CTU Quality Improvement and Education Research (C-QuIER)
Started on June 1, 2022, the CTU Quality Improvement and Education Research (C-QuIER) team has become a team that fosters and supports rigorous, frontline-driven quality improvement (QI) work in Medicine. C-QuIER team has been able to assemble a core, inter-disciplinary team, and garnered support from all levels of the university and hospital departments and leadership in a very short time. They have several important, in-progress projects at various stages. In there first 18 months, they have secured over 1.4 million dollars (CAD) in funding, and co- designed and tackled 15 projects that have engaged 15 trainees, 13 faculty, 5 patient advisors, dozens of frontline staff and leaders across 4 faculties and 9 health professions. This approach has garnered trust amongst frontline staff, trainees, and patients- caregivers and helped overcome change fatigue and renewed the culture of quality in Medicine.
The Right People
To create the kind of working group necessary to carry out all the important work we do, we have received several generous in-kind donations for physical space, personnel, and technology. The Centre for Education Research and Innovation (CERI) has provided C-QuIER with physical workspace for there Hub-protected days. Audrey Wharton, Director University Hospital (UH) Department of Medicine has provided us with 0.4 FTE registered nurse to support the make-up of our core team as well as laptop computers to support them in their work. We have also received one day a week in-kind donation for personnel for a Quality Improvement Facilitator from Maurice Williams, Quality and Performance, and ITS business system analyst from Andrew Mes, Digital Health Executive and Chief Informatics Officer. CQuInS has also supported the purchasing of the necessary software for our review project. We have also been asked by various members of hospital leadership to have quarterly meetings to support the ongoing momentum for this work and to continue the important conversations and collaboration that is needed for success. Similarly, we have been asked to participate in annual meetings with the Quality and Patient Safety Committee (QPSC).
The Right Projects
In total, over the past year, there Hub team has become involved in approximately 15 projects. Each project falls under at least one of their 4 core areas of focus: 1) doing quality right (projects focused on understanding how to improve the quality of QI work); 2) the right patient, right place, right time, and cared for by the right people (projects focused on improving the process of care); 3) clinical communication and collaboration; and 4) other targeted quality problems. Samples of each of these are shown in the figure below.
While each project is worthy of its own description below, they briefly focus on two of these. Their flagship project aimed at preventing the progression of frailty and improving mobility for frail and at-risk seniors in the clinical teaching unit (CTU). This project has been awarded an AMOSO Innovation grant for approximately $225,000. Together with collaborators from geriatrics, physical medicine and rehabilitation, PT, OT, PSWs, nursing, medicine, and various leadership, with their grant, they are excited to bring to LHSC UH medicine a recreational therapist, create a ‘safe fall’ space, implement a patient care protected time for nurses in the morning and evening to safely complete medication pass, and support the development, implementation and refinement of a personal support worker (PSW) handover tool to prioritize mobility. Another important example of an ongoing project our team is leading in collaboration with various team members, learners and hospital leadership, is a scoping review looking at populations at-risk for extended stay in the emergency department and how patients are prioritized for transfer to the medicine floor. Findings from this study will hopefully provide some key insights for access and flow and ED pull to floor metrics at LHSC, an organization and provincial priority.
Authentic Trainee Involvement in QI and Building Capacity:
Beyond the projects we have prioritized as a core team, our team is committed to investing in our learners and team. Too often QI projects led by trainees are not sustained or effective due to learner turnover and siloed work. Our approach has always been to conduct high-quality, impactful QI projects that tailor existing QI methods to garner trust amongst frontline staff, learners, and patients-caregivers to help overcome change fatigue and renew the culture of quality on the CTU. The creation of the hub and the support from the Academic Realignment Initiative fund and AMOSO Innovation grant, have given us the opportunity to establish a presence for the next 5 years and, hopefully beyond to remain a centralized place of support for high quality QI work. Our residents, fellows, and collaborators have already presented their work at the General Internal Medicine (GIM) and Department of Medicine (DOM) Resident Research Days and will be presenting at the Canadian Society of Internal Medicine (CSIM) and International Conference on Residency Education (ICRE) 2023. In addition, their core team members and various learners have worked to build their own QI capacity through the completion of the Fundamental of Quality Improvement Execution course generously supported through CQuInS.
