Elissa Falconer wins First Place in the NEJM QI Resident 360 Challenge
Out of 10 finalists, Elissa Falconer, MD, Emory general surgery resident and VA Quality Scholars Fellow, has been named the winner of the NEJM QI Resident 360 Challenge. Dr. Falconer and her study team will now be given the opportunity to write an article about their project for the NEJM Catalyst website as well as receive other prizes.
The goal of The Challenge is to provide a venue for residents and fellows to share their quality improvement projects with a global audience and receive feedback while also inspiring ideas for future projects. All entries were submitted as posters, which were then judged by a panel of experts representing the quality improvement community. Additionally, all submissions were open to the public for crowd voting from June 1-15, 2020.
As a VA Quality Scholars Fellow, Dr. Falconer is conducting QI research at the Atlanta VA Healthcare System. For The Challenge, she led a study which aimed to standardize and reduce non-adherence to patient discharge opioid prescribing recommendations at the Atlanta VA HCS. She and her team created institutional standardized discharge opioid recommendations for 13 common general surgery procedures, and found that 75% of the VA HCS's postoperative discharge opioid prescriptions were non-adherent as of September 2019 and the prior nine months. Their goal was to reduce non-adherence to 30% over the subsequent six months.
The team then designed and implemented a clinical decision aid/handout that recommended opioids by surgical procedure, an electronic order set that defined prescribing opioids via pre-set values for each procedure in accordance with recommendations, and dashboards that provided audit and feedback about provider performance regarding recommendations.
Over six months of implementation, the team observed a marked decrease in non-adherence to recommendations from 75% to 26%, and concluded that standardization influenced less opioid prescription upon discharge and less community diversion of opioids. These results have generated interest in expanding the protocol to additional general surgery procedures and other surgical specialties, as well as the initiation of efforts to educate veterans about proper disposal of unused opioids.