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Colleen’s First QI Project: Off to a Good Start!

By IHI Open School | Wednesday, January 30, 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. She’s ambitious, excited, and curious, and she’s ready to share the ups and downs of her project with the IHI Open School community.


Every Wednesday, for the next two months, Colleen will write a blog post about her progress. Follow along as she discusses what it’s like to be a student trying to make a change in the health care system. Will the project succeed in improving care for patients? Will the barriers and obstacles be too much to overcome? There’s only one way to find out.


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


After completing the IHI Open School Basic Certificate this summer, I was ready to start my own improvement project! I’ve never done one before, so I was excited to test what I had learned.


Using the IHI Open School’s Quality Improvement Practicum as a guide, I first identified a faculty mentor and health care system in which to work. My mentor (Dr. W) is well known in our school and community for working in quality improvement and patient safety, and she felt that her health care system would support and facilitate student involvement.


Dr. W and I met in early November to discuss the Practicum and potential areas for system improvement. I’m really interested in pediatrics and patient safety, and have observed that radiation studies like x-rays and CT scans are often essential in making diagnoses. In addition, they are fairly easy to obtain and can quickly rule out life-threatening illnesses. For example, if a child presents to the emergency department after falling on his head from a playground, an x-ray can quickly show if he has suffered a skull fracture requiring further studies and possible urgent treatment. However, radiation studies come at a cost of potential increased risks of cancer, especially in the pediatric population. With that in mind, we decided to look at imaging in the emergency department to see how often radiation studies are overused to make clinical diagnoses.


Dr. W is a director of clinical quality and works closely with multiple departments, so it was easy to obtain the data from the electronic medical recordrs. Her assistant had previously queried the emergency department database and collected a large (de-identified) dataset, including admission and principal diagnoses, dates, and types of scans. With this information, we could look at all imaging modalities for everyone, or, we could pick a specific imaging modality and/or diagnosis with which to measure its use. Due to the high radiation exposure of CT scans, I decided to focus specifically on that study. And, to narrow the study further, we decided to look specifically at head CT scans associated with the diagnosis of “headache.”  During the nine months included in the initial dataset, there were 1,178 CT scans for “headache.” 


The American College of Radiology allows users to search Appropriateness Criteria for utilizing imaging studies in diagnosis, so we started looking at some of the criteria associated with our selected imaging modality and headaches. Ratings range from 1 (usually not appropriate) to 9 (usually appropriate). For patients with chronic headaches and no new features, the criteria rating for CT scans is “4: may be appropriate.”


Now that I’ve decided on a project – and, along with Dr. W, signed the teacher-learner agreement – it’s time to put together the charter. We hope to expand our team prior to and during the PDSA cycles, including nurses, ED physicians and radiologists, staff, and patients.


But first, step one! I need to come up with a good, clear aim statement. Here’s what I have so far: Reduce the number of CT scans in patients with chronic headaches and no new features by 20% by April 2013.


What do you think? 


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