Value of QI experience at Virginia Mason

[criticalelement]

If you keep the patient warm, you avoided unintentional hypothermia, that's quality. If your patients post op pain score is 3 out of 10 higher than your partners, that's not quality. If you don't give abx within an hour of cut or give them late, that's poor quality whether the patient gets an infection or not.=

The problem I have with all of this is the one size fits all mentality.

Is there ever an instance where having a cool patient is good? Do you get dinged for it?

How about your partner who has better pain scores but brings patients to the pacu with a nasal trumpet because or a/wobstruction and having a nasal trumpet in? Is that quality? Does the checkboxes address that?

How about if you give antibiotics late and patient does not get an infection.. is that poor quality? Does the survey account for that?

How about if you DONT give antibiotics because they are not indicated, does the survey account for that?

Since when are anesthesiologists responsible for giving or ordering antibiotics? does the survey account for that? Why am I responsible for someone elses infection?

How about if antibiotics are NOT indicated? Does the survey account from that.

These are questions that I just though of in 30 seconds...

Patients are not widgets and you cant fit all patients in the same box.... There is variability in all of this..

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[gmbz]

Population based medicine is coming and it is scary as ****.

The problem I have with all of this is the one size fits all mentality.

Is there ever an instance where having a cool patient is good? Do you get dinged for it?

How about your partner who has better pain scores but brings patients to the pacu with a nasal trumpet because or a/wobstruction and having a nasal trumpet in? Is that quality? Does the checkboxes address that?

How about if you give antibiotics late and patient does not get an infection.. is that poor quality? Does the survey account for that?

How about if you DONT give antibiotics because they are not indicated, does the survey account for that?

Since when are anesthesiologists responsible for giving or ordering antibiotics? does the survey account for that? Why am I responsible for someone elses infection?

How about if antibiotics are NOT indicated? Does the survey account from that.

These are questions that I just though of in 30 seconds...

Patients are not widgets and you cant fit all patients in the same box.... There is variability in all of this..

 

[dannyboy1]

the anesthesia record is almost complete and utter bull$hit anyway so the idea of measuring quality from it is laughable.

 

[nimbus]

Let's just put it this way. My entire department is essentially 100% compliant with the quality metrics because we have processes in place to ensure compliance. For example we include antibiotic administration in our time outs. However, there is wide variation in actual quality and everybody including the surgeons and nurses know it.

 

[pgg]

the anesthesia record is almost complete and utter bull$hit anyway so the idea of measuring quality from it is laughable.

Paper charts are often fairy tales.

Electronic charts at least have accurate vitals. I would be idly curious to mine something like the last 3,000 lap choles (or carotids, or TURPs, or whatever) here, and see what the delta between pre- and post-induction blood pressure is, and if there are patterns related to who's doing the case. I daresay some quality judgments could be made there.

The rest of the SCIP criteria are silly. I find it especially entertaining that the JC lists the discredited DECREASE trials near the top of their references for the beta blocker requirement.

 

[Mman]

But if you set out sticks and carrots for the process then the process becomes disproportionately important and something to game. Instead of doing what's right for the patient, this encourages people to do what's right for their paycheck. Pretty bad way to practice medicine.

and that's why you need to be part of the one determining what is worth a carrot and what is worth a stick and working to help figure out how to measure things. If we don't do it, somebody less informed will and we will be judged on their decisions as dumb as they might be.

Doctors don't have a choice. It is happening. We just need to be part of the solution and not just complain about the problem.

 

[nimbus]

Paper charts are often fairy tales.

Electronic charts at least have accurate vitals. I would be idly curious to mine something like the last 3,000 lap choles (or carotids, or TURPs, or whatever) here, and see what the delta between pre- and post-induction blood pressure is, and if there are patterns related to who's doing the case. I daresay some quality judgments could be made there.

Agree this is what should be done but I have never seen it.

 

[OldGregg]

So, I interviewed at Virginia Mason for anesthesia and had a great interview experience there. It stands out among the other programs I've interviewed at so far in unique ways, but because it is unique I'm having trouble comparing it to other places I have encountered.

In particular, they are very into quality improvement, and have adapted the Toyota production system into the "Virginia Mason Production System" (VMPS). They have used interdisciplinary teams to completely redesign their ambulatory surgery area, as well as other units of the hospital. The culture of constant change and improvement was obvious and refreshing. Residents are actively involved in QI projects and receive formal training in the VMPS. The PD very much promoted this emphasis on QI and Lean principals as a strength of the program, and as something that makes their graduates unique and marketable. I guess my question is how valuable is this experience really when it comes time to get a job? Will anyone actually care that you have developed this skill set?

VM CA-2 here, just to follow up on the original question - it's a helpful skill set to have. One of our CA3s is outbound to a junior faculty position to a top tier Academic institution to pursue QI there. One of my classmates is looking to do the same. Do I think QI is THE reason you should choose this program above any other? Probably not, but it's a lot easier to get a QI project off the ground in a hospital that is receptive to changing its processes and is another bullet point on your resume. Even something as simple as learning how to identify, plan and implement an idea will be useful no matter where you end up working. PM me if I can answer any other questions for ya. Cheers!