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Improving Quality, Improving Health

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Medical student and doctor discussing poster presentation at symposium
Ari Hoffman, MD, (r) talks to students, including second-year medical student Leena Suleiman 

By Chris Cai, MS1

Today’s health systems are faced with a tough challenge: cutting costs while improving the quality of care. Frontline staff – physicians, nurses, and even medical students – are the most important agents in solving this complex problem.

Case in point: Students listening to nurses learned that all neurosurgery patients at UCSF are moved to the intensive care unit (ICU) after surgery, before being discharged or transferred to lower acuity care. This can gridlock the ICU and increase costs. Is it necessary? Second-year UCSF medical students Ezekiel Adigun and Gabriela Weigel decided to explore this area for their quality improvement project as part of the UCSF School of Medicine’s Bridges curriculum.

They found that, in fact, research showed some patients may not require such high levels of care and recover equally well in the post-anesthesia care unit. Working with neurological surgery nurse practitioner Jennifer Viner and quality and safety Program Manager Sarah Imershein, the students presented their findings at the second annual UCSF Health Improvement Poster Symposium September 21, 2017. The event drew hundreds of healthcare professionals, students, graduates, and researchers from across UCSF who collectively presented 150 posters.

“We definitely learned a lot from nurses and medical residents. Working in an interdisciplinary team was a big reason why the project was successful,” Adigun said. So far, 22 patients have used their Safe Transitions Protocol, leading to an average savings of $3,437 per patient without compromising safety or quality of care.

The group received a $50,000 grant from Caring Wisely™ to expand their project. Based on their analysis, roughly 45 patients per month could benefit from the Safe Transitions Protocol, potentially reducing unnecessary healthcare costs.

Niraj Sehgal, MD, MPH, Vice President & Chief Quality Officer for UCSF Health and Professor of Medicine in the Division of Hospital Medicine, sees the symposium as a means to recognize innovation and foster UCSF’s culture of continuous improvement.

“It’s astounding to walk around and see the amazing work done by so many parts of the organization,” said Dr. Sehgal, noting that the symposium is part of a larger effort at UCSF to implement ‘A3 thinking’—a method to systematically identify and understand problems.

“This year, we required project submissions to use a standard poster template that similarly focused on our A3 thinking framework. The vision is to have all of our improvement work embrace the disciplined problem solving that A3 thinking provides, and the symposium becomes one vehicle to learn and share such efforts where everyone is speaking the same language.”

Share Best Practices and Build Community

The event also represented a chance to share best practices and build community. UCSF internist Mai-Khanh Bui-Duy, MD, praised the diversity of professions and interests at the symposium.
“It's really nice to see such a breadth of projects in one place. Outpatient, inpatient, general medicine, and specialties are all represented.”

The diverse and robust turnout reflects UCSF’s institution-wide commitment to improving the quality of patient care.

“I have only been at UCSF for two months but have been really impressed by the amount of attention paid to quality improvement and patient safety. The fact we have such a great turnout for this event is a testament to that,” said Zachary Jacobs, MD, Clinical Fellow.

What’s in store for the next year? Having grown to 150 posters in just two years, the next UCSF Health Improvement Symposium may be even larger.

“As UCSF Health continues to grow and our students, residents, and fellows are increasingly involved in quality improvement work, my hope is that the symposium becomes an annual event that builds a community for learning about and sharing improvement work,” said Dr. Sehgal.