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Curriculum


FAQT: Fellows Applied Quality Training Curriculum (Updated Sept 2016)

Faculty Director

Faculty Mentors


Learning Objectives

  • Implement project, gather and analyze data using appropriate statistical methods
    • Outcome: complete final abstract and presentation
  • Apply team-based approach and QI methods to develop a small-group project
    • Outcome: complete project outline
  • Understand the application of basic statistical tests
    • Outcome: participation in didactic training
  • Review basic terminology and methods related to quality improvement (QI)
    • Outcome: completion of IHI modules
  • Recognize QI priorities for our facility
    • Outcome: participation in didactic training
  • Review communication skills including medical writing and oral presentations
    • Outcome: participation in didactic training
  • Review the process of regulatory oversight relating to QI and research
    • Outcome: submit UF IRB CQI forms for authorization
  • Distribute knowledge of findings
    • Outcome: submit abstract to an internal UF scientific meeting

Curriculum Overview

Review materials: All new house staff at the University of Florida complete modules within the Institute for Healthcare Improvement’s (IHI) Open School as part of their orientation. Additional selected readings will be offered for fellows to review as they desire.

Timeline: Projects will be conducted at a pace appropriate for each team with the first quarter of the year planning, the second and third quarters spent conducting projects and the fourth quarter analyzing, writing and presenting results. Teams are expected to meet with their mentors monthly and meet independently as necessary. Deadlines and suggested progress goals are described below.

  • July
    • Team meets with mentor to discuss ideas
    • Curriculum director meets with faculty for orientation
  • August
    • Complete project outline, submit to curriculum director (Appendix 1)
  • September
    • Develop project plan, update AIM statement if necessary
  • October
    • Select measures and statistical methods, identify data sources
  • November
    • Review UF IRB CQI Process
    • Teams review IRB forms with curriculum director
    • Submit forms to IRB
  • December
    • Finalize data collection plan
    • Begin gathering pre-intervention data
  • January
    • Present pre-intervention data in conference
  • February-March
    • Conduct projects
    • Gather post-intervention data
  • April
    • Analyze data
    • Submit project abstract (Appendix 2)
  • May
    • Prepare project presentations
    • Submit final presentation to curriculum director
  • June
    • Project presentations
    • Debriefing session and feedback

ACGME Competencies

  • Patient Care: Fellows will recognize the importance of continual quality improvement on delivering excellent patient care
  • Medical Knowledge: Fellows will learn knowledge about QI, including terminology and methods
  • Practice-based Learning and Improvement: Fellows with practice performing QI and demonstrate improvement in an aspect of clinical care
  • Interpersonal and Communication Skills: Fellows will be required to interact with a mentor to develop their QI project. Fellows will routinely interact with other health professionals (nurses, technologists, etc.) in implementing QI projects.
  • Professionalism: Fellows will work as a group in a professional manner to achieve the goals of this curriculum
  • Systems-based Practice: Fellows will engage in systems based practice which is central to completing QI projects as part of this curriculum

Outcomes Assessment

  • Assessment of Curriculum: Trainees will evaluate their confidence in the use of QI methods prior to training, and at the conclusion of each year of training. Trainees will provide feedback on the curriculum at the end of the year.
  • Assessment of Learners: Learners will present the findings from their projects at the end-of-year event with an award given to the best overall project. Team mentors will review performance of team members annually.

References

  1. Boonyasai RT et al. Effectiveness of Teaching Quality Improvement to Clinicians. JAMA 2007;29:1023-1037.
  2. Ogrinc G et al. Teaching and Assessing Resident Competence in Practoce-Based Learning and Improvement. J Gen Int Med 2004;19:496-500.
  3. Oyler J et al. Quality Assessment and Improvement Curriculum (QAIC) Toolkit. University of Chicago Medical Center.
  4. Davidoff F et al. Publication guidelines for quality improvement studies in health care: evolution of the SQUIRE project. BMJ 2009;338:a3152.

Sample Project Outline | Appendix 1 | FAQT QI Project Outline

Team name: Team Diet Dew

Fellows:

  • Sid Staton
  • Doug Luke
  • William Brearley

Faculty mentor:

  • R David Anderson, MD

Project title/topic

  • Reducing unnecessary noise in cath holding area

Metric for assessment

  1. Noise levels measured by smartphone
  2. Patient satisfaction with cath lab holding room experience

Quality domains

  • Patient-Centered

Brief description: We will measure the level of noise in the cath lab holding area throughout the day to identify the loudest times in the cath lab. We will observe the cath lab and try to identify the sources of noise which could be eliminated or moved to other areas. We will survey patient satisfaction before and after our changes to determine the improvement in patient experience with being in the cath lab holding area.


Sample Project Abstract (based on SQUIRE format, see references) | Appendix 2 | FAQT Abstract 

Team name: Team Diet Dew

Team members

  • Sid Staton
  • Doug Luke
  • William Brearley

Faculty Advisor

  • R David Anderson, MD

Project title

  • Reducing noise in cath lab holding area to improve patient satisfaction

Background and problem being addressed

  • The cath lab holding area is frequently chaotic and noisy. As a result, patients are sometimes frustrated with not being able to get the attention of a nurse, or are anxious because of the constant noise.

Study Question

  • Can a visual display of the current noise level encourage people to be quieter and will this improve patient satisfaction in the holding area?

Description of intervention: We borrowed a “traffic light” style noise detector from the hospital quality improvement office and had it installed in the cath lab holding area. This device has an adjustable control for selecting when lights will change colors based on the noise level detected (measured in decibels). We set the device to display the green light up to a noise level of 80 decibels (roughly equivalent to a vacuum cleaner). From 80-90 decibels (roughly equivalent to a garbage disposal ) the yellow light is displayed, and above 90 decibels (roughly equivalent to a lawnmower) the red light is displayed. We also measured the decibels continuously during the day using a smartphone app.

Method of evaluation: To establish a baseline, we measured the noise in decibels throughout the day for 5 days. We determined the average noise level for each hour of the day and then averaged those for the week. We distributed a 5 question survey to patients asking about the noise level and their overall satisfaction with care in the cath lab holding room. Questions responses were all on a 5 point scale with 1 being poor and 5 being excellent. We then installed the “traffic light” system as described. We analyzed the noise for 5 days after installation. The data from this period were collected but used as a “blanking period” for the staff to acclimate to the light and change their behaviors based on the visual feedback it provides. We gathered a third week of data and again surveyed patients using the same survey as before.

Results: Prior to our intervention, the average noise level fluctuated throughout the day with the highest average noise level  being 86.4 decibels from 2-3 pm. Patients rated their overall satisfaction as a 4.2 on a 5 point scale, with lower satisfaction of the noise level, 3.7 out of 5. During the “blanking period”, the noise levels were lower, but not statistically significant (82.3 decibels from 2-3 pm, p=0.09). After the “blanking period”, noise levels were further reduced, now significantly different from baseline (76.6 decibels, p=0.012). Overall patient satisfaction was not different (4.3 out of 5, p=0.72 compared to baseline), however satisfaction with the noise level was improved to 4.4 out of 5 (p=0.001).

Conclusion: Installation of a visual reminder system encouraged staff and patients in the catheterization laboratory holding room to significantly decrease the level of noise throughout the day. This translated into an improvement in patient satisfaction with the noise level, without an improvement in the overall satisfaction. The intervention was both inexpensive and rapidly effective at achieving our predetermined goals.

Lesson Learned: The internal hospital processes to have a new sign installed  were cumbersome and time-consuming. Similar interventions should plan for this process to take at least 3 months.

References

  1. Richardson et al. Development and implementation of a noise reduction intervention programme: a pre- and postaudit of three hospital wards. J Clin Nurs. 2009 Dec;18(23):3316-24.
  2. McLaren et al. Noise pollution on an acute surgical ward. Ann R Coll Surg Engl. 2008 Mar;90(2):136-9.
  3. Moore et al. Interventions to reduce decibel levels on patient care units. Am Surg. 1998 Sep;64(9):894-9.