Clinical | Quality & Safety
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The Department of Medicine and its more than 240 physicians are privileged to serve the people of the Charlottesville-Albemarle region, as well as thousands from elsewhere in Virginia and many other states. The department’s clinical care partners include University Medical Associates, University Physicians Charlottesville, and University Physicians Orange.
Over the last several years, the department has significantly enlarged its clinical footprint. New facilities, such as the Emily Couric Clinical Cancer Center (opened in 2011) and the Zion Crossroads Primary and Specialty Care clinic (opened in August 2013), have allowed for expansion in clinical services, and the recruitment of almost 40 new faculty members in 2013 will drive growth well into the future. The department continues to have a significant presence in the Shenandoah Valley, expanding both the range of services offered and the number of providers; in February 2014, it will move to a larger and more robust facility in Fishersville. The rapidly evolving area of telemedicine offers another important avenue for future growth.
Of the 15 specialties represented at the Zion Crossroads clinic, five are from the Department of Medicine (cardiology, endocrinology, gastroenterology, nephrology and pulmonology); a sixth, vascular care, includes several physicians from cardiovascular medicine. Many of the divisions have established new clinics during FY 2013, including:
- Eosinophilic esophagitis (EoE) clinic (Allergy)
- Cardiovascular urgent care clinic (Cardiovascular Medicine)
- Blue Ridge PACE geriatrics clinic (General Medicine, Geriatrics and Palliative Care)
- Orthopedic surgery patient clinic; hepatitis C clinic (Infectious Diseases)
- Rapid Access clinic/UVA Kidney Center (Nephrology)
- Pulmonary hypertension clinic (Pulmonary and Critical Care Medicine)
Department clinicians offer many cutting edge treatments and procedures; noteworthy examples include Hematology-Oncology’s program in high-dose interleukin-2 immunotherapy for metastatic renal cell carcinoma and malignant melanoma, the only one of its kind in Virginia; and Gastroenterology’s innovative treatment of gastric varices, which has made UVA a quaternary referral center for the condition.
The provision of primary care and the practice of internal medicine are undergoing rapid change – and the Department of Medicine is on the frontlines. The reorganization of its primary care practices along the lines of the “primary care medical home” model, and the transition of the entire medical center to an “accountable care organization” model, with key leadership from DOM faculty, are two important examples.
Quality Improvement and Patient Safety
Under the leadership of John Voss, MD, Vice Chair for Quality and Patient Safety, the department has strengthened its quality improvement (QI) program over the last several years. Margaret Plews-Ogan, Tracey Hoke (Pediatrics), and Dr. Voss established the Institute for Quality and Patient Safety (IQPS) to provide a focus for training and curriculum development in this area. Faculty liaisons for quality have been designated for the larger divisions, with responsibility for overseeing division-specific quality projects. During FY 2013, divisional QI plans were updated and one or two strategic focus areas were identified for the upcoming year.
Many QI initiatives have led to substantive changes; for example, Larry Gimple and colleagues in Cardiovascular Medicine organized a comprehensive quality program for the division that is a model for other divisions and departments. In Nephrology, Charles Brooks collaborated with faculty from Thoracic and Cardiovascular Surgery to develop a program for reducing post-operative acute kidney injury. George Hoke from General Medicine and Kyle Enfield from Pulmonary Medicine have worked tirelessly – along with Stephanie Mallow-Corbett (Pharmacy), Rebecca McMullen (QPI), and Cheri Blevins (ICU Nursing) – to successfully reduce sepsis mortality, the leading cause of death among patients at UVA.
Some QI initiatives have also resulted in significant cost savings for the institution: the Antibiotic Stewardship Program, led by Infectious Diseases’ Amy Mathers and Heather Cox, saved an estimated $4 million over the last four years; and the SCOPES project, headed by Gastroenterology’s Andy Wang and aimed at standardizing device utilization in the Endoscopy unit, produced almost $1 million in savings over its first two years.
With these and other initiatives – including the successful efforts by hospital epidemiologist Costi Sifri and colleagues to reduce the incidence of C. difficile in general medicine wards, and by Josh Eby, Amy Mathers and Heather Cox to improve pneumonia care – the Department of Medicine is well on its way to being an institutional leader in quality and safety. The work is never finished, however; it requires an on-going, multidisciplinary effort with other Medical Center departments and staff to be successful. This is reflected in the department’s project to improve its clinical documentation and coding practices, which it is working on in collaboration with the Medical Center Coding service.
The “QSLAM” Course
A cornerstone of the department’s QI efforts is a 20-hour course, developed by Dr. Voss, Katharine Schlag, and IQPS staff, entitled “Quality and Safety Leadership in Academic Medicine” (QSLAM). First offered in 2010, the course has received high marks from over 200 participants, including chiefs, administrators and quality liaisons from the department’s divisions, as well as department-level administrators. It starts with an introduction to quality, safety and medical error, followed by sessions on systems thinking and human factors, root cause analysis, and management of the QI process, among others. Attendees plan and implement a quality improvement project over a three- to six-month period, and present the results to the class.
IQPS offers the QSLAM course to staff throughout the UVA Health System; graduates have included faculty, staff, fellows, and graduate students from the departments of pathology and systems engineering, the School of Nursing, and the Health System development office. The institute is offering its first external course through the UVA Office of Continuing Medical Education during fall 2013, and plans to expand external offerings in 2014. It is currently listed on the website of the Association of American Medical Colleges as one of only a handful of quality and safety training programs at medical schools nationwide.