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Quality & Safety

July 11, 2023

Aldo Peixoto, MD

Vice Chair, Quality & Safety

The Department of Internal Medicine is dedicated to the ongoing improvement of quality and safety to provide the best possible patient care. The focus over the past year has been on building capacity and fostering a collaborative environment by aligning quality and safety efforts across the Department of Internal Medicine and Yale New Haven Health (YNHHS).

Several programs have expanded their reach, including the Graduate Medical Education (GME) Distinction Pathway in Health Equity, Quality Improvement, and Patient Safety. The pathway provides practical real-world education and experience for trainees interested in health care improvement, and is now offered to all residents and fellows. Developed by GME Quality and Safety Director Linda Fan, MD, faculty members Naseema Merchant, MBBS, and Michelle Hughes, MD, are key participants in the program’s planning and structure.

The department launched its Quality Improvement Bootcamp in the fall of 2021. The multisession course provided the foundation of quality improvement methodology. The curriculum was based on a course for trainees developed by Beth Emerson, MD, pediatric emergency medicine, and was adapted to include formative small-group discussions. The new format evolved into a GME course open to all faculty and trainees across YNHHS and Yale School of Medicine (YSM). The course, titled “The 2022–2023 Bootcamp in Health Equity and Quality Improvement,” debuted in late fall 2022, and used a curriculum developed by Beth Emerson, MD; Aldo Peixoto, MD; Lou Hart, MD; and Linda Fan, MD.

A newer addition to programming is the monthly morbidity and mortality conference for resident physicians. Established in 2020 by Lloyd Friedman, MD, and former VA Chief Resident in Quality and Patient Safety (CRQS) Jadry Gruen, MD, the conference’s aim is to foster a culture of safety for trainees by holding open dialogues on sensitive topics and cases without an attending present. This initiative is synched with the department-wide deployment of morbidity and mortality conferences in every section. Another significant impact on quality and safety has been the expanded use of care pathways. The Care Signature enterprise across YNHHS is led by Deborah Rhodes, MD, and the Medicine Care Signature Council is chaired by Lynn Tanoue, MD, MBA. Multidisciplinary teams of experts determine processes and roadmaps for multiple inpatient and outpatient settings to standardize practice in care provision. The group decides on best treatment for clinical conditions, and also builds pathways to improve process, efficacy, and safety. Since October 2020, 375 pathways have been launched—including COVID, mpox, heart failure, chronic obstructive pulmonary disease, pneumonia, acute kidney injury, and alcohol use disorders.

While there are many successes in the area of quality and safety, a noteworthy improvement was YNHHS’s reduction in COPD readmissions from 26 percent to 20 percent from 2021 to 2022. The significant decrease in readmissions speaks to the collaboration and teamwork involved, including the work of key collaborators Adam Ackerman, MD; Evelyn Adekolu, MD; Olutayo Temitop Imevbore, MD; and Carolyn Rochester, MD.

In addition, the department has begun to observe strong results from the sponsored Quality Improvement grant projects in diverse areas—from screening for hepatitis B and tuberculosis in rheumatology patients receiving biological agents to monitoring of self-administered erythropoiesis agents and end-of-life discussions in oncology. The department continues to sponsor a yearly quality improvement grant competition in the spirit of supporting innovation in patient care.

Submitted by Julie Parry on July 11, 2023