Quality Improvement

The Stanford Hospitalist Program is committed to patient safety and quality improvement (QI), improving patient clinical outcomes and satisfaction.  Our faculty are involved with numerous projects and hospital commitees, specifically focusing on  decreasing inpatient mortality, optimizing communication/handoffs, reducing errors, implementing cost-effective care, and optimizing transitions of care.  The projects below include some of our QI projects that have been presented at conferences or shared in the literature.

 


Award-Winning Poster Presentations:

E. Mou, H. Kwang, J. HomL.ShiehN. Ahuja, S. Harman, T. Johnson, A. Kumar, N. Shah, R. Witteles, C. Berube,  “Rate and Prevalence of Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting”, California Regional ACP, November 2016. Winner in Research Poster Competition

J. Lotfi, M. Turken, T. LewL. Shieh, “Making it Simple:  Process Improvement for Outside Records”, Society of Hospital Medicine: March 2016, RIV Innovation Finalist 

Silvia McCandlish, MD; Vyjeyanthi Periyakoil, MD; L. Shieh, Providers Learn What Matters Most: Providers Learn From Patients' Letter Advance Directives" California Regional ACP, November 2016  Winner in QI Poster Competition

M. Mandyam, G. Krishnan, K. Evans, L. Shieh, “ Piloting a Physician-centric Discharge Checklist in the EMR”, ACP National Meeting, Boston, MA, 2015 , National ACP QI Poster Winner

T. Leo and L. Shieh, “Teamcards- Improving Patient-Physician Communication with a Picture”, Society of Hospital National Meeting, Washington D.C., May 2010.   Finalist in the Research, Innovations and Clinical Vignettes (RIV) scientific poster competition

Shieh LGo M, Gessner D, Chen JH, Hopkins J, Maggio P., “Improving and sustaining a reduction in Iatrogenic pneumothorax through a multifaceted quality-improvement approach”, J Hosp Med, Jun 3 2015.  Winner of Best Innovation in Practice Management Award, Society of General Internal Medicine: “Reducing Iatrogenic Pneumothorax: Making Central Venous Catheter PlacementSafer”, Miami, Florida in 2009

Sepsis Innovation in Education and Screening

K Evans, W. Daines, J. Tsui, M. Strehlow, P. Maggio, L. Shieh, “Septris: A novel, mobile, online, game improves sepsis recognition and management”, Acad Med. 90(2): 180-4, Feb 2015.  Winner of Innovation Poster Competition at Society of Hospital Medicine: National Harbor, Maryland, 2013.  Play Septris at http://med.stanford.edu/septris/

E. Gyang, L. Shieh, L. Forsey, P. Maggio, A nurse-driven screening tool for the early identification of sepsis in an intermediate care unit setting, J of Hosp Med. 10(2): 97-103, Feb 2015

J. Rolnick, L. Downing, J. Shepard, W. Chu, J. Tam, A. Wessels, R. Li, B. Dietrich, M. Rudy, L. Castaneda, L. Shieh, “Validation of test performance and clinical time zero for an electronic health record embedded severe sepsis alert”, Appl Clin Inform, June 2016

Desautels T, Calvert J, Hoffman J, Jay M, Kerem Y, Shieh L, Shimabukuro D, Chettipally U, Feldman MD, Barton C, Wales DJ, Das R., “Prediction of Sepsis in the Intensive Care Unit With Minimal Electronic Health Record Data: A Machine Learning Approach”. JMIR Med Inform, Sept 2016

L. Downing,  J. Rolnick, AJ Wessels, J. Tam, S. Poole, P. Heidenreich, L. Shieh, “An Electronic Health Record-Based Severe Sepsis Alert to Improve Sepsis Treatment Performance: Randomized Evaluation”.   Society of Hospital Medicine, March 2016, RIV Trainee Research Winner

Improving Paging Effectiveness

L. Shieh, J. Chi, C. Kulik, A. Momeni, A. Shelton, C. DePorte, J. Hopkins,  “Assigning a team-based pager for on call physicians reduces paging error in a large academic hospital.” Jt Comm J Qual Patient Saf; 40(2): 77-82, Feb 2014

TeamCards - Physician Photo Cards

T. Leo and L. Shieh, “Teamcards- Improving Patient-Physician Communication with a Picture”, Society of Hospital National Meeting, Washington D.C., May 2010.   Finalist in the Research, Innovations and Clinical Vignettes (RIV) scientific poster competition

Improving documentation

R. Li, D. Fang, G. Krishnan, L Shieh, “Evaluating the Effectiveness of Problem-based Charting in Utilizing the Problem List to Structure Clinical Data in the Intensive Care Unit: A preliminary analysis of a retrospective time series study”, AMIA, San Francisco, March 2016

Improving Appropriate Blood Utilization

L. T. Goodnough, L. Shieh, E. Hadhazy, N. Cheng, P. Khari, and P. Maggio, “Improved blood utilization using real-time clinical decision support.,” Transfusion; 54(5):1358-65, May 2014

L. T. Goodnough, P. Maggio, E. Hadhazy, L. Shieh, T. Hernandez-Boussard, P. Khari, N. Shah, “Restrictive Blood Transfusions Practices are Associated with Improved Patient Outcomes,” Transfusion, Jul 4, 2014

J. Chen, D. Fang, L. Goodnough, K. Evans, M. Porter, L. Shieh, “Why providers transfer blood products outside recommended guidelines in spite of integrated electronic best practice alerts”, J Hospital Medicine, Jul 7, 2014

Improving Communication with Group Texting 

J. Przybylo,  A. Wang, P. Loftus, K. Hooper, I. Chu, L. Shieh, "Smarter Hospital Team Communication: Smartphone Group Text Messaging Improves Efficacy, Workflow, and Provider Satisfaction", Journal of Hospital Medicine; 9(9): 573-8, Sept 2014

CVC training Simulation  

Shieh L, Go M, Gessner D, Chen JH, Hopkins J, Maggio P., “Improving and sustaining a reduction in Iatrogenic pneumothorax through a multifaceted quality-improvement approach”, J Hosp Med, Jun 3 2015.  Winner of Best Innovation in Practice Management Award, Society of General Internal Medicine: “Reducing Iatrogenic Pneumothorax: Making Central Venous Catheter PlacementSafer”, Miami, Florida in 2009

Increasing High Value Care

D. Fang, G. Sran, D. Gessner, P. Loftus, A. Folkins, J. Christopher, L Shieh, “The Effect of Cost and Turn-Around Time Display on Inpatient Ordering of Reference Laboratory Tests”, BMJ Qual Saf. Aug 27, 2014

D. Svec, N. Ahuja, K. Evans, J. Hom, T. Garg, P.Loftus, L. Shieh, “Hospitalist intervention for appropriate use of telemetry reduces length of stay and cost”, J Hosp Med. Jul 7 2015

A, Kumar and L. Shieh, “Direct Cost and the Correlation with Patient Satisfaction”, Society of Hospital Medicine Annual Meeting, March 2016

J. Kittle and L. Shieh, “Reducing Unnecessary Labs:  The Human BPA Project”, Society of Hospital Medicine Annual Meeting, March 2016

E. Mou, H. Kwang, J. Hom, L.Shieh, N. Ahuja, S. Harman, T. Johnson, A. Kumar, N. Shah, R. Witteles, C. Berube,  “Rate and Prevalence of Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting”, California Regional ACP, November 2016. Winner in Research Poster Competition

Understanding Hand Hygiene Rounding Practices

V. Barroso, K. Evans, W. Caceres, P. Loftus, L Shieh, “Hand Hygiene of Medical Students and Resident Physicians: Predictors of Attitudes and Behavior”, Post Grad Med, Feb 2016 ‪

S. Carr and L. Shieh, “Hand hygiene- Follow the leader?”  Society of Hospital Medicine Annual Meeting, Seleted oral presentation, Washington D.C., Apr 2010. 

Improving the Discharge Process

M. Kantor, K. Evans, L. Shieh, “Pending studies at hospital discharge: A pre-post analysis of an electronic medical record tool to improve communication at hospital discharge”, J Gen Intern Med. 30(3): 312-8, Mar 2015

T. Garg, J. Lee, J. Chen, K Evans, L. Shieh, “Development of a best practice discharge checklist for hospital patients using the electronic medical record”, Jt Comm J Qual Patient Safety, 41(3): 126, Mar 2015

M. Ragavan, D. Svec, T. Bacai, I. Becabeh, S. Irmak, W. Chen, L. Shieh, “Barriers to Timely Discharge from the General Medicine Ward at an Academic Medical Tertiary Care Center”, Society of Hospital Medicine Annual Meeting,  National Harbor, Maryland, March 2015

M. Mandyam, G. Krishnan, K. Evans, L. Shieh, “ Piloting a Physician-centric Discharge Checklist in the EMR”, ACP National Meeting, Boston, MA, 2015 , National ACP QI Poster Winner

A. Smeraglio, L. Shieh, G. Krishnan, P. Heidenrich, Patients vs Providers:  Perspectives of 30-day Hospital Readmissions, Society of Hospital Medicine Annual Meeting, March 2016

R. Li, L. Castaneda, L. Shieh “Design and Implemtation of an EMR-Based Interactive Multidisciplinary Checklist on the Inpatient Medicine Ward”, Society of Hospital Medicine Annual Meeting, March 2016

Improving the Outside Hospital Transfer Process

J. Lotfi, M. Turken, T. Lew, L. Shieh, “Making it Simple:  Process Improvement for Outside Records”, Society of Hospital Medicine: March 2016, RIV Innovation Finalist

Improving Patient Shared Decision Making

M. Tan, K. Hooper, C. Braddock, L. Shieh, “Patient Whiteboards to Improve Patient Centered Care in the Hospital”, Postgrad Med J; 89(1056): 604-9, Oct 2013

R. Blankenburg, S. Rennke, P Yuan, S. Harman, D. Sakai, A. Khan, L. Shieh, I.Chua, P.Hosamani, L. Xie, J. Hilton, J. Satterfield, E. Huynh, B. Monash, “Got SDM?: A Multimodal Intervention to Improve Shared Decision-Making During Inpatient Rounds on Medicine and Pediatric Services”, 2016 Ray E. Helfer Award for Innovation in Medical Education from the Academic Pediatric Association

Silvia McCandlish, MD; Vyjeyanthi Periyakoil, MD; L. Shieh, Providers Learn What Matters Most: Providers Learn From Patients' Letter Advance Directives" California Regional ACP, November 2016  Winner in QI Poster Competition