Quality Improvement Basics: A Crash Course for Pediatric Cardiac Care

2019 ◽  
Vol 10 (6) ◽  
pp. 733-741 ◽  
Author(s):  
Katherine E. Bates ◽  
Jean Connor ◽  
Nikhil K. Chanani ◽  
Mary C. McLellan ◽  
Andrea McCormick ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Control Charts ◽  
Diagnostic Tools ◽  
Cardiac Care ◽  
Statistical Process ◽  
Sustained Improvement ◽  
Key Driver ◽  
Cardiac Intensive Care

Background: Lack of knowledge of quality improvement (QI) methodology and change management principles can explain many of the difficulties encountered when trying to develop effective QI initiatives in health care. Methods: An interactive QI workshop at the 14th Annual Meeting of the Pediatric Cardiac Intensive Care Society provided an overview of the role of QI in health care, basic QI frameworks and tools, and leadership and organizational culture pitfalls. The top five QI projects submitted to the meeting were later presented to an expert QI panel in a separate session to illustrate examples of QI principles. Results: Workshop presenters introduced two major QI methodologies used to design QI projects. Important first steps include identifying a problem, forming a multidisciplinary team, and developing an aim statement. Key driver diagrams were highlighted as an important tool to develop a project’s framework. Several diagnostic tools used to understand the problem were discussed, including the “5 Why’s,” cause-and-effect charts, and process flowcharts. The importance of outcome, process, and balancing measures was emphasized. Identification of interventions, the value of plan-do-study-act cycles to fuel continuous QI, and use of statistical process control, including run charts or control charts, were reviewed. The importance of stakeholder engagement, transparency, and sustainability was discussed. Later, the top five QI projects presented highlighted multiple “QI done well” practices discussed during the preconference QI workshop. Conclusions: Understanding QI methodology and appropriately applying basic QI tools are pivotal steps to realizing meaningful and sustained improvement.

scholarly journals A Quality Improvement Initiative to Reduce Bronchopulmonary Dysplasia in a Level 4 NICU—Golden Hour Management of Respiratory Distress Syndrome in Preterm Newborns

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 301
Author(s):  
Andrew M. Dylag ◽  
Jamey Tulloch ◽  
Karen E. Paul ◽  
Jeffrey M. Meyers
Keyword(s):  
Quality Improvement ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Control Charts ◽  
Fluid Management ◽  
Delivery Room ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Golden Hour ◽  
Surfactant Administration

Background: Prevention of chronic lung disease (CLD) requires a multidisciplinary approach spanning from the delivery room to Neonatal Intensive Care Unit (NICU) discharge. In 2018, a quality improvement (QI) initiative commenced in a level 4 NICU with the goal of decreasing chronic lung disease rates below the Vermont Oxford Network (VON) average of 24%. Methods: Improvement strategies focused on addressing the primary drivers of ventilation strategies, surfactant administration, non-invasive ventilation, medication use, and nutrition/fluid management. The primary outcome was VON CLD, defined as need for mechanical ventilation and/or supplemental oxygen use at 36 weeks postmenstrual age. Statistical process control charts were used to display and analyze data over time. Results: The overall CLD rate decreased from 33.5 to 16.5% following several interventions, a 51% reduction that has been sustained for >18 months. Changes most attributable to this include implementation of the “golden hour” gestational age (GA) based delivery room protocol that encourages early surfactant administration and timely extubation. Fewer infants were intubated across all GA groups with the largest improvement among infants 26–27 weeks GA. Conclusions: Our efforts significantly decreased CLD through GA-based respiratory guidelines and a comprehensive, rigorous QI approach that can be applicable to other teams focused on improvement.

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation

2021 ◽  
pp. 019459982110133
Author(s):  
Ellen S. Deutsch ◽  
Sonya Malekzadeh ◽  
Cecelia E. Schmalbach
Keyword(s):  
Patient Safety ◽  
Quality Improvement ◽  
Control Charts ◽  
Neck Surgery ◽  
Resident Training ◽  
Statistical Process ◽  
Ensure Patient Safety ◽  
Statistical Process Control Charts ◽  
The Individual ◽  
The Impact

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.

scholarly journals Crossing Knowledge Boundaries: Health Care Providers’ Perceptions and Experiences of What is Important to Achieve More Person-Centered Patient Pathways For Older People

2021 ◽  
Author(s):  
Cecilie Olsen ◽  
Astrid Bergland ◽  
Asta Bye ◽  
Jonas Debesay ◽  
Anne Langaas
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Providers ◽  
Quality Improvement Collaborative ◽  
Patient Journey ◽  
Patient Pathways

Abstract Background: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Older people’s patient pathways may be unpredictable and complex, posing significant challenges for health care providers (HCPs). In particular, appropriate follow-up in primary care after discharge is key. Current research in the field endorses person-centered care as crucial to improving the patient pathways of older people. The aim of this study was to explore HCPs’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.Methods: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs and three key persons who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. Results: A thematic analysis resulted in five themes: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathways of older people; and 5) ambiguity toward checklists and practice implementation. Conclusion: To understand the findings, it proved useful to see them in light of knowledge sharing and boundary crossing, which are central concepts in the literature on transitional care. HCPs in the collaborative shared and coproduced new knowledge of the patient pathways of older people based on a patient journey perspective. Mapping the patient journey and asking, “What matters to you?” facilitated the crossing of knowledge boundaries between the HCPs; hence, a new and more holistic view of the patient pathways of older people in the current context emerged. The centrality of getting to know the patient and the special role of providers working in home care services was a central finding. The study adds to existing knowledge by suggesting that the achievement of person-centered patient pathways for older people does not only depend on the crossing of knowledge boundaries among HCPs, but also between HCPs and older persons.

Statistical Process and Quality Control

2000 ◽  
pp. 233-244
Keyword(s):  
Quality Control ◽  
Quality Improvement ◽  
Quality Management ◽  
Total Quality Management ◽  
Statistical Process Control ◽  
Control Charts ◽  
Statistical Testing ◽  
Total Quality ◽  
Statistical Process ◽  
Sampling Plans

Abstract This chapter provides an introduction to statistical process control and the concept of total quality management. It begins with a review of quality improvement efforts in the extrusion industry and the considerations involved in developing sampling plans and interpreting control charts. It then lays out the steps that would be followed in order to implement statistical testing for billet casting, die performance, or any other process or variable that impacts extrusion quality. The chapter concludes with an overview of the fundamentals of total quality management.

scholarly journals Statistical process control part 1: a primer for using statistical process control in health care process improvement

2009 ◽  
Vol 33 (3) ◽  
pp. 408 ◽  
Author(s):  
Tamara G Chetter
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Process Control ◽  
Patient Care ◽  
Statistical Process Control ◽  
Care Process ◽  
Quality Improvement Effort ◽  
Statistical Process ◽  
Measurement Analysis ◽  
Quality Of Patient Care

QUALITY IMPROVEMENT is increasingly important for health care organisations both nation-wide and internationally. There is greater recognition of both the variances in patient care and the gaps between evidence-based research and current practice. At the same time, demand, not only for the quantity of services, but for higher quality services, continues to grow. Realising this, most major hospitals across Australia are initiating the redesign of hospital processes in order to maximise the timeliness and quality of patient care. But changing a process does not always result in an improvement.1,2 For this reason, a key component of any quality improvement effort is the robust measurement, analysis, and interpretation of appropriate clinical outcomes and processes, to ensure beneficial changes occur.

scholarly journals Reducing Mother-to-Child Transmission of HIV Using Quality Improvement Approaches

2019 ◽  
Vol 18 ◽  
pp. 232595821985563
Author(s):  
Nigel Livesley ◽  
Astou Coly ◽  
Esther Karamagi ◽  
Tamara Nsubuga-Nyombi ◽  
Stella Kasindi Mwita ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Control Charts ◽  
Hiv Transmission ◽  
Health Workers ◽  
Care Delivery ◽  
Care Quality ◽  
Data Systems ◽  
Statistical Process ◽  
Statistical Process Control Charts ◽  
Mother To Child

Over half of mother-to-child HIV transmission (MTCT) occurs postdelivery. Keeping mother–infant pairs in care remains challenging. Health workers in 3 countries used quality improvement (QI) approaches to improve data systems, mother–infant retention, and facility-based care delivery. The number and proportion of infants with known HIV status at time of discharge from early infant diagnosis programs increased in Tanzania and Uganda. We analyzed data using statistical process control charts. Mother-to-child HIV transmission did not decrease in 15 Kenyan sites, decreased from 12.7% to 3.8% in 28 Tanzanian sites, and decreased from 17.2% to 1.5% in 10 Ugandan sites with baseline data. This improvement is likely due to the combination of option B+, service delivery improvements, and retention through QI approaches. Reaching the global MTCT elimination target and maximizing infant survival will require health systems to support mother–infant pairs to remain in care and support health workers to deliver care. Quality improvement approaches can support these changes.

Role of medical education in health care reform

1997 ◽  
Vol 87 (1) ◽  
pp. 2-5
Author(s):  
MA Caselli
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Quality Improvement ◽  
Health Care Reform ◽  
Continuous Quality Improvement ◽  
Medical Profession ◽  
Medical Community ◽  
Continuous Quality

Health care reform will have great impact on the podiatric physician as the podiatric medical profession continues to integrate into the general medical community. The role of medical education in addressing five major issues that affect health care reform is explored. These issues include specialization, economics, continuous quality improvement, ethics, and fraud.

Quality improvement methodology can reduce hospitalisation for abscess management

2022 ◽  
pp. emermed-2021-211466
Author(s):  
Michael Dunn ◽  
Kate Savoie ◽  
Guliz Erdem ◽  
Michael W Dykes ◽  
Don Buckingham ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Pathway ◽  
Control Charts ◽  
Statistical Process ◽  
Incision And Drainage ◽  
Practice Nurses ◽  
Process Control Charts ◽  
Statistical Process Control Charts ◽  
Ed Visits

BackgroundAbscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management.MethodsA multidisciplinary team convened to decrease hospitalisation for patients with abscesses and completed multiple ‘Plan-Do-Study-Act’ cycles, including increasing I&Ds performed in the ED. Other interventions included implementation of a clinical pathway, training of procedure technicians (PT), updating the electronic medical record (EMR), credentialing advanced practice nurses in sedation and individual follow-up with providers for admitted patients. Data were analysed using statistical process control charts. Gross average charges were assessed.ResultsAdmissions for I&D decreased from 26.3% to 13.7%. Abscess drainage in the ED improved from 79.3% to 96.5%. Mean length of stay decreased from 19.5 to 11.5 hours for all patients. Patients sedated increased from 3.3% to 18.2%. The number of repeat I&Ds within 30 days decreased from 4.3% to 1.7%.ConclusionWe decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.

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