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Team Action Plans in Surgery

Team Action Plans in Surgery (TAPS) is a multi-level team-based approach to quality improvement and safety initiatives. Each team consists of one faculty member, one or two resident trainees, and often students at the undergraduate and medical student level. Projects are determined by the faculty and resident trainee, at which point, students are then selected to participate.  These students are generally selected based on their current involvement in research with surgery faculty and through their involvement through the Undergraduate Research Opportunity Program (UROP)

TAPS projects continue to progress.  One TAPS team led by Dr. Sandra Wong, Associate Professor in Surgery, is now in its second year. Curriculum is under way and the projects are being developed.  Dr. Wong, along with current resident, Dr. Seth Waits, House Officer 5,presented their TAPS project at the 2013 AAMC Integrating Quality: Increasing Value and Educating for Quality Meeting.  

The panel was called "Educating for Quality: Leveraging National and Local Partnerships for Improving Value and Educating for Quality" and they talked about "Development of Team Action Projects in Surgery (TAPS): a Multi-level Team-Based Approach to Quality Improvement."

More TAPS Projects

"Implementation of an Enhanced Recovery Protocol in Living Kidney Donors"

  • Team Members: Faculty Advisor (Michael Englesbe); Resident Leader (Seth Waits, House Officer 5); Medical Student (Kyle Sheetz); and Undergraduate Students (David Cron, Chris Lee, Shekinah Reser)
  • Goal of project: Implement an enhanced recovery protocol for living kidney donors
  • Progress report: Following implementation of the protocol, we have shown a significant decrease in post-operative length of stay from 2.0 to 1.5 days.  Additionally, narcotic use has decreased by over 50% and pain scores have improved. We continue to refine the enhanced recovery protocol and monitor outcomes.

"Evaluating Adherence to the Clinical Practice Guidelines for Treatment of C. Diff Infection"

  • Team members: Faculty Advisor (Sandra Wong); Resident Leader (Terry Shih, House Officer 5); Medical Students (Spencer Hiller, Arun Hariharan, Margaret Smith, Yongwoo David Seo)
  • Goal of project: We wanted to evaluate whether clinicians at UMHS were treating CDiff appropriately according to published clinical practice guidelines
  • Progress report: We have completed our patient data review and found a large proportion of patients were not appropriately treated. This inappropriate treatment was associated with increased patient mortality. We are in the process now of designing an intervention to increase dissemination and implementation of our treatment guidelines.

"Understanding institutional variation in duration of laparoscopic cholecystectomy"

  • Team members: Faculty Advisors (Michael Englesbe and Sandra Wong); Resident Leader (Brad Reames, House Officer 5), Medical student (Linda Li): Undergraduate Students (David Noble, Mitch Alameddine, Tucker Schumacher, and Jake Clafin)
  • Goal of project: A prospective observational study to better understand factors that contribute to increased operative durations and identify potential targets for quality improvement
  • Progress Report: Longitudinal assessment of cases is now complete, and the data is currently being analyzed to better understand risk factors for prolonged operative duration. 

"Improving the Inpatient General Surgery Consult Request Process"

  • Team members: Faculty Advisors (Sandra WongRebecca Minter); Resident Leaders (Rob Krell, House Officer 5 and Ben Bryner, House Officer 5)
  • Goal of project: Investigate issues related to requesting a consult from the general surgery services
  • Progress report: We created a value stream map of the entire consult process with the help of requesting services (internal medicine and emergency medicine) and assessed their thought processes in requesting consults.  We deployed a team of medical students to observe consult requests.  Analysis of those observations helped shape the recent reorganization of the acute care surgery teams.

These projects are supported and funded by ASDP as well as a recently awarded grant from the UofM Provost Office called the Transforming Learning for the Third Century (TLTC) Quick Wins grant program.