A Quality Improvement InQubator to Promote and Develop Emergency Medicine Quality Improvement Projects

The Division of Quality Improvement (QI) at Vanderbilt University Medical Center was created to expand resident and faculty-wide engagement in quality initiatives and QI education. A core group of QI trained faculty was limited in their ability to initiate and manage project proposals from non-QI trained residents and faculty. We developed an incubator to support QI projects throughout the department and provide mentorship for resident graduate medical education (GME) QI activities.

The Quality Improvement: InQubator (QI:IQ) was created to promote a standardized approach to quality improvement projects within the Emergency Department (ED). The QI:IQ program sought to create a novel and safe space to support EM residents, faculty, and staff in taking QI projects to fruition through a structured coaching process. Through coordination of key stakeholders, we sought to initiate projects and establish longitudinal mentorship.

We used the Model for Improvement described by the Institute for Healthcare Improvement to standardize QI projects conducted in the ED. We created a monthly meeting with quality leadership, operations leadership, nursing leadership, data analysts, and researchers. Participants were sent a guide to QI framework and attended a one-hour coaching session to: (1) define a SMART AIM; (2) identify data needs; (3) discuss QI methodology; and (4) provide tangible action items in the QI process.

From July 2022 to present, the QI:IQ program has supported over 25 projects. Approximately 80% have resulted in an implemented operational change in our EDs. Three projects have led to presentations at national meetings and received awards at either the institutional or national level. One project has resulted in published manuscript and two are drafted for submission.

The presentation will include five major sections, first, we will begin by providing background and introducing challenges which led to the creation of this incubator. We will emphasize the need to develop QI methodology and skills amongst residents, faculty and staff without overextending resources from a small contingent of QI trained faculty. Second, we discuss our incubator and the framework used during implementation. Two key factors include: (1) standing meetings with protected time from clinical work to meet and discuss QI projects and (2) a multidisciplinary team with members not just from ED quality but also operations, nursing, data analytics, and institutional quality, safety and risk prevention. This team allows for a diverse discussion and the ability to immediately begin problem solving the key questions and barriers of any project: how we obtain data, and how a project fits into our organization’s operations and priorities. Third, we will outline our QI project guide. This guide is used to structure both the initial meeting and the long-term management of the project. Often projects presented to QI:IQ are formulated as a research question but often are better suited for quality improvement methodology. The Model for Improvement framework allows us to structure these projects using a quality improvement approach. We identify department leaders needed to facilitate success. Finally, we often serially inQubate projects as they proceed to additional PDSA cycles or encounter barriers. The penultimate section of the presentation will discuss QI:IQ outcomes. We will highlight three projects: (1) Improving Door to ECG Time at a Quaternary Care ED; (2) Improvement of Time to Analgesia in ED Patients with Sickle Cell Anemia Presenting; and (3) Improving SEP-1 Bundle Compliance Across an Academic Hospital System. All three were presented at national meetings and have been published or drafted for submission. Finally, we will discuss an ongoing project related to seizure medication administration, and how it navigates the QI:IQ process. The final section will discuss QI:IQ challenges. Our largest challenge has been scaling this incubator, both in terms of increasing meetings and the longitudinal support for projects. Loss of momentum after the initial meeting has led to the handful of failures to achieve a systematic change in our system. Finally, lack of coordination with our research division and the IRB limited our ability to publish our early successes.