Using Individual Clinician Feedback as Key Driver for Multiple Quality Improvement Initiatives at Large Pediatric Urgent Care Network

Purpose/Objectives: Quality improvement (QI) project implementation can be complex and effective interventions can be elusive, especially at large organizations with varied clinician practice. Our institution’s large group of physicians and nurse practitioners work within a seven-site pediatric urgent care network in central Ohio. With several simultaneous QI projects we found trends showing varied compliance amongst clinicians that were present across initiatives. Prior studies have shown mixed results for individual clinician feedback as a primary intervention for quality improvement; we hypothesized that it would serve as a key driver in achieving and maintaining our project goals.

Design/Methods: In September of 2020 we began emailing monthly individual physician feedback for four QI projects: acute otitis media (AOM) treatment duration, skin and soft tissue infection (SSTI) treatment duration, RSV viral testing rate and viral panel testing rate. The email contained objectives for each project, gave individual performance in relation to goal, and showed ranking compared to peers. Clinician feedback was not punitive, and clinicians’ rank was not shared with the larger group. The audits were reviewed for accuracy and populated monthly by QI analyst and physician QI lead. Additionally, group compliance shown as a percentage was presented bimonthly at clinician conferences. Using statistical process control charts, we were able to track progress for all projects concurrently.

Results: When scorecards began, AOM and SSTI projects had already improved from baseline while RSV and viral panel testing projects were new. After scorecard initiation, the AOM project had a second baseline shift from 67% to 85% while the SSTI project was sustained at 85% and edged towards 90% (Figure 1). For our respiratory projects, the COVID 19 pandemic had diverging effects. The RSV season abruptly ended and testing dropped precipitously at our institution. As a steady increase in the prevalence of RSV returns, with the scorecard, we have not yet seen an increase in testing and are at less than 1 test per 1000 respiratory visits compared to the pre-pandemic 16 per 1000 respiratory visits (Figure 2). Conversely, for the more comprehensive viral panel testing, we saw a significant increase above the baseline with the pandemic, from 10 per 1000 respiratory visits up to 23 per 1000 respiratory visits. After initiation of the scorecard, we achieved the pre-pandemic goal of 5 per 1000 respiratory visits (Figure 2).

Conclusion/Discussion: Our scorecard approach was able to show that getting consistent, reliable, and relevant clinician direct feedback can meaningfully improve clinical practice across varied QI initiatives at different stages of development and with different objectives.