provide telehealth for patients during the pandemic

- Cancellation of telemedicine visits due to language barriers and limited access to interpreters

- Poor patient satisfaction with telehealth visits

This project will help you identify a problem you'd like to address, determine your current state, make a change, and measure results.

Medical errors are a common and serious problem in health care. The FDA receives more than 100,000 reports per year of medication errors (https://www.fda.gov/drugs/drug-information-consumers/working-reduce-medication-errors). In a widely cited 2016 Johns Hopkins study published in The BMJ, medical errors were the third highest leading cause of death in the nation. A medical error is a single event that should prompt a root cause analysis in order to prevent a recurrence. It also fulfills the intent of a QI project.

This project will help you apply the plan-do-study-act framework to a single medical event, measure its impact, implement a change to prevent future errors, and determine the results of the change you made.

ABPMR