Exploration of a quality improvement process to standardised preoperative tests for a surgical procedure to reduce waste

BackgroundPreoperative tests are done to determine a patient’s fitness for anaesthesia and surgery.Local problemAlthough routine tests before surgery in the absence of specific clinical indications are not recommended, we observed high volumes of routine preoperative tests were performed in our institution. We describe a process to implement a standardised preoperative investigational approach to reduce unnecessary testing before surgeries.MethodsA series of six Plan-Do-Study-Act (PDSA) cycles was conducted for root cause analysis and process mapping, development of standardised tool (GRID), collection of baseline data, education and feedback, pilot testing and implementation and uptake of GRID.Root cause analysis revealed a lack of awareness of guidelines and a lack of a standardised tool to guide preoperative testing. We undertook a pilot quality improvement project to reduce unnecessary testing before knee and hip arthroplasty by developing and implementing a standardised tool (GRID) and engaging all stakeholders.InterventionsA clinical development team (CDT) was formed, including all the stakeholders. Our CDT focused on a continuous rapid cycle improvement strategy.ResultsAfter implementation of the tool in a subgroup of patients undergoing elective hip or knee arthroplasty, unnecessary coagulation tests (activated partial thromboplastin time and the international normalised ratio), electrolyte/renal panel tests and electrocardiograms were reduced by 81% (91%–17%), 81% (41%–7%) and 68% (35%–11%), respectively. No surgery was delayed or cancelled due to tests not performed before surgery.ConclusionsA standardised preoperative investigational approach based on patients’ medical conditions rather than routine testing can reduce unnecessary tests before surgery. Further, implementing guidelines is more complex than developing guidelines. Hence, continuous PDSA cycles are essential to evaluate the processes in a quality improvement project. It can take time to build teams and have shared goals; however, once this is achieved, the success of a quality improvement project is certain.

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73. Surgical site infection after CABG: Root cause analysis and quality measures recommendation SSI quality improvement project

Journal of the Saudi Heart Association ◽

10.1016/j.jsha.2016.04.074 ◽

2016 ◽

Vol 28 (3) ◽

pp. 217

Author(s):

A. Arifi ◽

H. Alderaihem ◽

H. Najm

Keyword(s):

Quality Improvement ◽

Surgical Site Infection ◽

Quality Measures ◽

Root Cause Analysis ◽

Quality Improvement Project ◽

Site Infection ◽

Improvement Project ◽

Cause Analysis ◽

Root Cause

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A Fall Prevention Quality Improvement Project in a Long Term Care Facility: Critical Analysis

Journal of Nursing & Healthcare ◽

10.33140/jnh/02/02/00003 ◽

2017 ◽

Vol 2 (2) ◽

Keyword(s):

Quality Improvement ◽

Fall Prevention ◽

Quality Improvement Project ◽

Term Care ◽

Improvement Project ◽

Prevention Education ◽

Quality Improvement Process ◽

Root Cause ◽

Star Program

Falls are a main health burden among seniors, particularly in long term care facilities. A fall prevention quality improvement project was initiated in a geriatric care organization in Ontario, Canada. The purpose of this article is to critically analyze this quality improvement project for reducing fall incident rates by using a Six Sigma model. This quality improvement project consists of conducting a root cause analysis in post fall huddles, “Falling Star” program, and providing fall prevention education for residents and families. The strengths of this quality improvement process include the root cause analysis in post fall huddles and fall prevention education. Some limitations in this quality improvement process include insufficient collaboration with inter-professional team members and the exclusion of residents who are at fall risk, but had not fallen. Three recommendations are provided to increase the possibility of success for this project, including a monthly inter-professional fall safety meeting, the expansion of the “Falling Star” program for all residents at risk of falls, and staff education and training

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Complaints root cause analysis as a part of the medical devices quality improvement process

Scientific Papers of Silesian University of Technology Organization and Management Series ◽

10.29119/1641-3466.2020.145.50 ◽

2020 ◽

Vol 2020 (145) ◽

pp. 675-683

Author(s):

Aleksandra ZIARKIEWICZ ◽

◽

Justyna GÓRNA

Keyword(s):

Quality Improvement ◽

Medical Devices ◽

Root Cause Analysis ◽

Cause Analysis ◽

Quality Improvement Process ◽

Root Cause ◽

Improvement Process

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The 60-Minute Root Cause Analysis: A Workshop to Engage Interdisciplinary Clinicians in Quality Improvement

MedEdPORTAL ◽

10.15766/mep_2374-8265.10685 ◽

2018 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Lakshman Swamy ◽

Christopher Worsham ◽

Mark J. Bialas ◽

Christa Wertz ◽

David Thornton ◽

...

Keyword(s):

Quality Improvement ◽

Root Cause Analysis ◽

Cause Analysis ◽

Root Cause

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Reducing Nonsentinel Harm Events due to Medication Errors by Using Mini–Root Cause Analysis and Action

Global Journal on Quality and Safety in Healthcare ◽

10.36401/jqsh-20-25 ◽

2021 ◽

Vol 4 (1) ◽

pp. 27-43

Author(s):

Ghada Hussain Al Mardawi ◽

Rajkumar Rajendram ◽

Souzan Mohammed Alowesie ◽

Mufareh Alkatheri

Keyword(s):

Medication Errors ◽

Statistical Significance ◽

Root Cause Analysis ◽

Labor Costs ◽

Improvement Project ◽

Cause Analysis ◽

System Failures ◽

Root Cause ◽

Sentinel Events ◽

The Impact

ABSTRACT Introduction A full root cause analysis (RCA) such as that required following a sentinel event is time-consuming, labor-intensive, and expensive. This quality improvement project used a similar but abbreviated process (mini-RCA and action; mini-RCA2) in response to medication errors that caused less serious harm. Methods In 2018, all medication errors that caused harm due to system failures but were not sentinel events were investigated by mini-RCA2. The incidence of similar medication errors reported in the year before and in the year after the introduction of mini-RCA2 was compared to determine the impact of this intervention. Similar events were identified by searching the safety reporting system database for reported medication errors by drug name (e.g., Humate® P) and/or event type (e.g., prescribing error—omission of a patient's home medications on admission to hospital). The time and labor costs of this intervention were estimated. Results Seven medication errors were investigated by mini-RCA2. More than 48 members of staff from 11 clinical and nonclinical departments contributed to the identification of 39 system failures and made 42 recommendations, of which 22 (52%) were implemented. This reduced the recurrence of reports of similar events from 35 (0.57%) to 21 (0.36%). Although this 0.21% absolute decrease did not achieve statistical significance, recurrence of similar harm events was reduced from 7 (0.11%) to 0 (p = 0.016). Benefits were greatest when the mini-RCA2 recommendations were fully implemented. This reduced the recurrence of similar events from 9 (0.21%) to 0 (p = 0.007). A total of 251 hours (mean ± SD, 35.9 ± 16.6 hours) were required for this intervention. The associated labor cost was Saudi Arabia Riyal (SAR) 34,181 (US $8256; mean SAR ± SD, 4883 ± 1302 [mean US $ ± SD, $2102 ± $561]). Conclusion The use of mini-RCA2 to review medication errors provided a structured process to manage reported events, monitor the implementation of recommendations, and assess the effectiveness of implemented actions. The use of this rapid process to investigate errors that cause harm but are not sentinel events reduced recurrence of similar medication errors. Although the time and cost required for this intervention is not insignificant, the cumulative benefit to patients, healthcare professionals, and the organization are greater.

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