The Clinical Process Improvement Leadership Program (CPIP) is designed to facilitate the development of competencies needed by interprofessional frontline care teams across Mass General Brigham to actively lead and participate in clinical process improvement efforts. Participants are charged with addressing a clinical problem in their environment, resulting in projects that translate theory into action. Several teams from Brigham and Women’s Faulkner Hospital took part in the most recent session:
Chief Cardiology APP Jessica Lara MSN, RN, FNP-BC, and Senior Quality Analyst Katy O’Loughlin focused their CPIP project on racial and ethnic disparities for patients admitted to the hospital with heart failure. “For one of the quality measures that are tracked as part of the American Heart Association’s Get With The Guidelines (GWTG) Heart Failure program, BWFH data showed that there were racial and ethnic disparities in access to heart failure-related follow-up appointments,” explains O’Loughlin. “We brought together a workgroup that included leaders throughout the hospital and other important stakeholders involved in the clinical care of cardiology patients to focus on the measurements for the GWTG Heart Failure program. We decided as a group that improving disparities in access to follow-up care was a challenge we could tackle with the help of the CPIP program.”
O’Loughlin continues, “For this project, we sought to increase the number of follow-up appointments scheduled at discharge for minority patients with heart failure by testing multiple change ideas, which included direct outreach to clinical teams with reminders and resources to schedule appropriate follow-up appointments. Our overall goal was to gain new process/quality improvement skills that we can use to address this problem, as well as apply to other problems that we may see in our clinical or quality work here at BWFH.”
Hospitalist and PA Fellowship Director Carla Chipalkatty, PA-C, and Quality Improvement Analyst Jenna Ambrosi, RN, focused their CPIP project on excessive rates of hypoglycemia among non-critically ill patients. “BWFH has excessive rates of hypoglycemic events in admitted, non-ICU patients on the medical services. This is potentially introduced unintentionally based on medical treatment but is an issue that increases hospital length of stay, increases morbidity, impacts patient safety and can affect reimbursement and incur penalties,” explains Ambrosi. “We wanted to understand the root cause of the hypoglycemia problem and learn what we could implement in order to change it.”
Ambrosi continues, “We found that many of these patients have comorbid renal diseases as well as previous blood glucose levels that may indicate they are at risk for a hypoglycemic event. Our planned intervention is to include blood glucose readings in the interdisciplinary rounds so all providers are aware which patients may be at risk for a hypoglycemic event. Through CPIP we are learning the tools needed to create effective change in the hospital. Our data shows that there was some improvement in hypoglycemia rates post intervention. Additionally, the interdisciplinary teams are more aware of the risk of hypoglycemia for patients with kidney disease. There is also more awareness among the provider group around ordering insulin/diabetes medications.”
Inpatient Physical Therapy Manager James Manna, PT, DPT, OCS, and former Speech Pathology Supervisor Mira Fein, MS/CCC-SLP, focused their CPIP project on patient positioning during mealtimes. “James and I had both observed patients on the inpatient units eating in reclined positions, a challenge that encompasses both aspiration risk management and mobility,” explains Fein. “With our combined backgrounds in speech pathology and physical therapy, we felt we were well poised to work on a solution.”
By examining the barriers to proper patient positioning during mealtimes in depth, the team was able to propose a solution. “We coordinated with the interdisciplinary team on 7 North to come up with an intervention. We utilized our inpatient rehabilitation aide and paired them with nurses to provide pre-meal positioning rounds. The goal was to have patients correctly positioned prior to their meals arriving. We were encouraged to see that our initial results were very positive, with an increase from 50 to 80 percent of patients being upright for their meals,” says Manna. “The CPIP program helped us to set aside time to work on a project that is important for patient safety. On top of that, we have been able to meet other providers both within BWFH and across Mass General Brigham to better understand the similarities and differences between the challenges each of these sites face.”
Are you interested in participating in the CPIP program? Learn more about the application process here.
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