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Colleen’s First QI Project, Part Three: Choosing a Project – Again!

Last modified by IHI Open School on Wednesday, Mar 06, 2013

Editor’s Note: Colleen McCormick, a fourth-year medical student from Wright State University in Ohio, is using the IHI Open School Quality Improvement Practicum to conduct her first quality improvement project.

Every Wednesday, for the next two months, Colleen will write a blog post about her progress as a student trying to make a change in the health care system. Read her first and second posts here.

 

By Colleen McCormick, fourth-year medical student, Wright State University

 

In my first post, I introduced my improvement project and my aim statement: Reduce the number of CT scans in patients with chronic headaches and no new features by 20% by April, 2013.

 

Now, it was time to start the charter. What problems were we going to address? We assumed that overimaging with CT scans occurs in the emergency department. By addressing this problem, patient care could be improved in two key ways: unnecessary radiation exposure would be decreased, and the cost of care would be decreased.

 

As I looked at that large dataset (nearly 1,200 scans over the past nine months for patients with “headaches”), I realized that the scope of the study was much too large. Improvement projects are about small changes, right? In addition, the dataset did not have information that was specific enough to determine the ACR criteria.

 

Dr. W, my Faculty Advisor on the project, and I spoke about the potential directions we could go due to these barriers, and decided to narrow the focus of the project. Step 1 was to delve into a few patient charts and apply those criteria to the clinical situation.

 

We decided to look in depth at patient charts to determine if the diagnostic modality (CT scan) was appropriate for the suspected diagnosis. After going through four months of charts, which included all of the CT scans associated with headaches, only a few of the scans could even be considered inappropriate! Dr. W and I were proud of this fact (as was the radiology team), but in turn, it didn’t look like my project was going to be very useful!

 

I suppose this is a risk I faced since I was starting an improvement project without knowing the day-to-day of the health system! (It was a good lesson to learn and one I hope you can benefit from, too.)

 

So, it was back to square one for me. As I started to consider new projects, Dr. W presented one that her service had deemed important: increasing utilization of palliative care in the ICU. Palliative care teams have been shown to improve patient, family, and provider satisfaction; decrease length of stay; and, decrease hospital costs. Also, since I am interested in a career in oncology, palliative care is very important to me! So, I decided to take on this new adventure!

 

Let’s hope this project sticks!

 

Have any of you had similar experiences? Have you started on an improvement project and realized it was too big or wouldn’t be useful to the institution?

 

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