At Providence St. Vincent, we train doctors to own the system of care so
that we do the right thing, every time, for every patient.
Each resident designs and implements a quality improvement project during protected QI curriculum time over their three year residency. Our residents select a project that dovetails with future career interests, work directly with our own dedicated analyst to design process and outcome measures, "learn by doing" with guidance from faculty experts, and graduate with a unique set of skills including a deep understanding of systems of care delivery. Every project checks for disparities to ensure we are meeting the diverse needs of our community.
Green Inhalers: Dr. Abby Lindseth is improving the health of our community and the planet by sharing a preferred list of Dry Powder Inhalers (DPIs) to replace Metered Dose Inhalers (MDIs) which contain greenhouse gases. At Providence we recognize our underserved populations suffer disproportionately from heat waves, poor air quality and other consequence of greenhouse emissions and WE ACT to achieve our goal of carbon negative by 2030.
Vaccine Hesitancy: Dr. Nathan Edwards and Dr. Divya Nimmatoori are working to identify and reach out to clinic patients who are eligible but unvaccinated against COVID-19.
Support for Sobriety: Dr. Michael Knapp is leading work to support alcohol cessation with Medication Assisted Therapy (MAT) and coordinated behavioral health integrated in our residency clinic.
Inpatient
Sepsis Patient and Family Education: Drs. Beth Koschel and Brit Cook worked with the system Sepsis Focus Group and our Patient Family Advisory Council to create patient education integrated into our Sepsis Order Set. Her work was translated into Arabic, simplified Chinese, Russian, Spanish and Vietnamese to meet the needs of our diverse patient population across the entire 50+ hospital Providence Health System.
SGLT2i for CHF: Dr. Omar Pandhair worked with hospitalists, cardiologists and pharmacists to solidify workflows so that every patient admitted for heart failure is offered an SGLT2i.
COPD Pathway: Collaborating with a hospitalist mentor, Drs Nathan Zvejnieks, Gabe Hocum, Adrianna Morse, and Hannah Giger have designed a care pathway for patients with COPD. Process measures include percent of patients who get a blood gas early non-invasive positive pressure ventilation per GOLD guidelines and percent of patients who are referred to pulmonary rehabilitation at discharge. They are now working to reduce readmission. Preliminary results were presented at Oregon ACP 2021.
Early Mobility and Delirium Prevention: After securing a grant from the Providence Medical Foundation, resident Drs. Michael Silvas, Joe Miller, Tatyana Aleksandrova, and Lizzy Severson collaborated to hire 3 CNAs whom they trained as mobility aids to take all patients over age 65 on daily walks around our Accountable Care Unit as well as implement a package for delirium prevention including reorientation, water within arm’s reach, eyeglasses on, hearing aids in, and blinds open in the morning. Winner: 1st Place at ACP 2019 A new grant to focus on patients with neurocognitive disorders was secured in January 2022 and Dr. Lesley Hudson is working with an occupational therapist to build a care pathway for this vulnerable population. Dr. Nick Gates partnered to bring music as part of the delirium prevention workflow.
Community Acquired Pneumonia (CAP) Pathway: In collaboration with our pharmacists and nurses on the Accountable Care Unit, resident Drs. Leah Grant and Jillian Catral designed and implemented an evidence-based CAP Pathway including 3 elements which were shown in a clinical trial to reduce both length of stay and time on antibiotics by 2 days: 1) Early transition from IV to oral antibiotics when patient meets pre-specified clinical criteria, 2) Early mobility; 3) Shared patient , family, nurse, and physician understanding of criteria for discharge. QI Winner: 2nd Place at ACP 2020. The project was on hold during COVID but Drs. Christinia Patel and Kemin Fena are relaunching our CAP Pathway in September 2023.
Reduction of Unnecessary Labs: Dr. Khoi Nguyen used feedback and friendly competition to safely reduce lab tests, saving patients money as well as red cells. Value Winner: 1st Place at ACP 2020.
Under Pressure: In collaboration with a hospitalist, Dr. Jakob Feeney led a project to safely reduce unnecessary treatment of inpatient hypertension. QI Winner: 2nd Place ACP 2022
Intensive Care Unit
Goals of Care: Our intensivists are committed to early and frequent family meetings. Drs. Garrett Spencer, Heidi Reich, and Joanna Bove are collaborating with our system Institute for Human Caring to make sure those conversations are recorded in our “Good Green Goals of Care” tile within the electronic health record, all within 24 hours of ICU admission. Dr. Wiley Harkens has expanded the work to seriously ill floor patients, and Dr. Karissa Kunihira is collaborating with the emergency room physicians to be sure they refer to the Goals of Care tile when triaging patients. Drs. Daphne Sy, Ali Turfah, Michelle Nguyen and Allision Schue added a clinic workflow so that patients seen within 14 days of hospital stay for a transitional care management visit and those seen for an annual wellness visit have an opportunity to revisit goals of care with their primary care physician. Dr. Lexi Amatisto is building a smartlink to the Trusted Decision-Maker field into our resident admission template to ensure the patient’s proxy is clearly documented.
