A Quality Improvement Project to Optimize Patient Outcomes Following the Maze Procedure

Ambulation is the single most important nursing intervention in the prevention of postoperative complications. It is also a key component in maintaining optimal patient outcomes. Current literature has revealed that when ambulation is initiated early there is a marked decrease in pain, length of hospital admission, and overall complication rates. However, even with this depth of evidence early postoperative ambulation on the two surgical units at a teaching hospital in Rhode Island, patient ambulation continues to be inconsistent. The purpose of this quality improvement project is to improve nursing knowledge regarding early ambulation after surgery for the prevention of post-operative complications. This project utilized a pretest, educational in-service intervention, and posttest design. Seventeen out of a possible 22 surgical nurses participated in this project (N= 17, 77%). The educational in-service sessions combined information from an extensive literature review in the form of a 10-minute Power Point presentation. Pre and post tests were made up of 5 knowledge-based and 5 opinion-based questions. The mean scores for the pretest were 74% while the mean scores for the posttest were 95.2%. There was a 35% increase in overall scores following the educational intervention. APRNs play a pivotal role in establishing and implementing educational programs. This project aimed to recognize a need for ongoing education about postoperative ambulation for the surgical unit nurses. Educational programs about postoperative ambulation and complication prevention should be routinely incorporated in future trainings to ensure improved nursing knowledge and patient outcomes.

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Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009117 ◽

2019 ◽

Vol 28 (11) ◽

pp. 939-948 ◽

Cited By ~ 16

Author(s):

Soffien Chadli Ajmi ◽

Rajiv Advani ◽

Lars Fjetland ◽

Kathinka Dehli Kurz ◽

Thomas Lindner ◽

...

Keyword(s):

Quality Improvement ◽

Patient Outcomes ◽

Treatment Protocol ◽

Team Training ◽

Quality Improvement Project ◽

Improvement Project ◽

In Situ Simulation ◽

Simulation Based ◽

Stroke Thrombolysis

BackgroundIn eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis.MethodsAll members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick’s four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes.ResultsA total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times).ConclusionsImplementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions.

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A resident-led quality improvement project evaluating patient outcomes following biopsy diagnosis of malignancy

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2017.04.112 ◽

2017 ◽

Vol 76 (6) ◽

pp. AB24

Keyword(s):

Quality Improvement ◽

Patient Outcomes ◽

Quality Improvement Project ◽

Improvement Project ◽

Biopsy Diagnosis

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Implementation of Lean Daily Management: A Vascular Access Team Quality Improvement Project to Enhance Nurses’ Workflow and Patient Outcomes

Journal of the Association for Vascular Access ◽

10.2309/java-d-20-00011 ◽

2020 ◽

Vol 25 (3) ◽

pp. 18-27

Author(s):

Michele Schlauch ◽

Pam Rogers ◽

Rhonda Pyne ◽

Cathy Tomchik ◽

Carol Ellis ◽

...

Keyword(s):

Quality Improvement ◽

Patient Outcomes ◽

Vascular Access ◽

Cost Savings ◽

Central Line ◽

Quality Improvement Project ◽

Fiscal Year ◽

Substantial Cost Saving ◽

Improvement Project ◽

Clabsi Rate

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

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