Throughout the year we will explore quality improvement as our in-depth topic.  Join us on a mini-tour of tools, resources and ways to incorporate quality improvement models in everyday GME.  Our fourth installment, of six, is to look at a simple PDSA or PDCA cycle.

PDSA or PDCA is the acronym used for Plan, Do, Study (Check), Act.  Let’s look at an example for a family medicine residency program.

Issue:  Residents not using the correct field in the EMR to document flu vaccine given.  It is difficult to know who received or not, and if not, the reason why. We will perform a chart review to determine current status, determine gaps and set our goal to be all patients, that are eligible, will receive a flu vaccine.

Plan: Reduce patient refusal of flu vaccine by 20% over the next six months.

Do: The nurse will document flu vaccine status at the time of check-in along with reasons why the patient may not want the vaccine.  If refused, residents will intervene and discuss with patients the benefits of flu vaccine.

Study:  A simple chart will be prepared, weekly, which documents if the vaccine was given, not given or refused.

Act:  Based on data analysis, adjustments will be made, if needed, or if successful, the protocol will become standard practice.  If adjustments are to be made, a new PDSA will be implemented.

For further information on PDSA, with examples, visit the AMA STEPSforward site. In addition, the ACGME has posted a PDSA worksheet to aid in evaluating your self-study improvements.