Self-Directed Improvement Project Samples

Examples of successful clinical and non-clinical self-directed Improvement in Medical Practice projects recently submitted to the ABO for MOC credit are listed below. You are encouraged to browse these project plans and use them as templates to design a project relevant to your own practice or clinical interests.

Clinical Project Samples

TitleProject DescriptionTypeSettingTags
Assessing the Degree of Pain Associated with Intravitreal Injections In this practice, internal guidelines called for patients to be brought into the treatment room for an intravitreal injection within 5-20 minutes following instillation of 2% Lidocaine gel. However, compliance with this guideline was only at 64%. After implementing steps to streamline processes, 94% of patients were treated within these guidelines. In addition, patients’ average pain index score decreased from 1.12 to 0.5 after the project’s interventions. Clinical Group Practice Process of care
Less variation Patient outcomes
Critical Problem Areas in Patient Safety and Education in Age-Related Macular Degeneration This project sought to define a comprehensive strategy for specific and appropriate patient education measures regarding the prevention of progressive vision loss and new onset of vision loss, along with safety measures to minimize unnecessary vision loss. Among the project’s outcomes was that all but one patient in the study experienced an improvement in visual acuity. Clinical Medical Center AREDS
Endophthalmitis
Improving Effectiveness of Treatment of Patients with Diabetic Macular Edema Diabetes is an increasingly common, systemic disease often complicated by sight-threatening visual loss resulting from diabetic macular edema. Successful treatment can be slow and difficult, involving numerous visits and very expensive drugs. The aim of this project was to leverage resources to achieve improved eye health in patients with diabetic macular edema. Patients in this study experienced a greater rate of decrease in both blood sugar and systolic blood pressure following project implementation. Clinical Health Network Diabetes
Macular Edema
Visual loss
Improving Counseling and Compliance for Patients with Use of AREDS in Advanced AMD The project’s goal was to use data to increase the number of patients with advanced AMD taking AREDS. Initially, about half of patients were not taking AREDS. Following the plan’s interventions, which included a systematic patient outreach plan, 57% of patients who were counseled to take AREDS began to take AREDS within a 90-day follow-up period. The majority of patients who reported not taking AREDS in the 90-day follow-up period agreed to start taking AREDS as soon as possible. Clinical Multi-Specialty Group
Hospital
AREDS
Vitamin Supplementation
ARMD
Compliance Practice Improvement Counseling
Improving Amblyopia Compliance in Children This project examined compliance with patch therapy in pediatric patients. Interventions included enhanced patient education techniques and counseling. By the project's conclusion, patch compliance in 30 patients improved from 81% to 94%. The project helped staff learn what motivates families to patch and inspired the care team to more dilligently recommend correction of patient amblyopia. Clinical Solo Practice

Amblyopia
Patch therapy

Improving Rate of Gonioscopy Performed on Glaucoma Patients About 33% of patients presenting for glaucoma evaluation were receiving goniosopic evaluations. Gonioscopes were falling through the cracks, perhaps because patients were dilated prior to being identified as glaucoma suspects or having POAG. Implentation of a reference chart to ensure that the diagnostic tests were performed resulted in improved quality of care, with 97% of subsequent patients receiving a gonioscopy evaluation. Clinical Group Practice

POAG
Gonioscopy
OHTN
Glaucoma
Glaucoma Suspect

Reducing Extraneous OCT and VF Testing of Plaquenil Patients This project aimed to decrease extraneous testing in order to reduce risk to patients and conserve organizational resources. Following interventions, there was a 12.9% reduction in superfluous testing when all "Plaquenil patients" presenting to the clinic were examined. Given that prior to the intervention 100% of all Plaquenil patients were subjected to testing, the project had a significant and positive impact on patient safety as well as patient and healthcare facility time, energy, and money. Clinical Group Practice Plaquenil
Hydroxychloroquine
OCT
Screening
Retinal toxicity
Visual field testing
Inverse process measure
Reducing Incidence of Post-Intravitreal Injection Corneal Abrasion This project was designed to reduce the frequency of post-intravitreal injection corneal abrasions. The estimated risk of corneal abrasion in two large studies of intravitreal injections is roughly 0.15% (1 in 750). After making changes in the intravitreal injection procedure (provider/staff/equipment) over three months, the incidence of corneal abrasions after intravitreal injections at the clinic was dramatically reduced from 1 in 50 (2%) to 1 in 200 (0.5%). Clinical Multi-Specialty Group Corneal abrasions
Intravitreal injections
Reducing Rate of Perioperative Incidents Related to Intraoperative Time-Out Procedure To improve quality outcomes and create a safer medical practice environment for patients, this project addressed perioperative incidents related to gaps in the process of conducting sign-in/time-out for surgical vitreoretinal procedures. Following systematic changes to the sign-in/time-out processes, none of the 126 patients in the follow-up study groups experienced perioperative incidents. The surgical team plans to adopt these new processes as a “lifetime” project. Clinical Hospital

Air embolus during vitrectomy
LASIK flap damage
Surgical consent error
Surgical practice improvement
Surgical time-out

Reliability of Neuroimaging Studies Patients are seen for a variety of neuro-ophthalmic disorders and undergo neuroimaging. These scans are often interpreted by general radiologists without specific neuro-radiologic training. This project reviewed 54 neuroimaging studies by neuroradiologists at an academic medical center to see if any abnormalities were overlooked and/or misinterpreted, and if so, whether it altered the diagnosis and management of the patient. In 12/54 of cases, new or re-interpreted findings emerged which led to a change in diagnosis or patient management in 75% of those instances. Clinical Solo Practice

Neuro-Ophthalmic
Neuroimaging

Unilateral Ptosis Repair To improve Margin to Reflex 1 (MRD-1) symmetry in unilateral ptosis patients, this project incorporated Hering's Law testing in the preoperative assessment. Pre-intervention analysis of 40 unilateral ptosis patients revealed postoperative MRD-1 asymmetry to be 0.96 mm. Incorporating the Hering's Law test improved postoperative MRD-1 symmetry to an average of 0.48 mm over 40 unilateral ptosis patients, which was a 50% improvement. Clinical Group Practice

Contralateral
Margin to Reflex
Ptosis repair
Unilateral Ptosis

 

Non-Clinical Project Samples

TitleProject DescriptionTypeSettingTags
Avoiding Preventable Errors in Outpatient Intravitreal Injections To avoid errors in outpatient intravitreal injections, this plan introduced three interventions: 1) performance and documentation of a time-out; 2) site marking of eye to be injected; and 3) identification of injection errors or near misses. The study captured 8 near misses in 509 cases (1.6%) and resulted in no medical errors (such as wrong eye, wrong drug, etc.). Non-Clinical Outpatient Clinic Near misses
Intravitreal injection
Improving Compliance with Diabetic Patients The no-show rate among high-risk diabetic patients in one group practice was 3-12% higher than the national average. By making what the project author described as “small changes,” including calling patients the day before scheduled visits, the practice was able to reduce the no-show rate among patients with diabetes by 18%. Non-Clinical Group Practice Diabetes
Blindness
Compliance
Improving Doctor-Parent Communication for High-Risk ROP Patients In addition to receiving printed educational materials, just 13% of NICU parents were routinely receiving phone calls to discuss the status of their child’s ROP. To improve parent education, the team developed a plan to better educate parents about the need for close follow-up. By adding a phone call to a newly created checklist for ROP patients, the practice successfully reached 93% of parents to discuss care questions and schedule follow-up visits.  Non-Clinical

Healthcare Network
Hospital
Group Practice

Premature infants
Retinopathy
Education
Improving Long-Term Follow-up of NICU Graduates In this hospital setting, fewer than 3 out of 4 families were bringing their children to their scheduled ROP screenings. The goal of this project was to implement interventions to improve attendance, such as instituting reminder calls and texts, inquiring about transportation issues, and providing educational materials. Following the implementation of these interventions, attendance rose to 76.5%. Non-Clinical Hospital

Retinopathy of Prematurity (ROP)
Long-term follow-up

Improving No-Show Rates in Patients with Diabetic Eye Disease In patients with diabetic eye disease, the no-show rate for appointments was 26% in this group practice. After implementing a dual call-back system, where both the ophthalmology practice and the patient’s primary call practice provided appointment reminder phone calls, the no-show rate dropped to 18%. Non-Clinical Group Practice Appointment Scheduling
Cancellation
Call-back
No-show
Improving Approaches to Preventing Wrong Site Surgeries Through this project, an application for a pictorial description of the surgical site was created and implemented at surgery center. The post-project data revealed a 20% decrease in risk factors for wrong site errors such as incomplete laterality, incomplete booking forms, incomplete procedure description, and site marks that were removed during prep or cover by surgical draping. Non-Clinical Hospital Wrong site
In-Office Procedure Checklist Protocol Implementing a checklist protocol akin to airline pilots helps surgeons avoid unnecessary errors. In this project, a new system checklist was applied to in-office laser procedures. Following the introduction of the checklist, time-out use for these procedures rose to 100%. Utilizing a standardized checklist system increased the practice’s efficiencies, decreased patient wait times, and enhanced the ability to provide high quality patient care. Non-Clinical Solo Practice Time-out
Patient safety