Jump starting a quality and performance improvement initiative to meet the updated ACGME guidelines.

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residents to be trained in practice-based learning and improvement as well as systems-based practice. In an effort to establish a formal curriculum for graduate medical education, a Performance Improvement (PI) Training Program was initiated at Memorial University Medical Center. Training for the chief residents across all residency programs focused on the basic Six Sigma framework. Chief residents chose faculty sponsors and were also mentored by Six Sigma-trained staff. Faculty and physicians who participated in the initiative received PI/Continuing Medical Education credit. METHODS: A total of 17 presurveys and postsurveys were completed on 7 outcome measures. Nonparametric Wilcoxon signed rank 2-tailed tests were performed to test for significant change from presurvey to postsurvey. RESULTS: Analysis of the 2-year data (2009-2011) found statistically significant improvement for all 7 outcome measures. The surgical residents' PI Project for 2011 included the development of the Venous Thromboembolism Reassessment Tool. The project included a multidisciplinary team to develop a computer prompt that continued to trigger if the physician launched the prophylaxis or treatment form without ordering anticoagulation. The new prompt resulted in a 391% increase in anticoagulant orders. CONCLUSIONS: This study demonstrated that the resident-based PI Training Program was innovative, practical, and comprehensive. Education, tools, and skill development were provided on quality and PI theory and practice for resident physicians in support of the Accreditation Council for Graduate Medical Education core competencies of professionalism, practice-based learning and improvement, and systems-based practice.

Missile pulmonary embolus secondary to abdominal gunshot wound.

Missile pulmonary emboli are rare sequelae of traumatic entry of projectile missiles-generally bullets or bullet fragments-in which access to the systemic venous circulation is established by the missile, making it possible for the missile to migrate to the pulmonary arteries. In the case introduced here, a 24-year-old male presented to the ER with a gunshot wound to the abdomen. In the early course of his care, it was determined that he had suffered a missile pulmonary embolus secondary to a large fragment of a bullet penetrating the IVC. Despite the large perfusion defect created by this missile embolus, the patient recovered uneventfully without embolectomy.