Improving Healthcare Value: Effectiveness of a Program to Reduce Laboratory Testing for Non-Critically-Ill Patients With COVID-19

2021 ◽  
Vol 16 (8) ◽  
Author(s):  
Mustafa Abdul-Moheeth ◽  
Victoria Valencia ◽  
Stewart Schaefer ◽  
W Michael Brode ◽  
Kirsten Nieto ◽  
...  
Keyword(s):  
Critically Ill ◽  
Laboratory Testing ◽  
Control Charts ◽  
Disease Process ◽  
Choosing Wisely ◽  
Statistical Process ◽  
Evidence Based Practices ◽  
Unique Challenge ◽  
Process Control Charts ◽  
Statistical Process Control Charts

Avoiding routine, repetitive inpatient laboratory testing is a Choosing Wisely® recommendation, with benefits that may be even more pronounced in the setting of the COVID-19 pandemic, considering the need to limit unnecessary exposure, use of personal protective equipment, and laboratory resources. However, the COVID-19 pandemic presented a unique challenge: how to efficiently develop and standardize care for a disease process that had yet to be fully characterized. This article describes the development of a local committee to critically review evidence-based practices, reach consensus, and guide practice patterns, with the aim of delivering high-value care. Following the local introduction of recommendations and electronic health record order sets, non-critically-ill COVID-19 patients at our hospital had more inpatient days where they did not receive laboratory tests, achieving sustained special cause variation on statistical process control charts. The principles of Choosing Wisely® can be applied even within novel and rapidly evolving situations.

Reducing Unnecessary Respiratory Viral Testing to Promote High-Value Care

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Olivia Ostrow ◽  
Deena Savlov ◽  
Susan E. Richardson ◽  
Jeremy N. Friedman
Keyword(s):  
Control Charts ◽  
Respiratory Infections ◽  
Audit And Feedback ◽  
Improvement Strategy ◽  
Statistical Process ◽  
Process Control Charts ◽  
Statistical Process Control Charts ◽  
Viral Testing ◽  
Return Visits ◽  
Viral Respiratory Infections

BACKGROUND AND OBJECTIVES: Viral respiratory infections are common in children, and practice guidelines do not recommend routine testing for typical viral illnesses. Despite results often not impacting care, nasopharyngeal swabs for viral testing are frequently performed and are an uncomfortable procedure. The aim of this initiative was to decrease unnecessary respiratory viral testing (RVT) in the emergency department (ED) and the pediatric medicine wards (PMWs) by 50% and 25%, respectively, over 36 months. METHODS: An expert panel reviewed published guidelines and appropriate evidence to formulate an RVT pathway using plan-do-study-act cycles. A multifaceted improvement strategy was developed that included implementing 2 newer, more effective tests when testing was deemed necessary; electronic order modifications with force functions; audit and feedback; and education. By using statistical process control charts, the outcomes analyzed were the percentage of RVT ordered in the ED and the rate of RVT ordered on the PMWs. Balancing measures included return visits leading to admission and inpatient viral nosocomial outbreaks. RESULTS: The RVT rate decreased from a mean of 3.0% to 0.5% of ED visits and from 44.3 to 30.1 per 1000 patient days on the PMWs and was sustained throughout the study. Even when accounting for the new rapid influenza test available in the ED, a 50% decrease in overall ED RVT was still achieved without any significant impact on return visits leading to admission or inpatient nosocomial infections. CONCLUSIONS: Through implementation of a standardized, electronically integrated RVT pathway, a decrease in unnecessary RVT was successfully achieved. Audit and feedback, reminders, and biannual education all supported long-term sustainability of this initiative.

TOTAL QUALITY MANAGEMENT USING PARETO DIAGRAMS AND STATISTICAL PROCESS CONTROL CHARTS (SPC) APPLIED TO PRECAST BEAMS

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Mifta Priyanto
Keyword(s):  
Quality Management ◽  
Process Control ◽  
Total Quality Management ◽  
Statistical Process Control ◽  
Control Charts ◽  
Range Limit ◽  
Total Quality ◽  
Statistical Process ◽  
Process Control Charts ◽  
Statistical Process Control Charts

This paper presents the application of Total Quality Management Method using Pareto diagrams and Statistical Process Control charts (SPC). These tools can be applied to both the manufacturing and construction sectors. A Pareto diagram can figure out some of the dominant problems of the projects, and SPC can determine whether the data variation is within control limits. SPC can measure the quality of performance in learning curve using the upper-range limit and lower-range limit of the control analysis. A case study was conducted on a precast beams installation at a rental multi-story residential project in Jakarta, Indonesia. Based on the measurement, some data are outside of the control limit due to the problems identified in the Pareto diagram. Further analysis by measuring the Process Capability Ratio (Cp) produces a value <1, indicating that project management needs to be careful about process variation.

Sign in / Sign up

Export Citation Format

Share Document