Our Quality Council provides oversight, coordination, and input into the Quality Improvement activities of the Department of Internal Medicine Clinical Experience and Quality Program. It is comprised of representatives from each division of internal medicine, trainees, and patients who come together on a regular basis.
The Quality Improvement Award is designed to help develop leaders in quality improvement within the department. To apply, faculty members must propose a quality improvement project, providing a detailed description of the problem the project will attempt to address including the underlying causes of the problem, goals of the proposed project, and a summary of the expected outcomes. Applicants are also required to include the setting and impact, approach, and the significance of the project including how it will improve clinical practice. One award is given per academic year.
Michelle Jacobs, MS, CGC, Division of Genetic Medicine
We are pleased to announce that Michelle Jacobs, MS, CGC, Clinical Assistant Professor in the Division of Genetic Medicine, has been selected as this year's recipient of the Department of Medicine’s Faculty Quality Improvement Award. Michelle’s project, “Using Tumor Findings to Increase Appropriate Referrals for Germline Genetic Testing”, was selected from a pool of high quality submissions.
Hundreds of oncology patients undergo tumor sequencing each year with the goal of identifying targeted therapies through precision medicine. This testing can impact cancer treatment and early detection (screening) or preventative options for patients and their families. Approximately 5-10% of cancer patients have a hereditary cancer syndrome, but these are largely underdiagnosed. Follow up on tumor sequencing results suspicious for hereditary findings could be an important way to address this issue. If a hereditary cancer syndrome is identified through follow up testing, this would then allow for a personalized medicine approach for patients as well as any family members.
At Michigan Medicine, the number of patients who are referred for evaluation of potential germline findings discovered through tumor sequencing is much lower than at comparable academic institutions. This project seeks to leverage existing somatic sequencing test results to address this discrepancy.
Jordan Schaefer, MD, FACP
Jordan Schaefer, MD, FACP, Division of Hematology and Oncology
We are pleased to announce that Dr. Jordan Schaefer, from the Division of Hematology and Oncology, has been selected as this years’ recipient of the Department of Internal Medicine’s Faculty Quality Improvement Award. Dr. Schaefer’s project, “An Intervention to Reduce High Risk Aspirin Use for Primary Prevention,” was selected from a pool of high quality submissions.
Recent studies have shown that for some patients, taking a daily, low dose aspirin to prevent heart attacks or strokes may significantly increase bleeding and not prolong survival. This increase in bleeding can be serious and may offset any potential benefit of aspirin in reducing blood clots. Accordingly, guidelines have become more conservative in whom aspirin is suggested. Aspirin for primary prevention is not routinely suggested for adults over 70 years old and is not advised for patients with an increased risk of bleeding.
Millions of patients in the United States take aspirin. For many of these patients, taking aspirin does more harm than good. Given that aspirin is over-the-counter, some patients take it without it being suggested by a medical professional. It is possible that providers are not even aware their patients are taking aspirin, especially if aspirin is omitted from patient medication lists in the electronic medical record (EMR). There is no established method to try to reduce the excess use of aspirin in the primary care setting.
With the growing complexity of this often overlooked issue, the purpose of the proposed project is to implement a quality improvement intervention to reduce high risk aspirin use for primary prevention. Specifically, the intervention will explore the impact of reconciling patient reported aspirin use in the EMR and use an alert system to encourage primary care providers to consider discontinuing aspirin for patients when the anticipated risk exceeds the benefit.
Daniel Giesler, MD, Division of Hospital Medicine
We are pleased to announce that Dr. Daniel Giesler from the Division of Hospital Medicine has been selected as this years’ recipient of the Department of Internal Medicine’s Faculty Quality Improvement Award. Dr. Giesler’s project, “Reducing Overuse of Antibiotics at Discharge (ROAD) Home,” was selected from a pool of high quality submissions.
Antibiotics prescribed at hospital discharge account for more than half of antibiotic exposure related to hospitalization for common infections. Furthermore, antibiotics prescribed at discharge are major contributors to excessive antibiotic duration and potentially inappropriate use. However, methods to improve antibiotic use at hospital discharge have not been well developed. Fortunately, more clinical and diagnostic data are available at the time of discharge making it an opportune time to perform an antibiotic “timeout,” allowing providers to be more mindful about continued antibiotic use.
The ROAD Home project team, which includes representatives from Hospital Medicine and Pharmacy, seeks to improve antibiotic use at hospital discharge through the implementation of a pharmacist-delivered antibiotic timeout and checklist. They hope to reduce antibiotic overuse and Clostridioides difficile infection.
Rajan Ravikumar, MD, Division of Allergy and Clinical Immunology
Our first recipient is Dr. Rajan Ravikumar from the Division of Allergy and Clinical Immunology, whose multi-disciplinary project aims to improve the appropriate use of antibiotics in hospitalized patients. The team, including Dr. Tejal Gandhi from the Division of Infectious Diseases, Dr. David Bozaan from the Division of Hospital Medicine and representatives from pharmacy, nursing, and Health Information and Technology Services (HITS), will evaluate the impact of a penicillin skin-testing protocol designed to help separate out the significant number of patients who report an allergy to penicillin but don’t have a true IgE-mediated reaction to it. The goal is for more patients be safely treated with first-line antibiotics.
Our quality team partners with the Department of Internal Medicine's Graduate Medical Education program to expose residents to patient safety and quality improvement (PS/QI) across all three years of residency.