The 2020 Emory Quality Conference has been postponed indefinitely due to COVID-19, but that doesn’t mean work in this area has stopped. Emory’s interprofessional faculty development course in quality improvement was able to continue virtually, and with it, at least 13 projects. The course is conducted in evening workshops spanning six months, allowing medical and nursing faculty to fit it into their schedules. Faculty participants must have a project and recruit a team that includes at least one trainee and at least one non-physician health professional. A poster presentation of the participant's QI project is due at the last class meeting.
“Quality improvement is an iterative process,” says Nate Spell, associate dean for education and development in the medical school. “Often your original attempts fail, but you learn from the process to improve your next attempt. This course is designed to give faculty a grounding in the basics of quality improvement so they can continue working on it in the future.”
Spell teaches the course, along with Corrine Abraham, director of the DNP program at the nursing school and Adam Webb, chief quality officer at Emory University Hospital.
Thirteen teams presented posters virtually in late April. Peter Thompson (pictured above left), who recently took over the role of quality officer for the division of plastic surgery, and his team mounted a project to reduce infection rates following implant-based breast reconstruction. At the outset, the division’s infection rate was between 7% and 10%, which often resulted in readmissions. He surveyed the surgeons and found significant variations in the protocols used by each of them. Some changed gloves before handling the implant and some did not. Some soaked the breast implant in an antibiotic solution for more than five minutes, others soaked for a shorter time, and other gave the implant a quick rinse or did not soak at all.
Thompson and his team then reviewed the literature and developed a best-practice protocol for the pre-operative, intra-operative, and post-operative phases. He started out using the new protocol himself just to make sure it was do-able. He then introduced it to the other surgeons. Using the new protocol, the division recorded three months of infection-free cases before surgeries were suspended for the COVID-19 pandemic. “Right now we are using the protocol on the Clifton Road campus only, but we plan to expand it to Midtown and Saint Joseph's,” says Thompson.
Thompson is quick to credit the course for his success. “I did not have any background in quality improvement, and the course did such a great job of giving us the tools, the organization, and the structure to succeed in these projects,” he says. “Any success we’ve had is totally due to what we were able to learn from this course.”
Bolanle Akinsola (pictured above right) used her time in the course to change the type of IV fluids given to children in the emergency room. An assistant professor in the department of pediatric emergency medicine and a physician with the Children's Healthcare of Atlanta, Akinsola faced the problem of “this is how we’ve always done it.”
For years, young children were given hypotonic maintenance IV fluids in the ED, that is, fluids more dilute than the body’s natural makeup. “There was no scientific data to back this up, just a feeling of kids are smaller, so they should do better with a weaker solution,” says Akinsola.
In late 2018, the American Academy of Pediatrics (AAP) came out with the recommendation that children aged one month to 18 years should be given isotonic maintenance IV fluids, or fluids balanced to resemble the body’s natural makeup. But getting physicians who have done things one way for years and years to make a change can be a heavy lift.
First Akinsola and her team mounted an education campaign with data to back up AAP’s recommendation. They made some changes in the electronic medical records system that made ordering isotonic IV fluids easier than ordering hypotonic fluids. And they followed up with a practice review, giving individual feedback to outlier physicians.
When Akinsola and her team started her intervention, use of isotonic IV fluids in the Children's Healthcare of Atlanta EDs was less than 20%. The goal was to raise maintenance IV fluid use to 80%, which they achieved in September 2019. By the first of the year, use of isotonic fluids had reached over 90%.
You can see all 13 posters here. Applications for the next session of Faculty Development in Quality Improvement will occur later this summer.—Martha McKenzie | 
