What’s the most personally meaningful QI project you’ve worked on?

James Moses, MD, MPH; Medical Director of Quality Improvement, Boston Medical Center

I think the most influential QI project I’ve worked on has been a project focused on sickle cell patients presenting to our pediatric emergency room with pain. And the reason I think that this has been most influential for me personally is there’s just been a long historical disparity for sickle cell population that is wrapped in race and socio-economic status. These are patients who basically have their red blood cells sickling within their microvascular system, causing pain and kind of morbidity throughout every organ system that has small vessels. And they have objective and valid reasons to have pain episodes, and yet our health care system over time has really mitigated and un-validated these pain episodes largely because of provider bias and health care bias and [the patients’] need for opioid medication to treat their pain.

So we did an improvement project tied to improving the time to pain management for these patients, really from start to finish in our pediatric ED. And we achieved success — yes, through some concrete tools of a checklist and an algorithm and a pain medication calculator — but those were really just tools to get to where the meat of the problem was, which was kind of the bias of the ED in not realizing that this pain of a 10 out of 10 should be treated as an emergency. And what I’ve really gotten a lot of reward from out of that project was seeing the emergency department staff change their lens through learning. We were able to bring them on a journey where they were able to see these patients and their complaints in a different light. And it was really through QI that that was achieved.