Three Wayne State University School of Medicine students were recognized by the Detroit Medical Center as winners of the third annual Quality Education and Safe Systems Training Quality Improvement Research Day Poster Competition.
The event, which took place in April, showcased resident and student research projects that tackled the topics of patient safety and quality improvement in a clinical setting.
This year's first place winners, in a tie, are medical students Leslie McDonough, Kevin Onofrey and Darshan Patel.
McDonough and Onofrey, a fourth-year student, teamed to present "Impact of equipment delay in the operating room of a busy tertiary medical center: A prospective study." Their faculty mentor is David Edelman, M.D., a surgical resident at the DMC.
Patel's winning entry was titled "Meeting screening guidelines: A quality improvement project to increase HIV screening and testing." His mentor is Diane Levine, M.D., associate professor of internal medicine.
"This was a wonderful opportunity to get my feet wet in research. Even more exciting was being part of a student team that came up with their own project idea and then saw it all the way to the end," said McDonough, a third-year medical student planning to go into general surgery. "Winning this award was wonderful recognition of our hard work. It showed us that these types of projects matter to the hospital and have a real impact on efficiency and patient safety."
McDonough said she and Onofrey examined delays in the operating room related to equipment delays, such as broken equipment, wrong equipment or unsuitable equipment due to a surgeon preference. They then asked how often such delays occur and what their impact was in terms of prolonged anesthesia for patients, inefficiency in the operating room and funding losses. "The idea came about when a few of us were doing our surgery rotation earlier this year," she said. "We noticed a great deal of surgeries were delayed because of equipment problems, and these delays keep the patient under anesthesia longer and put a great deal of stress on the OR staff and surgeons."
Patel, a third-year student, plans a career in radiation oncology, but is keeping his options open.
"I couldn't have done anything without the hard work and support of our inter-professional team and of my mentor, Dr. Diane Levine, who has inspired me to keep working hard and to keep achieving despite the heavy workload and the various other activities I am involved in," he said.
While shadowing Dr. Levine at the ambulatory internal medicine resident training clinic, Patel noticed what he thought was no appreciable difference in the HIV screening rates between African-American patients and Caucasian patients. He brought this to the attention of Dr. Levine, and they agreed the issue needed to be quickly remedied.
"We realized that there wasn't an appreciable difference between screening rates of African-Americans and Caucasian patients," Patel said. "The overall screening rate was just abysmal, thus providing an excellent opportunity for a quality improvement project."
After creating an integrated team consisting of an undergraduate student, a medical student (Patel), a resident and attending physicians, medical assistants and the clinic manager, the team initially set out to double the HIV screening rate for African-American patients, but then broadened its scope to increase screening rates across the board by 300 percent.
Patel's team then implemented a three-pronged approach. First, they created posters and pamphlets to increase patient awareness and to include them in their health care, hoping that would lead to patients asking their physicians about HIV if the physicians didn't bring it up. They then trained medical assistants as the first points of care in the screening process by educating them about the disease and the necessity of increased screening. Finally, the team worked with the resident and attending physicians to have them document patient HIV screening in the "physician comments" section since the electronic medical records system did not have a dedicated place for HIV screening. During the first three months, the team sent members to the clinic every weekday to provide support and encouragement.
"After our five-month intervention, we saw our screening rate improve by nearly 400 percent," Patel said. "When we started, the screening rate was only around 5.5 percent. We realized the necessity for creating local champions for these changes to be sustainable and meaningful. Thus, the next phase of our project will be to identify local champions, create ownership, empower them to make changes and provide positive reinforcements for a sustained increase in overall HIV screening rates."