Background:
Continuous quality improvement (CQI) in health care systems necessitates an approach to review care delivery processes, systems, group and individual performances, incidents and outcomes. A robust process should 1) be multidisciplinary, 2) occur in “real-time”, 3) provide detailed review and discussion of care processes, performance and outcomes and 4) generate actionable rapid cycle improvement opportunities.
Aim:
To craft a sustainable management process for CQI for all clinical operational units of the Vanderbilt Heart and Vascular Institute (VHVI).
Methods:
We convened a standing multidisciplinary biweekly managerial forum (termed ImPact - “Improving Patient Care Together”) of quality medical directors, key clinical physicians and nurses, nursing unit managers, hospital administrators, and quality consultants. ImPact follows a standing structured agenda: 1) all mortalities since last meeting, 2) morbidity including “major misses” and major adverse events, 3) rapid response team calls, 4) out of ICU “codes”, 5) events reported by staff in our hospital's anonymous reporting system, 6) events brought forward by any clinician or unit manager, 7) interval progress on ongoing rapid cycle improvement projects.
Results:
The topics for rapid cycle improvement that have surfaced to date are listed in the
Table
. In addition to facilitating and prioritizing rapid cycle quality improvement and patient safety efforts, ImPact provides a link to our regular morbidity and mortality (M&M) conferences in cardiology and cardiac surgery. We have been able to identify common issues that extend beyond individual clinical care areas, allowing better understanding of vulnerabilities in systems of care
Conclusions:
A multidisciplinary, structured, regularly scheduled meeting of physician and nursing clinical and quality leaders, unit managers and administrators is a critical component of performance management and improvement.
Quality Topics Identified
Topics
Contribution, n
Percent
Handoff and communication
9
27
Equipment
7
21
Medication administration
5
15
Education to staff (M&M)
4
12
Patient transport
3
9
Blood product administration
2
6
Risk management
2
6
Vascular service integration
1
3
