VA National Center for Patient Safety
Chief Resident in Quality and Safety
The VA National Center for Patient Safety (NCPS), in partnership with the VA Office of Academic Affiliations, has developed the Chief Resident in Quality and Patient Safety (CRQS) program. The CRQS program is a one-year program for recently graduated residents. During their chief year, residents focus on learning and teaching about quality and patient safety, and engaging in improvement activities at their home facility.
The CRQS program now includes 83 chief resident positions at 57 VA medical centers. Each fellow will participate in the national curriculum led by NCPS, which includes a week-long, face-to-face meeting and monthly sessions using distance technology. In addition, CRQS participants pursue projects at their home facility.
NCPS public affairs officer, Derek Atkinson, recently discussed the CRQS program with former fellow Dr. Eric Yanke from the Madison VAMC:
How did you hear about the CRQS program and what interested you in it?
Our Associate Chief of Staff for education at the time mentioned it to me and invited me to Washington, D.C. for the national meeting of CRQS program directors. I went with him and our COS and got a great look at the program “behind the scenes” so to speak. This was during my 2nd year of internal medicine residency, so it was an easy decision to apply for CRQS position during my 3rd (final) year of residency. The University of Wisconsin Internal Medicine Program has a strong patient safety curriculum, particularly at the VA. I really enjoyed that experience during my residency, and taking a year to devote to quality improvement and patient safety sounded very interesting.
Describe your experience in the program?
I was the first CRQS at our site, so I had a lot of flexibility with the year. Our local leadership was very supportive in both my academic and more practical quality improvement projects. My academic work used a human factors engineering model (SEIPS model) to analyze how well we adhered to C. difficile infection prevention practices, specifically, the VA’s nationally mandated C. difficile infection prevention bundle. I hosted focus groups with residents, attendings, nurses, and environmental services, which yielded some fascinating insight into the workflow of various groups.
My more practical project was redesigning our inpatient insulin infusion protocol to streamline the ordering process and better adhere to national guidelines. The main goal was to reduce hypoglycemia while on the insulin infusion, which we definitely achieved based on our post-intervention analysis. It was a lot of work getting our changes through all the various committees, but it was completely worth it.
Did it change your perception on the role/importance of patient safety?
Absolutely. My biggest shift in perception was recognizing the crucial role that our built systems of care play in both patient safety and medical errors. This encompasses our electronic health record, physical environment, and institutional culture (in addition to many more). Previously, there was a small part of me that felt if providers worked harder, spent more time, or were “more careful,” most medical errors could be avoided. Now, I recognize our systems of care play just as important a role as individual providers’ skill and knowledge.
How did the program prepare you for your current position?
As an attending hospitalist, I am always working with residents and medical students on the medicine wards. My CRQS year provided significant insight into how the VA system works and specifically how the VA approaches quality and safety. When residents and students point out problems or systems issues, I can usually find the right person to help them begin addressing the issue. I also have been fortunate enough to continue my academic work during my non-clinical time. We still have lots of focus group data to analyze and publish from my CRQS year!