Featured Resident-Led Projects

The Stanford Neurology Residency Quality Improvement Curriculum generates mentored quality improvement projects that lead to local practice improvements and peer-reviewed publications. Three examples are listed below. For additional resident- and fellow-led projects, please visit the Stanford Resident/Fellow Quality Improvement & Patient Safety Symposium.

Increasing appropriate utilization of viral testing of cerebrospinal fluid

As residents, Dr. Kyle Lyman, Dr. Evan Madill, and Dr. Prateek Thatikunta recognized a number of opportunities to improve the process of obtaining and testing cerebrospinal fluid in hospitalized patients. By partnering with faculty mentors representing the Neurohospitalist and Neurocritical Care Divisions and Microbiology, they successfully designed and implemented an intervention based in the electronic health record to sustainably reduce unnecessary laboratory tests. A description of the project was published in The Neurohospitalist.

Expanding access to MRI for patient with cardiac devices

Two major studies came out in 2017 demonstrating the safety of MRI in patients with non-conditional, legacy pacemakers and other cardiac rhythm devices. As a resident, Dr. Collin Culbertson cared for a patient who desperately needed an MRI to guide his treatment, but was unable to get one. Dr. Culbertson spent months working with colleagues in neuroradiology and cardiology to understand the barriers to creating a new process for these patients. His relentless advocacy led both to a Viewpoint publication in JAMA Neurology and major steps forward in our local policy and practice.  

Prion disease-related safety precautions

As the ward service junior resident in December 2016, Katherine Werbaneth was tasked with performing lumbar punctures on two separate patients with suspected Creutzfeldt-Jakob disease within a span of 10 days. She sought out guidance from the Stanford policy on safety precautions related to this condition, but felt that it lacked sufficient detail. Dr. Werbaneth presented on this topic at Morbidity, Mortality, & Improvement conference and found that other residents shared her experience. Dr. Werbaneth decided to survey the top 50 neurology programs in the country and found significant variability in safety policies. Dr. Werbaneth presented her findings at a platform presentation at AAN, where the project was awarded an Abstract of Distinction, one of 24 out of over 3000 abstracts. A manuscript describing the study has been published in The Neurohospitalist.  

Improving communication when transferring stroke patients out of the ICU

A team of residents, led by Dr. Nick Murray, studied the process of transferring stroke patients out of the ICU and identified lack of standardized communication as an opportunity for improvement. The main intervention was to devise a standardized checklist completed by the transferring Neurocritical Care team. In pre-post analyses, the implementation of this checklist was associated with reductions in median hospital length of stay and a perception among residents of increased patient safety. A manuscript describing this project has been published in The Neurohospitalist.