Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
Piloting of data collection is finally underway! My mentor, Dr. Ian Jenkins, an attending in the Division of Hospital Medicine at the University of California, San Diego, and I are currently collaborating with the Surgical Intensive Care Unit at UC San Diego to conduct a daily review of urinary catheter (UC) necessity for patients on the unit, and subsequently coordinating with nursing staff on the unit to look for opportunities to implement UC alternatives.
Specifically, we are collecting data about the percentage of appropriate UC as well as data regarding the response to intervention for inappropriate UC identified. We decided to pilot the data in the ICU because of its excellent safety culture. A potential downside to piloting data on this hospital unit is that fewer catheters are typically removable in this setting, but we are hopeful that we will still obtain a rich data set, with a better understanding of how to expand data collection to other hospital units.
As far as timeline, we are past the halfway point. One thing that has surprised me is how long it has taken to get piloting phase underway. To that end, I think that our initial project timeline was ambitious, especially because we were unclear on how well initial project enthusiasm would translate into subsequent project participation. Up until this point, our research approach has largely been to fine tune each process prospectively. For instance, we decided a pilot run of data collection prior to final project data collection would allow us to ensure a smoother data collection process. While this has slowed things initially, we are optimistic that this will allow us to progress more quickly and smoothly in the latter stages of the project. We are not currently planning to change this research approach for the time being, but we are open to the idea depending on how well the data piloting phase progresses.
Outside of data collection, the project has provided an excellent opportunity to learn and improve clinical skills. Specifically, the project has improved my understanding of the indications for urinary catheter use, as well as helped me to develop a more critical mindset regarding medical indications in general. The project has made me more aware of the importance of really asking and thinking about why a patient is on a specific medication or using a specific medical device, which is something that is very helpful for anticipating and avoiding errors in the clinical setting.
Overall, I have enjoyed my participation in the project to date and it has increased my enthusiasm for participating in a quality improvement project.
Victor Ekuta is a third-year medical student at UC San Diego.