Past QI Projects

Worked on improving the discharge medication process in efforts to improve efficiency around inpatient discharges and reduce barriers to throughput

Looked at the role of Seroquel in combating post operative emergence delirium

Developed a multidisciplinary clinic for head and neck cancer patients to reduce time to diagnosis and treament, increase patient compliance, and improve efficiency delivery of care

• • • Increasing Quality by Decreasing Intervention: Perioperative Management of Minor Hand Procedures

    • Improve care of patients with a reduction of sequelae of anesthesia, unnecessary tests, cost, and unnecessary hospital visits, as well as improved patient satisfaction

• • • Minimizing unnecessary interventions at night to promote sleep hygiene and patient satisfaction

• • • Improving postnatal quality assurance in newborns with prenatal concerns for cardiac abnormalities on fetal echocardiogram

• • • Impact of race and socio-economic status on remission of neurologic disorders

    • We expect to develop a tool for social determinants of health (SDH) screenings and integrate screening into existing workflow

• • • Improving the blood loss calculation for obstetric patients having a c-section in order to improve outcomes and the need for blood transfusion postoperatively

• • • Working with attendings with the goal of reducing unnecessary bloodwork on hospitalized patients

• • •  Looking at compliance with hand hygiene project, and if there are low numbers what are the obstacles in the process and how it can be improved

Clarkston Community Health Center (CCHC) is a free clinic that opened in 2013 to provide primary and preventative healthcare to the uninsured refugee and indigent population of Clarkston, a major refugee resettlement area located just outside the city of Atlanta. The CCHC serves as both a primary care and urgent care for members of this community, and now  houses multiple specialty clinics including Women's Health, Dental, Ophthalmology, Cardiology, and is progressively becoming a comprehensive healthcare center for the community. The clinic is staffed by volunteer health professionals and students. In March 2016, IHI partnered with CCHC to improve clinic processes and patient flow. Since then, we have significantly expanded our efforts at the clinic through a QI team and a Special Projects team.

In partnership with CCHC volunteers, this QI team tackled various areas in need of improvement at the clinic using QI methods. In 2018-2019, one sub-team worked on increasing hand-washing (see below) among volunteer providers and students and increasing proper cleaning of exam rooms in between patients. Another sub-team worked on implementing a checklist of essential close-out activities for volunteers.

A. CCHC Clean Team, 2017-2018

Beginning in February 2017, the Institute of Healthcare Improvement (IHI) Emory University chapter partnered with Clarkston Community Health Center (CCHC) to improve hand hygiene amongst the staff providing direct patient care at both the primary care and women’s health clinics. The IHI Quality Improvement (QI) Team identified three areas of potential improvement: 1) visual cues and signs, 2) education on proper hand hygiene practices, and 3) location of hand sanitizer. The team's goal is to increase healthcare provider, staff, and volunteers’ baseline hand hygiene practices at CCHC by 80% by mid- October 2017.

The IHI QI team has implemented two multi-step rapid Plan-Do-Study-Act (PDSA) cycles focused on the first two areas for improvement. The first cycle consisted of hanging posters regarding proper hand hygiene techniques, and the key moments to realize the practice. The second PSDA cycle consisted of administering a pre-and-post assessment regarding a review of proper hand hygiene practice. Feedback was solicited from health care staff and volunteers prior to, during, and following each PDSA cycle and incorporated. This feedback has been considered in planning for subsequent cycles. 

The fourth PDSA cycle will consist of making alcohol-based hand sanitizers and gloves readily available at the point of care (patient encounter). The fifth PDSA cycle will involve the implementation of wall mounts with hand sanitizer. A budget for needed supplies as well as a sustainability plan for future procurement are underway.

B. CCHC Language QI Team, 2017-2018

Limited culturally and linguistic appropriate resources for this community (representing over 60 languages) present a significant barrier to utilization of healthcare resources. In Spring of 2017, this team received the HIP-ACTSI-GSU Student Seed Grant to help CCHC achieve its mission to become a "culturally and linguistically competent facility". Specifically, the team worked to adapt a modified community health worker model to achieve the following aims:

• • Aim 1. To reduce barriers in accessing healthcare by providing translated print and website materials

  • Aim 2. To build capacity by strengthening the existing interpreter network

  • Aim 3. To foster community engagement and piloting a community medical interpreter system by training community members to become certified medical interpreters

After implementation, the percentage of patients who received adequate interpretation services rose from 25% to 42%, meeting the team's aim of a 50% improvement within a year. 

C. CCHC Patient Flow Team, 2016-2017

In spring 2016, the Emory University Chapter of the IHI Open School partnered with Clarkston Community Health Center (CCHC), a quickly growing clinic that opened in 2015 to provide affordable primary health care to underinsured and uninsured refugees and indigent people in Clarkston. With process flow maps and spaghetti diagrams to better understand clinic flow, the team identified three core areas of intervention to improve clinic processes and volunteer and staff experiences at the clinic: patient flow, volunteer coordination, and patient forms. Using concurrent PDSA cycles, the team implemented a patient flow checklist, a task list of volunteer roles, and simplified forms to streamline the patient intake process. After implementation of these interventions, the average total clinic time decreased by nine minutes, and the majority of staff and volunteers surveyed (78 percent) reported an improvement in clinic experiences. Moreover, this project allowed the team to build a positive rapport with the clinic and community members for more extensive partnerships and projects in the future. 

IHI launched a quality improvement team at Emory’s Patient-Centered Primary Care Clinic. This team was student-led and focused on issues such as diabetes care, hypertension medication compliance, and tracking of prescription practices.

Wondering what a Patient-Centered Medical Home is? The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the simplest to the most complex conditions. Want to learn more about patient-centered medical homes? Click here.

Our chapter of the IHI Open School (through our Diabetes Quality Improvement Team) has partnered with the Good Samaritan Health Center, a community health center serving 25,000 low-income patients annually, to work to improve quality of care for high-risk and vulnerable patients with diabetes. 

Goal: To improve care for diabetics in a high-risk safety net patient population through student-led quality improvement projects

Aim: To improve management of diabetes at Good Sam by improving adherence to national guidelines and resolving gaps in care. By improving management of diabetes among low-income patients, we can decrease the emotional, physical, and financial burden that this disease causes patients and play an important part in eliminating healthcare disparities.

The Diabetes Passport: A Self-Management Tool for Diabetics 

The Good Samaritan Health Center was looking for a method for diabetic patients to maintain continuity with their provider in order to improve the quality of care diabetics received. Specifically, it was important to Good Sam to have patients be aware of the yearly screenings recommended for diabetics, such as eye and foot exams, so that patients would know when and how often to come to the clinic. We learned from the clinic staff of one unfortunate case, when a diabetic patient was lost to follow-up, and returned years later with kidney disease that could have been prevented had this patient known to see a doctor regularly. The Spring 2015 Diabetes Quality Improvement Team came together to brainstorm how we could help the clinic reach the goal of having all of the clinic's diabetic patients get the recommended yearly screening for patients with Type 2 Diabetes, including foot exams, eye exams, and urine and blood tests. We researched evidence-based methods for diabetes self-management, adapted these methods to better fit the Good Samaritan population, and created a "Diabetes Passport," a tool to guide patients through the daily, monthly, and yearly 'to-do's' in the management of their diabetes. We implemented the passport within the clinic and identified the best place within the clinic's workflow for the passport to be distributed to patients. Finally, to determine the success of the passport, we reached out to patients to determine how the passport changed the way they managed their diabetes. We plan to continue to collect data to determine the effect of the passport on frequency of follow-up appointments.

Preventing Diabetes Among High-Risk Pre-Diabetics 

For its initial project, the Diabetes Improvement Team focused on diabetes prevention with lifestyle intervention or the drug metformin. High-quality evidence exists showing that diabetes can be prevented with lifestyle intervention or metformin, but much of this evidence has not been implemented in practice. We did a quality improvement project to identify high-risk pre-diabetes patients at Good Sam and attempted to improve the rate at which lifestyle intervention or metformin therapy was initiated. We used data from the clinic's EMR to identify individuals with high-risk pre-diabetes, and then partnered with clinicians to design a protocol to guide clinician decision making around which patients could benefit from behavior modifications or drug therapy. Future directions include improving patient uptake of lifestyle intervention, using population health methods to identify patients most at-risk, and improving the efficiency with which lifestyle intervention is delivered at Good Sam.

Sepsis is among the leading causes of death in hospitalized patients and throughout the world. Because of this, Grady recently instituted a new algorithm to be used any time a medical provider suspects a patient has sepsis. The Grady Sepsis Guideline addressed the following aspects of sepsis care: A) Approach to identification of sepsis, severe sepsis, and septic shock; B) Acute resuscitation (3-hour bundle); C) Ongoing management (6-hour bundle).

In order to improve patient flow through our operating room, a committee of surgeons, anesthesiologists and surgical staff at Emory University Hospital had a student conduct time studies and identify strategies in order to target prevention/education efforts/measure future improvements.

Students performed an audit of current practices and assisted in implementation of process improvement efforts. Data collection occurred via in-person observation in the operating room as well as data capture from the electronic medical record. Deliverables included process improvement summaries, graphical analysis prevention bundle compliance compared to baseline performance, and recommendations for further improvements.

The Quality Academy is partnered with IHI Open School to connect students to faculty-led QI projects. Students worked directly with faculty across the Emory community and participated in various workshops related to quality and process improvement throughout the academic year.