CEO 3.2 Seek out and apply best practices, measure the effects of changes and develop strategies to improve performance
CEO 3.3 Demonstrate an understanding of the role of the student and the physician in the improvement of the healthcare delivery system.
As I have progressed through medical school, I have recognized the importance of evidence- based medicine. Throughout all of M1 and M2, the preclinical training was based upon a foundation of research. While I was cognizant of this prior to entering my clinical years, I was having difficulty understanding how to incorporate evidence based medicine into everyday practice. I found it overwhelming to try to balance the knowledge I already had with acquiring new knowledge. I did not realize that utilizing resources while on the wards was not only acceptable, but encouraged.
I received feedback from my third year general medicine rotation that I needed to expand upon my medical knowledge. While I went home and focused on methods such as Anki and clinical questions, my medical knowledge increased yet I still needed to improve upon the medical management plans. I received feedback from an evaluation to go home and spend 15 minutes reading UpToDate for the management of a condition I came across with my patient that day. When I started to implement UpToDate and the Hospitalist Handbook in the clinical setting, my plans began to improve as did my understanding of medical management. For example, using these resources, I could quickly determine what the maximal dosage was for a medication for the clinical indication. My improved ability to develop medical plans for patients resulted in me being able to provide better care to patients.
During my fourth year, I started to understand the importance of critically analyzing the healthcare delivery system to improve patient care and outcomes. As part of Part 3 curriculum, I had to complete a QI project. This provided a perfect opportunity to improve upon patient care by recognizing deficits of the system. My group’s project was focused on decreasing 60 -day readmission rates to the Ross Heart Hospital for patients with acute exacerbations of heart failure. After gathering data from stakeholders, the group decided health literacy and complexity of medication regimen were root causes of the problem. By critically analyzing the root causes of the readmission rates, our group was able to determine what was impeding better care.
The intervention was aimed at addressing the root causes by using a standardized document with the list of medications including their class of medication, and the importance of taking the medications regularly. On the day of discharge, the nurses reviewed the document with the patients. Bedside nurses implemented the teach-back method to ensure the patients understood their medication regimen.
With the implementation of the intervention, the heart failure readmission rates decreased from 38 to 19. The QI project helped me realize the role of the physician and student in the healthcare system was not only follow guidelines set forth by the research of others, but to be able to critically analyze what is occurring in the clinical environment to improve upon any processes.
After having completed a QI project in medical school, I realize I am in a unique position to expand upon these skills in residency. As I move forward, I would like to complete more QI projects as they can ultimately improve upon patient lives while allowing me to make contributions to the field of medicine.