The Impact of Nutrition-Focused Quality Improvement Interventions on Length of Stay and Readmission Rates Among Hospitalized Malnourished Patients

Abstract Background Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017. Methods Retrospective study of CLABSI events as defined by the CDC’s National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed. Results A comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline. Conclusion Study findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI. Disclosures All authors: No reported disclosures.

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Do quality improvement interventions for person-centered family planning work? Evidence from Kenya

Gates Open Research ◽

10.12688/gatesopenres.13120.1 ◽

2020 ◽

Vol 4 ◽

pp. 44

Author(s):

Nadia Diamond-Smith ◽

Katie Giessler ◽

Meghan Munson ◽

Cathy Green

Keyword(s):

Quality Improvement ◽

Family Planning ◽

Lessons Learned ◽

Cross Sectional ◽

Middle Income ◽

Health And Human Rights ◽

Centered Care ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

The Impact

Background: Quality of care for family planning, especially person-centered care, is important from a health and human-rights standpoint. Few interventions have aimed to improve person-centered family planning (PCFP) in low and middle-income countries. In this study, we tested the impact of a quality improvement (QI) intervention in Kenya on aspects of PCFP included in a validated measure of PCFP and on the overall PCFP scale. Methods: We conducted QI cycles in three facilities providing family planning in Nairobi and Kiambu Counties, Kenya, with three facilities serving as controls. Cross-sectional baseline data was collected from 478 women receiving family planning in 2016 and end line data was collected from 640 in 2017-18. We analysed the impact of the QI intervention on PCFP using difference-in-difference models. Results: We found no impact of the QI intervention on either PCFP or the overall PCFP scale. Conclusions: We take away key lessons learned from the null findings of the intervention that are important for future interventions. Lessons learned include the need to be flexible in light of external factors that prolonged the study and probably led to burnout; and simplifying measurement and procedures.

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Using Quality Improvement Methodology to Increase Communication of Discharge Criteria on Rounds

Hospital Pediatrics ◽

10.1542/hpeds.2021-006127 ◽

2022 ◽

Author(s):

Katherine Christianson ◽

Alexandra Kalinowski ◽

Sarah Bauer ◽

Yitong Liu ◽

Lauren Titus ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Academic Medical Center ◽

Hospital Medicine ◽

Transitions Of Care ◽

Audit And Feedback ◽

Quality Improvement Initiative ◽

Readmission Rates ◽

The Impact ◽

Discharge Criteria

OBJECTIVE: Clear communication about discharge criteria with families and the interprofessional team is essential for efficient transitions of care. Our aim was to increase the percentage of pediatric hospital medicine patient- and family-centered rounds (PFCR) that included discharge criteria discussion from a baseline mean of 32% to 75% over 1 year. METHODS: We used the Model for Improvement to conduct a quality improvement initiative at a tertiary pediatric academic medical center. Interventions tested included (1) rationale sharing, (2) PFCR checklist modification, (3) electronic discharge SmartForms, (4) data audit and feedback and (5) discharge criteria standardization. The outcome measure was the percentage of observed PFCR with discharge criteria discussed. Process measure was the percentage of PHM patients with criteria documented. Balancing measures were rounds length, length of stay, and readmission rates. Statistical process control charts assessed the impact of interventions. RESULTS: We observed 700 PFCR (68 baseline PFCR from July to August 2019 and 632 intervention period PFCR from November 2019 to June 2021). At baseline, discharge was discussed during 32% of PFCR. After rationale sharing, checklist modification, and criteria standardization, this increased to 90%, indicating special cause variation. The improvement has been sustained for 10 months. At baseline, there was no centralized location to document discharge criteria. After development of the SmartForm, 21% of patients had criteria documented. After criteria standardization for common diagnoses, this increased to 71%. Rounds length, length of stay, and readmission rates remained unchanged. CONCLUSION: Using quality improvement methodology, we successfully increased verbal discussions of discharge criteria during PFCR without prolonging rounds length.

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On Using Statistical Process Control Charts to Analyze the Impact of Quality Improvement Interventions

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/s1553-7250(10)36016-8 ◽

2010 ◽

Vol 36 (2) ◽

pp. 94-95

Author(s):

Karen Homa

Keyword(s):

Quality Improvement ◽

Process Control ◽

Statistical Process Control ◽

Control Charts ◽

Statistical Process ◽

Process Control Charts ◽

Statistical Process Control Charts ◽

Improvement Interventions ◽

Quality Improvement Interventions ◽

The Impact

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The Institute for Healthcare Improvement–NeuroPoint Alliance collaboration to decrease length of stay and readmission after lumbar spine fusion: using national registries to design quality improvement protocols

Journal of Neurosurgery Spine ◽

10.3171/2020.5.spine20457 ◽

2020 ◽

Vol 33 (6) ◽

pp. 812-821

Author(s):

Scott L. Zuckerman ◽

Clinton J. Devin ◽

Vincent Rossi ◽

Silky Chotai ◽

E. Hunter Dyer ◽

...

Keyword(s):

Quality Improvement ◽

Length Of Stay ◽

Discharge Planning ◽

Lumbar Fusion ◽

Nonparametric Tests ◽

Learning System ◽

Design Quality ◽

Implementation Phase ◽

Healthcare Improvement ◽

The Impact

OBJECTIVENational databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of care delivered. Reducing the length of stay (LOS) and readmission after elective lumbar fusion was chosen as the pilot module.METHODSThe NPA-IHI program prospectively enrolled patients undergoing elective 1- to 3-level lumbar fusions across 8 institutions. A three-pronged approach was taken that included the following phases: 1) Research Phase, 2) Development Phase, and 3) Implementation Phase. Primary outcomes were LOS and readmission. From January to June 2017, a learning system was created utilizing monthly conference calls, weekly data submission, and continuous refinement of the proposed QI tool. Nonparametric tests were used to assess the impact of the QI intervention.RESULTSThe novel QI tool included the following three areas of intervention: 1) preoperative discharge assessment (location, date, and instructions), 2) inpatient changes (LOS rounding checklist, daily huddle, and pain assessments), and 3) postdischarge calls (pain, primary care follow-up, and satisfaction). A total of 209 patients were enrolled, and the most common procedure was a posterior laminectomy/fusion (60.2%). Seven patients (3.3%) were readmitted during the study period. Preoperative discharge planning was completed for 129 patients (61.7%). A shorter median LOS was seen in those with a known preoperative discharge date (67 vs 80 hours, p = 0.018) and clear discharge instructions (71 vs 81 hours, p = 0.030). Patients with a known preoperative discharge plan also reported significantly increased satisfaction (8.0 vs 7.0, p = 0.028), and patients with increased discharge readiness (scale 0–10) also reported higher satisfaction (r = 0.474, p < 0.001). Those receiving postdischarge calls (76%) had a significantly shorter LOS than those without postdischarge calls (75 vs 99 hours, p = 0.020), although no significant relationship was seen between postdischarge calls and readmission (p = 0.342).CONCLUSIONSThe NPA-IHI program showed that preoperative discharge planning and postdischarge calls have the potential to reduce LOS and improve satisfaction after elective lumbar fusion. It is our hope that neurosurgical providers can recognize how registries can be used to both develop and implement a QI tool and appreciate the importance of QI implementation as a separate process from data collection/analysis.

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