Health professions students can play a critical role in quality improvement initiatives, both during their training and in their careers. At the 2015 IHI National Forum in December, the IHI Open School selected four student and resident projects from close to 100 submissions to highlight in a special storyboard session. Faculty judges also selected runners up. We’re showcasing this great work in this blog post — click on the link within each project to learn more. (Pictured above from left to right: Sherril Gelmon, DrPH, and Wendy Madigosky, MD, MSPH, Lisa Miller, CPHQ, Leland Hull, MD, Stephanie Hudey, MS, and Sierra Barrett, and Ross Hilliard, MD. Gelmon, Madigosky, and Hilliard were session faculty.)

To start working on your own improvement project, check out the IHI Open School Quality Improvement Practicum. Consider sharing your work at this year's IHI National Forum with a student scholarship.

Storyboard Winners

Stephanie Hudey

Medical student, University of South Florida

Tampa, Florida

Project: Improving care and minimizing clinic time at student-run free clinic

What they did: The free, student-run BRIDGE Healthcare Clinic provides 800 medical visits each year for uninsured patients.  Their services are in such demand that the clinic has a four-month wait list. The team at BRIDGE wanted to improve the efficiency of their operations by decreasing the total visit time and the patients’ wait times. They tested several changes, including clarifying coordinator roles, creating a patient checkout checklist, improving training of volunteers, and reducing staff turnover.

Key takeaway: “Be persistent and organized, and if your first intervention doesn't work, continue to modify and try others, but make sure to allow enough time to see changes come to fruition,” Hudey said. “Also, don't think that interventions have to be overly complex or complicated. Try simple things first and have brainstorming sessions with your colleagues if you can't think of anything new.”

Leland Hull

Internal medicine resident, Louis Stokes Cleveland Department of Veterans Affairs Medical Center

Cleveland, Ohio, US

Project: Improving colorectal cancer screening rates

What they did: At the VA primary care clinics in Cleveland, only about 57 percent of patients completed stool samples for colorectal cancer screenings after providers ordered them. Dr. Hull’s team wanted to improve the rate by 15 percent, so they sent letters generated through the electronic medical record to remind patients about the test. So far, this change hasn’t improved rates, but the team is still awaiting results.

Key takeaway: “Don’t shy away from involving stakeholders,” Hull said. “In fact, the more stakeholders we were able to involve, the easier and more widely accepted by clinic staff the project became, and the more I learned about clinic flow in general.”

Lisa Miller

Public health student, Oregon Health & Science University

Portland, Oregon, US

Project: Improving screening for social needs

What they did: Miller’s team worked at a Federally Qualified Health Center to develop a reliable process for screening behavioral health patients for social needs, using the electronic medical record. Through several PDSA cycles, the team found that using an auto-populated list of social needs, such as housing, transportation, and food security increased the percentage of patients with social determinants of health documented in their medical records. Now, the team is working on creating a community health worker role at the clinic to help these patients.

Key takeaway: “I worked with a faculty advisor and with an interprofessional team that has grown as the project has grown. This team, which is now growing to include a team of community members and clinic patients, has ensured that our work benefits from the broadest perspective, reach, and resources possible.”

Sierra Barrett

Undergraduate health sciences student, Brock University

St. Catharines, ON

Project: Improving referrals to avoid unnecessary admissions

What they did: With pediatric admission rates on the rise, the Niagara Health System wanted to offer an alternative to inpatient care through a Pediatric Rapid Assessment Clinic, where children could receive quick care and a discharge or be admitted to the hospital, only if necessary. The team worked with the emergency department to help physicians make appropriate referrals to the clinic. By the end of the project, 100 percent of these referrals fit the criteria for an appropriate referral.

Key takeaway: “I led an interdisciplinary team consisting of the chief of pediatrics, the chief of emergency medicine, and medical students under the supervision of my professor, Dr. Madelyn Law,” Barrett said. “This has been an incredibly unique experience.”

Runners Up

Maya Dewan

Resident, The Children’s Hospital of Philadelphia

Philadelphia, PA

Project: Reducing unnecessary blood tests

What they did: Physicians often order complete blood count testing of patients who are recovering from surgery without a documented clinical reason — about 30 percent of low-risk patients were receiving these tests before the project. The team at Children’s wanted to reduce routine blood tests of low-risk patients by 50 percent. They ran small tests, focusing on education of providers, workplace reminders, and discussing lab testing at handoffs, and achieved their goal. They estimated that avoiding the unnecessary tests saved about $30,000 over six months.

Key takeaway: Working as a trainee in the pediatric intensive care unit opened my eyes to the overuse of laboratory testing, so I set out to identify a focused and targeted intervention to reduce testing in one cohort,” Dewan said. “My advice is that you shouldn’t try to tackle every aspect of overuse at once. Start small and focused to demonstrate success, then begin to spread.”

Lizzeth Alarcón

Medical student, Boston University School of Medicine

Boston, MA

Project: Increasing in-person interpreter participation in Pediatric Ward

What they did: At Boston Medical Center, a safety net hospital, 30 percent of patients have limited English proficiency. But there was no system to ensure that in-person interpreters could participate in rounds on the inpatient pediatric ward. Alarcon and her team aimed to increase the number of encounters that included interpreters to 75 percent. They established a process to anticipate the need for interpreters, created interpreter scheduling forms, and communicated weekly with the inpatient team to share data, answer questions, and get feedback. They saw a big improvement: the percent of encounters with an interpreter increased from none to an average of around 60 percent.

Key takeaway: “I joined this QI project because of my interest in language differences and associated health disparities,” Alarcón said. “For anyone interested in working to improve the care for patients and families with limited-English proficiency, understanding what interpreting services are available in your clinical setting and how to best optimize their day-to-day use is one of the first steps in working toward equitable care.”

Melissa Wan

Undergraduate pharmacology student, University of British Columbia

Vancouver, BC

Project: Creating a quality improvement practicum

What they did: The University of British Columbia IHI Open School Chapter worked with its university to develop a shadowing program and then a practicum program for medical, undergraduate, health administration, business, and nursing students. Projects have included improving operating room turnover times, reducing operating room case cart discrepancies, and reducing the number of medicines seniors have to take.

Key takeaway: “Engage with those that see the potential in students: those that see the unique and objective perspectives and the innovative solutions and ideas that students can bring,” Wan said. I would also recommend starting small, with one or two projects, to ensure that the practicum meets both the needs of the students and goals of the institution. This has been key to opening up new projects and opportunities, as well as allowing us to perform PDSA cycles to drive continuous improvement along the way!”