Bootcamp in Sustainable Quality

Improving Blood Work Availability Ahead of Post-Op ENT Clinics

AIM Statement: Reduce the percentage of patient encounters in the Endocrine Post-Op ENT clinic in which patients have not completed their blood work within 1 day to 2 weeks prior to their appointment, by 50% by April 1, 2022.

Drs. Wei Wang, Lindsey Chow, Hernan Franco, Kristin Clemens (Faculty Lead)

Improving Bowel Preparation for Inpatient Colonoscopies Using the Model For Continuous Improvement

AIM Statement: Increase the percentage of adequate inpatient bowel preparation to above 90% by May 2022.

Drs. Khaled Alazemi, Adbulaziz Almudaires, Betty Cai, Vadim Iablokov, Hasib Rahman, Mayur Brahmania (Faculty Lead)

Inpatient Endoscopy Throughput: A Quality Improvement Initiative

AIM Statement: By July 2022, we will increase endoscopy throughput by a least 1 procedure per day to reduce the utilization of on-call/weekend endoscopy.

Drs. David Hudson, Ziad Hindi, Christopher Lavalle, Mohammed Alsager, Abdulaziz Alajmi, Mayur Brahmania (Faculty Lead)

Fractured Management: Appropriate Pharmacological Prescribing for New Fragility Fractures

AIM Statement: By July 2022, increase in proportion of patients that have been consulted to GIM for perioperative assessment of fragility fracture to start an actionable plan for medication start at discharge, from 29% to 100%.

Drs. James Boudreau, Carley Campbell, Mathias Fricot, Zahra Merali, Christina Vailaveettil, Saira Zafar (Faculty Lead)

Obesity and GLP-1 Use in Multicare Kidney Clinics

AIM Statement: To increase the prescription rate of GLP-1a in qualifying CKD stage 3-5 patients with diabetes and obesity presenting to the London MultiCare kidney Cinic, by May 2022.

Drs. Adam Bloom, Yasaman Torabi, Fawaz Alanazi, Mohammed Bukhari, Kristin Clemens (Faculty Lead)

Improving INR Control Amongst Patients in a Specialized Warfarin Clinic

AIM Statement: By May 2022, decrease the proportion of high-risk warfarin patients with low time in range from 55% to 25%.

Drs. David Maj, Steve Gryn (Faculty Lead)

Promoting Smoking Cessation in Patients with Non-Traumatic Lower Limb Amputations

AIM Statement: To increase the percentage of individuals with non-traumatic amputations who receive comprehensive smoking-cessation counselling in the Parkwood Institute Amputee Rehab Program by 50% by July 30, 2022.

Drs. Carmen Baker, Ali Bateman (Faculty Lead)

Inpatient initiation of pharmacotherapy for smoking cessation

AIM Statement: By June 2023, increase the rate of initiation of smoking cessation therapies by 20% following prescription.

Abdallah Bin Maither, Max Deschner, Rock Hou, Ali Malik, Mike Nicholson (Faculty Lead)

Improving Pulmonary Pressure Estimation by Echocardiogram at LHSC

AIM Statement: We aim to improve the echographic estimation of pulmonary arterial pressure for all patients receiving an echocardiogram, especially for patients having a referral question asking to screen for pulmonary hypertension and patients with cardiac transplant.

Drs. Ping Yu Xiong, Zachary Singer, Dimitar Saveski, Neville Suskin (Faculty Lead)

Reducing Clinic Wait times for Higher Priority Referrals to the Osteoporosis and Bone Disease Program

AIM Statement:To reduce the average wait time of High Priority Referrals to 120 days over 1 year.

Drs. Aisha Yusuf Ibrahim, Cassandra Hawco, Jeffery Tong, Kristin K Clemens (Faculty Lead)

Reducing Laboratory Waste: An Approach to Reducing Unnecessary Gamma Glutamyl Transferase (GGT) Testing in the Inpatient Setting

AIM Statement:We aim to reduce the inappropriate testing of GGT for inpatients at London Health Science Centre (LHSC) with the goal of GGT:ALP ratio <0.25 within 6-8 months.

Drs. Gurpreet Malhi, Hasan Bualbanat, Nisha Howarth, Tamoor Afzaal, Raed Al-Ramadan, Anouar Teriaky (Faculty Lead)

Improving communication of post-discharge follow up plans to family physicians for patients assessed by consult medicine.

AIM Statement:Improve the rates of consult medicine sign-off notes being copied to family physicians to 100%.

Drs. Eden Liu, Aaron Leung, Darren Yau, Saira Zafar (Faculty Lead)

Improving Efficiency of Paracentesis Procedures in the CTU setting at Victoria Hospital

AIM Statement: Reduce the time required to gather equipment for a paracentesis by residents on the CTU service at VH by 25% in 8 months time.

Drs. Ahmed Zaki, Rajiv Lakhani, Hamza Mahmood, Saira Zafar (Faculty Lead)

Discontinuing Prolonged VTE Prophylaxis in Inpatients with SCI: A Quality Improvement Initiative

AIM Statement:To decrease the percentage of patients with newly diagnosed SCI admitted to 4AE SCI Parkwood Institute who receive prolonged VTE prophylaxis from 48% to 30% by May 30th 2023.

Drs. Lauren Cormier, Heather Mackenzie, Ali Bateman (Faculty Lead)

Optimizing the treatment of iron deficiency in end-stage renal disease at London Health Sciences Centre

AIM Statement:By June 2024, we aim to decrease the proportion of hemodialysis patients with iron deficiency by 20%.

Drs. Zhubo D. Zhang, Joey Liu, Mohammad Faraz, Dilraj Sanghera, Omar Assiri, Abdulaziz Bari, & Michael Chiu (Faculty Lead)

Improving Palliative Care Referrals For Patients With Advanced Cancer in Pleural Disease and DAP Clinics

AIM Statement:Increase referrals of patients with locally advanced or metastatic lung cancer in the Diagnostic Assessment Program (DAP) to Palliative Care by 25% by March 2023.

Drs. Jaymee Shell, Shayan Kassirian, Yassmin Behzadian, Inderdeep Dhaliwal (Faculty Lead)

Geriatrics screening and assessments in new elderly patients in outpatient malignant hematology clinics and applying the results in patient-centred treatment decisions

AIM Statement: By December 2023, all elderly patients >65yo in LRCP malignant hematology clinics will have a Geriatrics 8 screening assessment as part of initial consultation.

Drs. Aatif Qureshi, Mohammed Abu Farhaneh, Alan Gob (Faculty Lead)

Early Discharge Protocol Adherence in Low-Risk STEMIs Post Primary PCI

AIM Statement: To improve the rate of early discharge - within 48 hours of primary PCI - for low-risk STEMI patients from 65% to 90% by April 2024.

Drs. Vinay Jayachandiran, Thomas Raissi, Bryan Stringer, Neville Suskin (Faculty Lead)

PTH on the GRU: Falling through the cracks

AIM Statement: By September 2024, for patients admitted to the Parkwood Institute Geriatric Rehabilitation Unit with a fragility fracture and incomplete osteoporosis workup, increase the number of patients with a parathyroid hormone level ordered during admission to 90%.

Drs. Lauren Winquist, Mary-Margaret Taabazuing (Faculty Lead)

Increasing RAAS Blockade in PD Patients to Preserve Residual Renal Function

AIM Statement: By April 2024, increase the proportion of PD patients on RAAS blockade by 25%.

Drs. Antonia Zhu, Muath Alrehaili, Naief Alhowaiti, Abdullah Niyazi, Michael Chiu (Faculty Lead)

Improving Calcium Binder Use in Hyperphosphatemic Dialysis Patients

AIM Statement: By May 2024, we will increase the proportion of hyperphosphatemic dialysis patients in the UH dialysis unit on appropriate calcium containing binders by 10%.

Drs. Gustavo Olaciregui Carrera, Adam Forster, Mohammad Alajmi, Hatoun Elazhary, Michael Chiu (Faculty Lead)

Improving the Quality and Quantity of Patient Education Provided by Residents to Stroke Inpatients: A Quality Improvement Initiative

AIM Statement: To assess the utility of templates and resident education workshop in improving patient education provided by learners to stroke inpatients at University Hospital, with a goal of improvement of 50% in quality by April 2024.

Drs. Mihilkumar Patel, Umangjot Kaur Bharaj, Jennifer Mandzia, Anita Florendo-Cumbermack (Faculty Lead)

Beyond Counting Sheep: Enhancing Inpatient Sleep Quality Through Quality Improvement

AIM Statement: By June 2024, enhance sleep quality and quantity by 25% for hospitalized adult patients at the London Health Sciences Centre, leveraging non-pharmacological interventions.

Drs. Jihad AlKharbooshi, Erin Nuro, Robin Sawaya, Anita Florendo-Cumbermack (Faculty Lead)

Increasing the Western Physical Medicine & Rehabilitation Weekend Handover Completion Rate: A Quality Improvement Initiative

AIM Statement: Increase the Western PM&R weekend handover completion rate from 68% to 100% by March 2024 to improve communication, satisfaction, and patient care.

Drs. Sydney Knight, Heather MacKenzie, Ali Bateman (Faculty Lead)

Review of Transesophageal Echocardiogram Requests at Victoria Hospital

AIM Statement: Increase the approval of inpatient transesophageal echocardiograms (TEE) at Victoria Hospital to 85% by May 2024.

Drs. Jasmin Nari, Osama Smettei, Sarah Blissett (Faculty Advisor)

Review and Optimization of Thrombolytic Instillation in Chest Tubes

AIM Statement: Understanding and improving the process by which patients of Respirology receive chest tube lytics, and the impact on patient length of stay and duration of chest tube.

Drs. Cameron Ashe, Mina Ishak, Jana Aljohani, Abdullah Almazrooa, Michael Nicholson (Faculty Lead)

Boosting efficiency in stress echocardiogram scheduling at LHSC

AIM Statement: By April 2025, to reduce the no show rate in stress echocardiogram from 29% to 15%.

Drs. Xavier Theroux, Maria Luz Garagiola, Sarah Blissett (Faculty Lead)

Demystifying the Decline in London’s Cardiac Rehabilitation Referral Rates

AIM Statement: By July 2025, we will aim to improve the referral rates to cardiac rehabilitation for patients post coronary revascularization, acute coronary syndrome, and coronary artery bypass surgery by 100% from its current baseline of 25-50%.

Drs. Nancy Wang, Christopher Chiang, Muhtashim Mian, Ashlay Huitema, Robert McKelvie, Neville Suskin (Faculty Lead)

Wait Times for Urgent Endocrinology Referrals

AIM Statement: By April 2025, increase successful patient booking and decrease administrative burden involved in clinic booking for the Endocrinology urgent clinic.

Drs. Ahmed Al Shaer, Melissa Ge, Samantha Bruzzese, Amanda Berberich (Faculty Lead)

Improving Alcohol Use Disorder Management in Hospitalized Patients

AIM Statement: By May 2025, to increase the baseline prescription rate of medications for alcohol use disorder at discharge by 25%.

Drs. Alvi Islam, Yifan Han, Zaki Alhashimalsayed, David Hudson (Faculty Lead)

Paracentesis Clinic Optimization

AIM Statement: Reduce ER visits for paracentesis in cirrhotic patients by 25% by May 2025.

Drs. Khalid Alseiari, Mohammed Alkhalifa, Noora Alfaraj, David Hudson (Faculty Lead)

Reduction of Duplicate NGS Testing at LHSC

AIM Statement: To reduce the number of unnecessary duplicate NGS testing by 50% in the next year.

Drs. Aidan McKee, Ortenc Hoxha, Jodi Chiu, Alan Gob (Faculty Lead)

Improving Lumbar Puncture Success with Ultrasound Guidance

AIM Statement: By December 2026, reduce the number of unsuccessful lumbar punctures in CNS inpatients by 30%.

Drs. Kai Qing Xiong, Alexander Fraser, Anita Florendo-Cumbermack (Faculty Lead)

Reducing Wait Times for Urgent Neurology Clinic Patients Using Quality Improvement Methodology

AIM Statement: To reduce wait times at the UNC to 3 business days by June 30, 2025, and sustain this improvement.

Drs. Jenan Al-Tawari, Brendon Pilgrim, David Zok, Kendra Cotton, Anita Florendo-Cumbermack (Faculty Lead)

Improving Pleural Fluid Culture Yield with Liquid Based Microbiology

AIM Statement: To increase the proportion of pleural fluid culture results with an identified bacterial pathogen by 20% within 8 months, for patients admitted to the Respirology inpatient ward.

Drs. Crystal Leung, Karen Cholmondeley , Lugain Khoj, Malcolm Sherwood, Mike Nicholson (Faculty Lead)

Waste Not, Want Not: A Quality Improvement Initiative to Reduce Inappropriate Disposal of Non-Hazardous Waste

AIM Statement: Reduce the frequency of hazardous waste bin replacement in the Parkwood Outpatient Clinic from once monthly to once every 8 weeks by August 31, 2025.

Drs. Rylie Bonkowski, Ali Bateman (Faculty Lead)