The following faculty have listed their areas of interest in QI, patient safety, and systems improvement as a resource to trainees looking for potential projects and/or faculty mentors.

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Parnassus/Mount Zion/Laurel Heights
San Francisco General Hospital (SFGH)
San Francisco VA (SFVA) Medical Center

Parnassus/Mount Zion/Laurel Heights

Faculty Name: Margaret Fang
Division: Hospital Medicine (Parnassus)
Contact Information: mfang@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Anticoagulation (both inpatient and outpatient).
 
Description of QI Project:
1. Many opportunities through the anticoagulation clinic, including evaluating patients. attitudes and understanding of anticoagulation and INR control.
2. Health related quality of life related to anticoagulation.
3. Bleeding complications on anticoagulation.

Faculty Name: Stephanie Rennke
Division: Hospital Medicine (Parnassus and Mount Zion)
Contact Information: srennke@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Transitions in Care Patient-Provider communication, patient education around medication management, and medication safety.
 
Description of QI Project:
1. ASK US-PAL program: This program will be a pilot study around the development and implementation of a bundled approach to patient-provider communication around the time of discharge, focusing on education around medication management, self-efficacy, and adherence.
2. FACT program: In collaboration with the Institute on Aging we are developing a post-hospitalization telephone service for well-being checks and medication reminders and counseling for community elders. We will be evaluating medication adherence and readmission rates.

Faculty Name: Brad Sharpe
Division: Hospital Medicine (Parnassus)
Contact Information: sharpeb@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Improving the care of inpatients, improving the ED to inpatient transition, improving the transfer of patients from outside hospitals to the Medicine Service Core Measures for community-acquired pneumonia.
 
Description of QI Project:
1. Transfers from outside hospitals: The transfer of patients from outside hospitals is complex involving multiple steps and areas for failure. The current process is not optimized, places patients at risk, and makes care challenging for house-staff. We seek to improve and streamline the process of transfers from outside hospitals.
2. ED to Medicine Transition: The transition in care from the ED to Medicine is complex and is a high-risk time for patients. The current process if not optimized. We seek to work with the Emergency Department to streamline and improve this process.
3. Time of discharge: The average time of discharge for patients on the Medical service is after 3pm. National guidelines state the goal discharge time should be closer to noon. We seek through case review and PDSA cycles to safely discharge patients earlier in the day.
4. House-staff supervision: New duty hours regulations mandate increased supervision for house-staff and we are implementing a night hospitalist for the 201.

Faculty Name: Michelle Mourad
Division: Hospital Medicine (Parnassus)
Contact Information: michelle.mourad@ucsf.edu
 
QI/Safe focus or areas of interest: Improving Discharge and Quality and Safety.
 
Description of QI Project:
1. Creation of a patient centered medication card for discharge medication education.
2. Obtaining 2 week follow up for all patients discharged from the medicine service.
3. Implementing high quality electronic discharge summary completed at the time of discharge.
4. Reliably identifying pending tests and follow up needs at the time of discharge and communicating these to the outpatient provider.
5. Providing pharmacy teaching to patients at high risk for medication adverse events
6. Patient-centered education around their discharge diagnoses, home care and follow up plans.
We'd welcome anyone who is interested in implementing small tests of change to improve the safety for patients as they transition out of the hospital.

Faculty Name: Catherine Lau
Division: Hospital Medicine (Parnassus)
Contact Information: clau@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Improving patient communication and satisfaction in the hospital, improving transitions of care.
 
Description of QI Project:
1. The Standardized Whiteboard Project was launched in an effort to improve patient-centered communication in the hospital. The project has already been piloted on several units in the hospital and we are now planning on rolling out the Standardized Whiteboard to all units in the hospital on a quarterly basis. The continued success of the project will require continued multi-disciplinary champions and feedback of audit data to all stakeholders. There is also a further opportunity to study whether Standardized Whiteboard use improves patient satisfaction scores and whether patient knowledge of their caregiver, diagnosis, and plan of care both in and out of the hospital improves clinical outcomes.

Faculty Name: Sumant Ranji
Division: Hospital Medicine (Parnassus)
Contact Information: sumantr@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Care transitions (especially around hospital discharge), teaching QI and patient safety to residents and students, resident involvement in the hospital discharge process, and rapid response teams.
 
Description of QI Project:
1. PCP communication - I am interested in analyzing the content and quality of communication with referring PCP's by residents caring for hospitalized patients. We have a large database (>3000 patients) of patients whose PCP's were contacted during hospitalization, and receive weekly reports of PCP communication notes for currently hospitalized patients. There is an excellent opportunity to analyze two-way communication between outpatient and inpatient physicians and examine its effect on patient care both during and after the hospitalization.
2. Hospital readmissions - we conduct structured reviews of all patients readmitted to the medicine service within 30 days of discharge, including a multidisciplinary assessment and discussion with the patient. We are interested in mining these reviews to identify which readmissions are truly preventable, evaluate the effectiveness of our discharge process, identify further.

Faculty Name: Diane Sliwka
Division: Hospital Medicine (Parnassus)
Contact Information: dsliwka@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Procedure Safety, Case Review/Adverse Event Review, Quality and Safety Education, Simulation, and Patient Satisfaction.
 
Description of QI Project:
1. Procedure Safety: Review of procedure service complications, procedure process improvement.
2. Hospital Medicine Case Review: use of real cases to initiate further data collection, rapid improvements, or working groups for system improvements. Dissemination of case review learnings to house-staff and hospitalists through newsletter notifications. Data analysis of case reviews.
3. Quality and Safety Education: curriculum building and implementation for quality elective at Parnassus
4. Simulation: Mock Code Sessions monthly
5. Patient Satisfaction: Several projects to improve patient communication with physicians, inter-service communication, physician training in strategies to improve patient satisfaction.

Faculty Name: Seth Landefeld
Division: Geriatrics (Laurel Heights)
Contact Information: sethl@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Micro-system redesign, outcomes measurement, drug safety, and autopsy.
 
Description of QI Project:
1. Design of model practice for frail elders.
2. Improving hospital function to improve safety/outcomes for frail elders

Faculty Name: Helen Kao
Division: Geriatrics (Laurel Heights/Parnassus/off-site)
Contact Information: helen.kao@ucsf.edu
 
QI/Safe focus or areas of interest: Geriatric transitions of care, access to care for homebound (reducing ED/hospital visits), intersection of geriatrics-palliative care, and geriatrics co-management with orthopedics.
 
Description of QI Project:
1. Collaboration with BOOST and CHF Discharge Team to improve transitions of care and reduce readmissions for complex/frail older adults with heart failure.
2. Planning stage for possible geriatrics-orthopedics co-management.

Faculty Name: Elizabeth Adkins Murphy
Division: Hospital Medicine (Parnassus)
Contact Information: ElizabethA.Murphy@ucsfmedctr.org
 
QI/Safe focus or areas of interest: Geriatric Inpatient Quality and Safety, Acute Care for the Elderly Unit, Fall Prevention, Pressure Ulcer Prevention, and Patient Satisfaction.
 
Description of QI Project:
1. Project Leader for the Mt Zion Acute Care for the Elderly Unit, a five-bed ACE Unit with protocols and staff specially oriented to the care of the hospitalized elder. Piloting multiple protocols including protocols aimed at delirium screening, non-pharmacologic sleep enhancement, and mobilization.
2. Post-Fall Assessment: standardization of clinical management and documentation after a fall.

Faculty Name: Anna K. Abramson
Division: Hospital Medicine (Mount Zion/Parnassus)
Contact Information: anna.abramson@ucsf.medctr.org
 
QI/Safe focus or areas of interest: HIV inpatient testing to evaluate for generalized screening and decreasing barriers to specialty care in highly mobile groups, namely continental professional cyclists.
 
Description of QI Project:
1. Mount Zion inpatient screening of all new admits patients aged 18 - 65, recording prevalence and incidence.

Faculty Name: Niraj Sehgal
Division: Hospital Medicine (Parnassus)
Contact Information: nirajs@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: Safety culture, teamwork and communication, organizational change, and engaging trainees into QI/PS activities.
 
Description of QI Project:
1. Teamwork and communication initiatives focusing on structured tools that improve the way different disciplines care for and communicate about patients.
2. Patient-centered communication tools.
3. Working with specialty divisions and their QI faculty champions around systems for learning from adverse events and specific QI efforts (opportunities to potentially work in specialty area for QI project).
4. QI and Safety Educational initiatives.
5. Error Disclosure.

San Francisco General Hospital (SFGH)

Faculty Name: Alice Chen
Division: General Medicine (SFGH)
Contact Information: achen@medsfgh.ucsf.edu
 
QI/Safe focus or areas of interest: Primary care delivery redesign
 
Description of QI Project:
1. Multiple opportunities for clinic-based interventions in the General Medicine Clinic at SFGH. Current projects include but are not limited to: increasing vaccination rates (PVX and Tdap), smoking as a vital sign, colorectal cancer screening follow-through, improving controlled substances prescribing practices, preparation for EMR implementation, panel management, and enhancing MEA roles.
2. eReferral projects include a PCP survey and ratings of the quality of referrals and specialist responses.

Faculty Name: Lauren Goldman
Division: General Medicine (SFGH)
Contact Information: goldmanl@medicine.ucsf.edu
 
QI/Safe focus or areas of interest: None
 
Description of QI Project:

Faculty Name: Claire Horton
Division: Medicine (SFGH)
Contact Information: hortonck@medsfgh.ucsf.edu
 
QI/Safe focus or areas of interest: Ambulatory QI, ambulatory safety monitoring and systems to improve, QI and health disparities / safety net QI, teaching project-based QI to residents in ambulatory settings, team-based ambulatory care, and disease registries.
 
Description of QI Project:
1. Scheduling improvement project - reduced the % of 'never-scheduled' follow-up appointments from 18% to 11% with team-based approach to change scheduling practices.
2. Pap improvement project - improved pap screening rates by use of registry, PCP involvement, and clinic-based multidisciplinary team.
3. Tetanus booster improvement project - increased rates of tetanus booster from 20% to 29% by use of MEA protocols and education.
4. Panel management project - using MEAs for f/u contact of patients with poorly controlled diabetes between visits. Metrics being evaluated: no-show rates, med adherence, others.
5. No-show improvement project - brief phone-based patient interviews assessed root cause of no-shows to resident clinics.
6. Assessment of team-based care in GMC: found significant improvement in residents' perceptions of patient continuity and quality of care after initiation of continuity NP program. Administrative data also identified improved continuity: patient visits to their 'primary ca".

San Francisco VA (SFVA) Medical Center

Faculty Name: Read Pierce
Division: Internal Medicine/Hospital Medicine (San Francisco VA)
Contact Information: read.pierce@ucsf.edu; read.pierce@va.gov
 
QI/Safe focus or areas of interest: Teamwork, communication, medical decision-making, and cost-effective care.
 
Description of QI Project:
1. Evaluation of local and national complication rates in cardiac cath labs through the largest database in the nation (CART-CL). There are significant opportunities to explore how complications are defined (outcomes research), captured (medical informatics), and used to alter patient referral patterns (comparative effectiveness and economics).
2. Improving lung cancer care, including tracking of incidental pulmonary nodules on imaging and shortening time-to-diagnosis when lung cancer is suspected and time-to-treatment when a diagnosis is made. There are almost countless interesting projects for residents and fellows ranging from clinical studies around best practices to creation of novel data systems to work-flow redesign and improvement across specialty units (radiology, chest clinic, oncology clinic, thoracic surgery clinic, medical practice).
3. Evaluation of bleeding rates among patients sent for elective colonoscopy before and after a recent VA guideline change that now has patients continue aspirin therapy around the time of colonoscopy. In addition to clinical outcomes studies, there are ample opportunities to create better systems for accurately capturing adverse events.
4. Improving rates of unexpected acute kidney injury among patients admitted to the Orthopedic Surgery service for elective joint operations.
5. Facilitating and improving standardized hand-off of critical patient information to the primary care team at the time of hospital discharge. An efficient electronic template (checklist) was launched in fall 2010, but initial data suggests relevant information is rarely reaching PCPs in a timely fashion. Numerous opportunities exist to work on communication strategies, EHR improvement, and handoff curricula for inpatient and outpatient teams.
6. Improving flexible clinic access to reduce urgent care and ED visits for medication refills. As the VA creates a robust patient-centered medical home model, there are many avenues for measuring, tracking, and improving timely access to clinics.
7. Endocrinology staff at the VA are exploring adequacy of our tracking systems for continuous vit-D supplementation in patient's after gastric bypass. Currently, no single system exists for capturing patients who have this operation, and there is no dedicated ownership of follow-up for metabolic physiology monitoring in the post-operate period. There are multiple opportunities to think above development of "smart IT" tools to connect existing parts of the electronic medical record and feed relevant information to providers.