Quality Improvement & Patient Safety
The UVA Hospitalist group continually strives to improve the delivery of healthcare to our patients, the education of our learners, and the satisfaction of our jobs with work that falls under the umbrella of patient safety and quality improvement.
Hospitalists serve as medical directors for the four General Medicine units in the UVA Medical Center hospital. Our medical directors partner with nurse managers to oversee quality, safety, and operations on each unit. They lead communication with physicians on the units regarding quality and safety priorities and standards, perform root cause analysis on quality and safety events, collaborate in longitudinal improvement efforts on many fronts, and report to the Associate Chief Medical Officer (ACMO) for Acute Care and other senior medical center leadership.
In addition to formal leadership roles, our hospitalists are integrally involved in many QI/PS initiatives that align with program, department, service line, and/or institutional priorities. Learn more about our work below.
UVA hospitalists participate in innovative initiatives to improve health and well-being for people with complex medical and social needs. Based on early success in a pilot program to reduce hospital days and readmissions for a subset of patients with sickle cell disease, the expanded Medicine HOME Program was launched in 2019 and aligned with UVA Population Health in 2021. Dr. Amber Inofuentes serves as medical director, and Dr. Ian Crane as physician lead for the Diabetes subgroup. In collaboration with an RN Clinical Program Coordinator and Licensed Clinical Social Worker, we provide consultative and support services for 30-35 enrolled patients with a range of medical and behavioral health challenges. Multidisciplinary individualized care plans (ICP) and intensive care coordination across the home–outpatient–inpatient spectrum aid in addressing barriers to care. We are currently piloting a bridge clinic for a small group of patients to provide home-based primary care, with plans to publish the results of a qualitative study highlighting barriers to care from the perspective of enrolled patients.
In 2019, the program received the Charles L. Brown Award for Excellence in Patient Care Quality and has presented its work at national meetings of the Society of Hospital Medicine and the National Center for Complex Care.
Drs. Amber Inofuentes and Jessica Dreicer serve as physician-leads for a longitudinal interprofessional PS/QI project to improve medication reconciliation for patients discharging to skilled nursing facilities (SNF). Sustained reduction in the frequency and severity of discharge medication errors has been achieved through ongoing efforts to make it “easier to do the right thing” in the electronic medical record and the introduction of a discharge medication “huddle” practice.
This work won the Charles L. Brown Award for Excellence in Patient Care Quality in 2021 and has been presented at local and regional Grand Rounds and an international conference.
Dr. Jessica Dreicer, supported by Dr. George Hoke and Dr. Angel Morvant, serves as physician lead for a longitudinal quality improvement project to improve the care of hospitalized patients with venous thromboembolism. UVA is one of approximately 10 sites around the country who simultaneously participated in a mentored QI project through the Society of Hospital Medicine. The project led to increased standardization of care and documentation of care for patients with VTE as well as a discharge order set.
Additional projects are ongoing, with successive cycles to refine and implement strategies to effect and sustain improvements. These include:
- Enhancing patient progression and reducing Length of Stay (LOS)
- Optimizing Structured Interdisciplinary Rounds (SIDR) to improve team communication
- Implementing early warning systems (EWS, NEWS+) to improve detection and response to patient clinical deterioration
- Optimizing use of telemetry resources through stewardship practices
- Improving early recognition and management of sepsis to reduce mortality
- Reducing high-rish medication errors through discharge pathway review (see SNF project above) and pharmacist consultation for admission medication history
Several hospitalists partner with Quality & Performance Improvement coaches to mentor longitudinal QP/PS projects for internal medicine residents. Current areas of focus for improvement include:
- Communication from inpatient to outpatient clinicians in discharge summaries
- Transition from infusion to subcutaneous insulin for patients with diabetic ketoacidosis
- Completion of inpatient colonoscopy preparation
- Evidence-based prescribing and documentation of PPIs
- Protocol for blood transfusion pre-treatment for patients with cancer
- Chronic care appointment follow-up after COVID-19 diagnosis
- Handoff between residents at shift transitions
- Triage of on-call physician phone calls