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 each unit’s quality, safety, and operations. 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.
Medicine HOME Program
UVA hospitalists participate in innovative initiatives to improve the health and well-being of 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. Collaborating with an RN Clinical Program Coordinator and Licensed Clinical Social Worker, we provide consultative and support services for 30-35 enrolled patients with various 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 piloting a bridge clinic for a small group of patients to provide home-based primary care. We plan 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. It 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.
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