Quality Improvement Project Submission Form NICAP QI Project Application This form must be completed when submitting a project in coordination the Neuormedicine Interdisciplinary Clinical and Academic Program (NICAP). Questions regarding this application should be sent to Dr. Jacqueline Baron-Lee, Director of Quality Improvement, at jbaronlee@ufl.edu. Date of Submission* Name* First Last Position*NICAP Steering Commitee MemberFacultyAdministratorResidentFellowDepartment*NeurosurgeryNeurologyEmail* Project Title*Description of Project* Visual Text What is the Problem? This is your problem statement.Overall Goal*Visual Text What are we trying to accomplish? This is your AIM Statement. Your aim should be specific, measurable and time-bound. EX: We will reduce same-day surgery cancellations by 50% within 6 months.Measures*Visual Text How will we know that change is an improvement? This is a critical piece of the project There are several types of measures, including process (what was done) and outcome (what happened). Process measure example: percentage of staff washing hands before an encounter with a patient, use of an emergency manual during a critical incident in the operating room, percentage of ASA 4 patients seen in pre-op clinic at least 7 days before scheduled surgery. Outcome measure examples: Incidence of wound infections, outcomes of intraoperative critical incidents, same-day surgery cancellations. Process measures are often easier to measure for smaller projects and can often be obtained through online surveys.What is the Intervention?*Visual Text What changes can we make that will result in an improvement? Be specific and realistic.Team Members of the Project* Inclusive list of members.Who are the stakeholders?* Who will be affected to make the change successful?UF Health Big Aim* Select All Zero Harm Reduce Variation Increase Value Transform our Culture Perfect Patient Experience Please indicate the UF Health Big Aim(s) relating to your project. To find out more about the UF Health Big Aims, please visit nicap.med.ufl.edu.Key Words Relating to the Project* Please list between 3-5 keywords
