Johns Hopkins Hospital
Baltimore, MD
Program Director: Henry Fessler, MD
Type of Program: Pulmonary and Critical Care Medicine
Abstract Authors: T. Sidharthan, MD; P. Galiatsatos, MD; A. Lambert, MD; H. Fessler, MD; and V. Sidhaye, MD
Competence in quality improvement is vital to medical practice and emphasized in graduate medical education and by fellowship accreditation and specialty credentialing boards. Interprofessional practice with care shared by physicians and midlevel providers (MLPs), physician assistants and advanced care nurses, is an increasingly prevalent staffing model. However, the management of specialized patients by MLPs, their training, and their role in a medical team lacks clear definition in many clinical settings. We describe a fellow-implemented quality improvement project designed to 1) train pulmonary and critical care (PCCM) fellows in quality improvement, 2) provide education for MLPs in the conditions prevalent in our medical unit, and 3) improve the ability of MLPs to function more independently and improve their patient care. The Progressive Care Unit (PCU) at Johns Hopkins Bayview Medical Center is a 14-bed pulmonary and intermediate critical care unit managed by an attending pulmonologist, a PCCM fellow, and 2 MLPs. The MLPs provide day-to-day management, with fellows and the attending acting in supervisory roles.
We devised a longitudinal quality improvement project to expose fellows to concepts in quality improvement through participation in a program-wide Plan-Do-Study-Act cycle. Fellows, attendings, and MLPs were independently surveyed to assess limitations in MLPs competency in key areas of pulmonary disease management and perform needs-assessment analysis for improvement. Likert scale surveys addressed attitudes toward MLP medical knowledge, continuity of MLP staffing on the unit, and satisfaction with overall team-based management and provider roles. Median scores and frequencies were calculated to compare groups and assess competencies. Qualitative data was coded and frequency lists were generated to assess interventions. The 2015-2016 fellow class developed a longitudinal intervention that a) implemented an educational curriculum for MLPs aimed at perceived knowledge gaps, b) aimed to improve continuity among MLPs in the PCU, and c) and assessed satisfaction among MLPs by engaging key members of the mid-level team. Surveys will be administered at the end of the intervention and Chi-squared tests will be applied to compare groups before and after intervention. Data supports fellow-lead quality improvement interventions among fellows, attending physicians, and MLPs alike.
