Case Study: COST Framework Achieves Reductions
As a non-profit academic medical health system, the University of Chicago (UChicago) Medicine unites five organizations to fulfill its tripartite mission of medical education, research and patient care: Pritzker School of Medicine, Biological Sciences Division, Medical Center, Community Health and Hospital Division, and UChicago Medicine Physicians.
Problem
Leaders at UChicago Medicine sponsored a quality improvement initiative to reduce overuse of proton pump inhibitor (PPI) infusion among patients with upper gastrointestinal bleeding via a Choosing Wisely Challenge. While continuous infusion of PPIs is recommended in these patients for specific situations, such as before endoscopic identification of ulcers with high-risk features, many times PPI infusions may be continued for 72 hours without indication.
Solution
Under the Challenge sponsored by the Center for Healthcare Delivery Sciences & Innovation, UChicago Medicine crowdsourced overuse reduction initiatives, building infrastructure for more than 10 projects. The interdisciplinary intervention effort was trainee-led, institutionally supported and based on a Culture, Oversight, Systems Change, Training (COST) framework. One of the projects, called Skip the Drips, involved changes to the electronic health record system that required selecting an appropriate indication for PPI infusion orders, monthly order tracking by pharmacists, and educational materials.
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