ASH Clinical News May 2016 | Page 59

TRAINING and EDUCATION patients . Inappropriate use of IVC filters is a problem ; the devices themselves are expensive and , in most cases , unnecessary . Again we have developed an EMR-based tool that requires the clinician to select an indication for the IVC filter placement ( i . e ., a patient with venous thromboembolism [ VTE ] who cannot be anticoagulated , a patient with pulmonary embolism and hypotension , or a perioperative patient who cannot receive anticoagulation for a recent VTE ). The protocol also requires a consult with an interventional radiologist . By implementing this process , we are hoping that we can reduce inappropriate use and ensure that IVC filters are eventually removed .
Many of our fellows ’ quality improvement projects involve simple measures such as adding a prompt in the IT and EMR system that makes it easier for clinicians to do the right thing .
Making Room for Quality Education Quality improvement , in theory , sounds simple , so why isn ’ t it a commonplace practice ?
There are multiple reasons . First , faculty members need to be trained in quality improvement . Second , they need to have the time and resources to train residents and fellows . Scarcity of time , as with every aspect of clinical practice , is a barrier . Luckily , quality improvement projects usually do not require much funding – aside from the necessary resources to pay for statistical work , data collection , and information technology time . However , depending on the amount of data collection and analysis needed , it could be conducted by the fellow who is in charge of the project .
Each institution is different , of course , and some won ’ t have the resources to establish a formal teaching program . We are fortunate to be a part of an organization where we have a quality improvement training program for faculty and trainees , but there are other options available to educators and learners , such as online modules

“ Historically , quality has not been a standard part of the training curriculum . Quality improvement – an evolving cycle of identifying a problem , planning a solution , executing that plan , and evaluating its progress – is a new concept for medical educators .”

and training programs . For instance , the Institute for Healthcare Improvement Open School program offers courses in quality , cost , and value that are free of charge to residents and fellows . Giving faculty and trainees access to this type of training is an important first step .
Next , you have to provide trainees with opportunities to act on what they learned . Come up with a variety of projects ; involve them in the process , have them troubleshoot , ask them to think of ideas of what can be done , and help them implement the plan and measure the outcomes .
Overall , our mission is to raise awareness about the importance of quality improvement . There ’ s a misconception that publishing papers about quality improvement initiatives is difficult , but quality improvement is scalable : it can be very small or very big . Depending on how the analysis is performed and the amount of data collected , a quality improvement project can evolve into a fullfledged research project . And , if one institution has discovered a problem , there is almost certainly another institution with the same problem . Sharing the data we gather can help us learn best practices from each other .
In my opinion , quality improvement is a fun and enjoyable process that can produce results rather quickly . A quality improvement project like the ones our fellows are working on can have a turnaround time of three months , compared with a research project that can take years to show any tangible results . It ’ s a satisfying process and something that a fellow can easily do in a short period of time .
And , regardless of the perceptions , these projects produce publishable data . Leading one of these efforts also looks good on your resume . When quality starts becoming a larger part of our daily lives as clinicians , what institution doesn ’ t want someone who knows how to improve quality ?
Importantly , quality improvement training can be incorporated at every level of the hospital and at any academic institution or private organization . Our internal medicine residents are actively conducting these types of projects , and it has become a fundamental part of their training curriculum . Still , this type of training isn ’ t widespread and recognized as a valuable part of hematology / oncology training . That needs to change . ●

Quality at the ASH Annual Meeting

Major and ongoing changes in the U . S . health-care system have made quality a larger part of caring for patients . In response to these changes , hematologists – particularly those specializing in non-malignant blood diseases – are exploring an innovative , sustainable new role : the “ systems-based hematologist .”
The role of the systems-based hematologist is still being defined , but an ASH report published in March 2015 , 1 highlights multiple areas where involving the systems-based hematologist would lead to cost-effective decision-making . At this year ’ s ASH annual meeting , the systems-based approach will be the focus of an Education Spotlight Session , in which Dr . Morton will discuss the role of the systems-based hematologist in a community-based , health-care system .
Read below for some details – and make sure to add it to your annual meeting agenda in December .
Systems-Based Hematology : A New Career Path for Hematologists Chair : David Garcia , University of Washington , Seattle , WA , United States
Why Systems-Based Hematology ? ( Community-Based System ) Colleen Morton , Regions Hospital , Saint Paul , MN Janice Lawson , Tallahassee Memorial Hospital , Tallahassee , FL
Why Systems-Based Hematology ? ( Academic-Based System ) Marc Zumberg , University of Florida , Gainesville , FL Nathan Connell , Brigham and Women ’ s Hospital , Boston , MA
Why My System Supports a Systems-Based Hematologist Brian Rank , HealthPartners , Bloomington , MN Thomas Staiger , University of Washington Medical Center , Seattle , WA
reference
1 . Wallace PJ , Connell NT , Abkowitz JK . The role of hematologists in a changing United States health care system . Blood . 2015 ; 125:2467-70 .
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