Featured Resident-Led Projects
The Stanford Neurology Residency Quality Improvement Curriculum generates mentored quality improvement projects that lead to local practice improvements and peer-reviewed publications. Three examples are listed below. For additional resident- and fellow-led projects, please visit the Stanford Resident/Fellow Quality Improvement & Patient Safety Symposium.
Expanding access to MRI for patient with cardiac devices
Two major studies came out in 2017 demonstrating the safety of MRI in patients with non-conditional, legacy pacemakers and other cardiac rhythm devices. As a resident, Dr. Collin Culbertson cared for a patient who desperately needed an MRI to guide his treatment, but was unable to get one. Dr. Culbertson spent months working with colleagues in neuroradiology and cardiology to understand the barriers to creating a new process for these patients. His relentless advocacy led both to a Viewpoint publication in JAMA Neurology and major steps forward in our local policy and practice. Dr. Culbertson has continued to advance this work as a Vascular Neurology fellow.
Prion disease-related safety precautions
As the ward service junior resident in December 2016, Katherine Werbaneth was tasked with performing lumbar punctures on two separate patients with suspected Creutzfeldt-Jakob disease within a span of 10 days. She sought out guidance from the Stanford policy on safety precautions related to this condition, but felt that it lacked sufficient detail. Dr. Werbaneth presented on this topic at Morbidity, Mortality, & Improvement conference and found that other residents shared her experience. Dr. Werbaneth decided to survey the top 50 neurology programs in the country and found significant variability in safety policies. Dr. Werbaneth presented her findings at a platform presentation at AAN, where the project was awarded an Abstract of Distinction, one of 24 out of over 3000 abstracts. A manuscript describing the study has been published in The Neurohospitalist. Now an Epilepsy fellow, Dr. Werbaneth is working with Stanford infection control to revise our institutional policy for prion precautions.
Improving communication when transferring stroke patients out of the ICU
A team of residents, led by Dr. Nick Murray, studied the process of transferring stroke patients out of the ICU and identified lack of standardized communication as an opportunity for improvement. The main intervention was to devise a standardized checklist completed by the transferring Neurocritical Care team. In pre-post analyses, the implementation of this checklist was associated with reductions in median hospital length of stay and a perception among residents of increased patient safety. A manuscript describing this project is in press in The Neurohospitalist. As a Neurocritical Care fellow, Dr. Murray continues to seek opportunities to improve transitions of care.