STEPP IN: A Multicenter Quality Improvement Collaborative Standardizing Postoperative Handoffs

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Anthony J. Piazza ◽  
Beverly Brozanski ◽  
Theresa Grover ◽  
John Chuo ◽  
Teresa Mingrone ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Postoperative Care ◽  
Positive Impact ◽  
Communication Process ◽  
Respiratory Care ◽  
Quality Improvement Initiative ◽  
Process Measures ◽  
Communication Processes ◽  
High Satisfaction ◽  
Team Engagement

OBJECTIVE To reduce care failures by 30% through implementation of standardized communication processes for postoperative handoff in NICU patients undergoing surgery over 12 months and sustained over 6 months. METHODS Nineteen Children’s Hospitals Neonatal Consortium centers collaborated in a quality improvement initiative to reduce postoperative care failures in a surgical neonatal setting by decreasing respiratory care failures and all other communication failures. Evidence-based clinical practice recommendations and a collaborative framework supported local teams’ implementation of standardized postoperative handoff communication. Process measures included compliance with center-defined handoff staff presence, use of center-defined handoff tool, and the proportion of handoffs with interruptions. Participant handoff satisfaction was the balancing measure. Baseline data were collected for 8 months, followed by a 12-month action phase and 7-month sustain phase. RESULTS On average, 181 postoperative handoffs per month were monitored across sites, and 320 respondents per month assessed the handoff process. Communication failures specific to respiratory care decreased by 73.2% (8.2% to 4.6% and with a second special cause signal to 2.2%). All other communication care failures decreased by 49.4% (17% to 8.6%). Eighty-four percent of participants reported high satisfaction. Compliance with use of the handoff tool and required staff attendance increased whereas interruptions decreased over the project time line. CONCLUSIONS Team engagement within a quality improvement framework had a positive impact on the perioperative handoff process for high-risk surgical neonates. We improved care as demonstrated by a decrease in postoperative care failures while maintaining high provider satisfaction.

A quality improvement project to reduce restrictive interventions in a mental health service

2021 ◽  
pp. 1-12
Author(s):  
Darren Savarimuthu ◽  
Katja Jung
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Positive Impact ◽  
Essential Elements ◽  
Quality Improvement Project ◽  
Psychiatric Ward ◽  
Quality Improvement Initiative ◽  
Successful Implementation ◽  
Evidence Based ◽  
Improvement Project

Background/aims This article describes a quality improvement project that aimed to reduce restrictive interventions on an acute psychiatric ward. In light of a service level agreement and based on a trust-wide target, the purpose of the project was to reduce restrictive interventions by 20% within a period of 6 months. It was also anticipated that a least restrictive environment could have a positive impact on patient experience. Methods Three evidence-based interventions were introduced to the ward during the quality improvement project. These included positive behaviour support, the Safewards model and the productive ward initiative. Results There was a 63% reduction in restrictive interventions over a 6-month period through the successful implementation of a series of evidence-based interventions to manage behaviours that challenge on the mental health ward. Conclusions The project identified collaborative team working, staff training and adequate resources as essential elements in the success of the quality improvement initiative. However, co-production was found to be crucially significant in bringing sustainable changes in ward environment and in addressing restrictive practices.

Implementation of a checklist before colonoscopy: a quality improvement initiative

Endoscopy ◽  
2017 ◽  
Vol 50 (03) ◽  
pp. 203-210 ◽  
Author(s):  
Omar Kherad ◽  
Sophie Restellini ◽  
Charles Ménard ◽  
Myriam Martel ◽  
Alan Barkun
Keyword(s):  
Quality Improvement ◽  
Positive Impact ◽  
Quality Improvement Intervention ◽  
Quality Improvement Initiative ◽  
Team Communication ◽  
Intervention Period ◽  
Retrospective Audit ◽  
Safety Outcomes ◽  
Checklist Implementation ◽  
Improvement Intervention

Abstract Background and study aims Checklists can prevent errors and have a positive impact on patient morbidity and mortality in different surgical settings, and possibly also in gastrointestinal endoscopy. The aims of this study were to reinforce commitment in safety culture and better communication among team members in endoscopy, and to prove the feasibility of successful checklist adoption before colonoscopy. Patients and methods The study involved a pre – post quality improvement intervention involving all consecutive patients undergoing a colonoscopy at a single academic endoscopy unit. The first part of the study was a retrospective audit, carried out over a 3-month period (July to September 2016). A checklist developed through a formal validation process was implemented during the intervention period (October to December 2016). Primary outcomes were changes in patient and team satisfaction after the quality improvement intervention, using validated 5-point scale questionnaires. Secondary outcomes included successful procedure completion rates and safety outcomes. Results During the baseline and comparative intervention period, 1317 and 1141 colonoscopies, respectively, were performed. Overall, checklists were fully completed by nurses and physicians for 791 patients (69.3 %). Mean overall patient satisfaction was high at baseline and did not differ following the quality improvement intervention (4.66 vs. 4.63; P  = 0.5). Perception of team communication and teamwork was improved after checklist implementation. Comparative analyses of per-procedure and safety outcomes did not differ between the pre- and post-checklist implementation. Conclusion Adoption of an endoscopy checklist before colonoscopy is feasible, and significantly increases perception of team communication and teamwork. Additional studies are needed to assess the generalizability of these results to complex endoscopic procedures and to characterize any improvement in patient safety outcomes.

scholarly journals A Quality Improvement Initiative to Reduce Postoperative Delirium among Cardiac Surgery Patients

Geriatrics ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 111
Author(s):  
Rohan M. Sanjanwala ◽  
Brett Hiebert ◽  
David Kent ◽  
Sandy Warren ◽  
Hilary Grocott ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Improvement ◽  
Patient Care ◽  
Postoperative Delirium ◽  
Care Program ◽  
Health Care Team ◽  
Care Process ◽  
Care Bundle ◽  
Quality Improvement Initiative ◽  
Process Measures

Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions.

scholarly journals 2348. Incorporating Electronic Medical Record Hard Stops to Reduce Inappropriate Clostridioides difficile Testing at an Academic Medical Center: A Quality Improvement Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S807-S808
Author(s):  
Seetha Lakshmi ◽  
Kimberly Atrubin ◽  
Andrew Myers ◽  
Jonathan Teter ◽  
Ripal Jariwala ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Quality Improvement Initiative ◽  
Process Measures ◽  
Clostridioides Difficile ◽  
Phone Calls

Abstract Background Clostridioides difficile is the most common pathogen causing healthcare-associated infections. This study highlights the multi-disciplinary efforts to reduce C. difficile infections (CDI) at a large, tertiary care teaching facility. Methods A quality improvement study was performed between March 2017 and April 2018, using six Plan-Do-Study-Act cycles that included transmission prevention, diagnostic stewardship, education, and antimicrobial stewardship. Process measures included hand hygiene, isolation precautions, low-level disinfection compliance, number of tests ordered, lab cancelation of tests, and compliance with the Electronic Medical Record (EMR) hard stop for patients with laxative use, and negative C.difficile test in the past 7 days. Results A total of 2,046 C. difficile tests were ordered during the initiative. Of the 124 patients with a positive C. difficile LabID event, 50% were male with a median age of 65 years (range: 11–92 years). A 53% reduction in C. difficile LabID events (7.5 to 4 events per 10,000 patient-days, P < 0.001), with a pronounced decrease between cycle 4 and 5 (5.4 to 2.9 events per 10,000 patient-days, P < 0.001) was achieved. The largest decrease in C. difficile lab tests ordered was seen after implementation of the EMR hard-stop (cycle 5), with fewer than 0.5 LabID events per 1,000 patient-days for each subsequent month after EMR hard-stop implementation. Frequent reasons for physician phone calls to Infection prevention department was related to chronic use of lactulose in patients with cirrhosis (30%) and unexplained diarrhea (70%). Based on provider feedback, EMR changes were made to remove lactulose from the hard-stop and offer infectious disease consultation upfront. There was 99% compliance with electronic medical record hard stop. There was a nonsignificant increase in lab cancelations due to inappropriate stool specimens over time (1.9% to 3.1% from cycle 1 to 6, P = 0.28) A 55% reduction in hospital-onset CDI surveillance events (from 6.9 to 3.2 per 10,000 patient-days, P < 0.001) was noted. Conclusion A multi-disciplinary Quality Improvement initiative is a successful strategy in reducing CDI events, with the largest decrease seen with introduction of EMR hard stops. Disclosures All authors: No reported disclosures.

scholarly journals Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story

2016 ◽  
Vol 8 (2) ◽  
pp. 214-218 ◽  
Author(s):  
Syed Ahmed Hussain ◽  
Camelia Arsene ◽  
Corinne Hamstra ◽  
Tess H. Woehrlen ◽  
Wilhelmine Wiese-Rometsch ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pay For Performance ◽  
Medical Center ◽  
Stroke Care ◽  
Care Process ◽  
Quality Improvement Initiative ◽  
Optimal Care ◽  
Process Measures ◽  
Resident Participation ◽  
Vte Prophylaxis

ABSTRACT  In 2014, the Detroit Medical Center launched a new program to engage residents and fellows in a strategy to deliver optimal care within 1 year, focusing on quality at an earlier stage of their careers and preparing them for working posttraining.Background  Residents from clinically relevant residency and fellowships programs were selected to be Resident Quality Directors. The project involved development of an interactive electronic health record (EHR) checklist to visually depict real time gaps in 40 process measures, while focusing on 14 areas related to stroke and venous thromboembolism (VTE) prophylaxis. We also implemented an incentive approach, using a pay-for-performance (P4P) model.Methods  The project included 800 residents led by 14 resident quality directors. We were able to achieve 100% resident participation. Prior compliance with VTE quality measures 6 months was 88.5%, with performance increasing to 94.2% (P &lt; .006) at 6 months and 100% at 12 months (P &lt; .005) after the intervention. The VTE prophylaxis score improved from the 89.7% to 92.9% range at inception to 100% by 12 months. A similar steady improvement of stroke process measures was observed, with a 100% compliance within 12 months. The institution made 4 incentive payments to trainees (ranging from $300 to $4,000 per year). The remaining 26 process measures remained at goal with above 95% compliance.Results  This quality improvement initiative was associated with system-wide quality performance on VTE prevention and stroke care process measures, which was facilitated by a interactive EHR-based checklist and linkage to P4P incentive payments.Conclusions

scholarly journals Pursuing Perfection: An Asthma Quality Improvement Initiative in School-Based Health Centers with Community Partners

2008 ◽  
Vol 123 (6) ◽  
pp. 717-730 ◽  
Author(s):  
Mona E. Mansour ◽  
Barbara Rose ◽  
Kim Toole ◽  
Carolyn P. Luzader ◽  
Harry D. Atherton
Keyword(s):  
Quality Improvement ◽  
Health Centers ◽  
Quality Improvement Initiative ◽  
Community Partners ◽  
Process Measures ◽  
Activity Restriction ◽  
School Based ◽  
Children With Asthma ◽  
Ed Visits ◽  
School Based Health Centers

This article describes an innovative asthma quality improvement initiative conducted in school-based health centers (SBHCs) with collaboration among multiple community partners including the children's hospital, a federally qualified health center, the health department, the public school, and parents of children with asthma. The aim was to improve the health of children with asthma in these schools, as measured by minimal asthma-related activity restriction and reduction in asthma-related emergency department (ED) visits. Process measures tracked included the percent of children with ( 1) asthma severity classified, ( 2) persistent asthma with controller medication prescribed, and ( 3) written care plans. Data supported a statistically significant decreasing trend for the percent of SBHC children reporting activity restriction due to asthma. In addition, trend analysis demonstrated a statistically significant difference in ED visits for asthma in the SBHC group compared with a non-SBHC group. Improvements were demonstrated for all process measures. Factors contributing to success included emphasis on community engagement, transparency in sharing ideas and results, benefits outweighing human resource costs of participating, readily available data to drive improvement, and the use of multiple intervention strategies.

Caring for the healthcare professional

2018 ◽  
Vol 32 (3) ◽  
pp. 402-415 ◽  
Author(s):  
Keith Adamson ◽  
Nancy Searl ◽  
Sonia Sengsavang ◽  
John Yardley ◽  
Mark George ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Compassion Fatigue ◽  
Positive Impact ◽  
Quality Improvement Initiative ◽  
Emotional Impact ◽  
Content Type ◽  
Culture Of Care ◽  
Quality Patient Care ◽  
Quantitative Descriptive ◽  
The Impact

Purpose Hospitals must systematically support employees in innovative ways to uphold a culture of care that strengthens the system. At a leading Canadian academic pediatric rehabilitation hospital, over 90 percent of clinicians viewed Schwartz Rounds™ (SR) as a hospital priority, resulting in its formal implementation as a quality improvement initiative. The purpose of this paper is to describe how the hospital implemented SR to support the socio-emotional impact of providing care. Design/methodology/approach This quantitative descriptive study provides a snapshot of the impact of each SR through online surveys at four assessment points (SR1-SR4). A total of 571 responses were collected. Findings All four SR addressed needs of staff as 92.9-97.6 percent of attendees reported it had a positive impact, and 96.4-100 percent of attendees reported each SR was relevant. Attendees reported significantly greater communication with co-workers after each SR (p<0.001) and more personal conversations with supervisors after SR2 and SR4 (p<0.05) compared to non-attendees. Attending SR also increased their perspective-taking capacity across the four SR. Practical implications As evidenced in this quality improvement initiative, SR addresses staff’s need for time to process the socio-emotional impacts of care and to help reduce those at risk for compassion fatigue. SR supports and manages the emotional healthcare culture, which has important implications for quality patient care. Originality/value This research details an organization’s process to implement SR and highlights the importance of taking care of the care provider.

scholarly journals Pain, agitation and delirium assessment and management in a community medical-surgical ICU: results from a prospective observational study and nurse survey

2018 ◽  
Vol 7 (4) ◽  
pp. e000413 ◽  
Author(s):  
Ramez Maximous ◽  
Franziska Miller ◽  
Carolyn Tan ◽  
Mercedes Camargo ◽  
Katie Ross ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Demographic Data ◽  
Clinical Information ◽  
Quality Improvement Initiative ◽  
Delirium Assessment ◽  
Process Measures ◽  
Care Gap ◽  
Mortality And Morbidity ◽  
Daily Data ◽  
Surgical Icu

BackgroundDelirium is a common manifestation in the intensive care unit (ICU) that is associated with increased mortality and morbidity. Guidelines suggested appropriate management of pain, agitation and delirium (PAD) is crucial in improving patient outcomes. However, the practice of PAD assessment and management in community hospitals is unclear and the mechanisms contributing to the potential care gap are unknown.ObjectivesThis quality improvement initiative aimed to review the practice of PAD assessment and management in a community medical-surgical ICU (MSICU) and to explore the community MSICU nurses’ perceived comfort and satisfaction with PAD management in order to understand the mechanisms of the observed care gap and to inform subsequent quality improvement interventions.MethodsWe prospectively collected basic demographic data, clinical information and daily data on PAD process measures including PAD assessment and target Richmond Agitation-Sedation Scale (RASS) score ordered by intensivists on all patients admitted to a community MSICU for >24 hours over a 20-week period. All ICU nurses in the same community MSICU were invited to participate in an anonymous survey.ResultsWe collected data on a total of 1101 patient-days (PD). 653 PD (59%), 861 PD (78%) and 439 PD (39%) had PAD assessment performed, respectively. Target RASS was ordered by the intensivists on 515 PD (47%). Our nurse survey revealed that 88%, 85% and 41% of nurses were comfortable with PAD assessment, respectively.ConclusionsDelirium assessment was not routinely performed. This is partly explained by the discomfort nurses felt towards conducting delirium assessment. Our results suggested that improvement in nurse comfort with delirium assessment and management is needed in the community MSICU setting.

scholarly journals Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department

2020 ◽  
Vol 9 (1) ◽  
pp. e000811
Author(s):  
Sameer Masood ◽  
Victoria Woolner ◽  
Joo Hyung Yoon ◽  
Lucas B Chartier
Keyword(s):  
Quality Improvement ◽  
Head Injury ◽  
Ct Scan ◽  
Head Injuries ◽  
Healthcare Utilisation ◽  
Ct Scans ◽  
Quality Improvement Initiative ◽  
Statistical Process ◽  
Process Measures ◽  
Specific Patient

Over 90% of patients with head trauma seen in emergency departments (EDs) are diagnosed with minor head injuries. Over-utilisation of CT scans results in unnecessary exposure to radiation and increases healthcare utilisation. Using recommendations from the Choosing Wisely Canada (CWC) campaign and quality improvement (QI) methodology, we aimed to reduce the CT scan rate for head injuries by 10% over a 6-month period.Baseline CT scan rates were determined through a 27-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and Plan-Do-Study-Act (PDSA) cycles, which included (1) improving provider knowledge about the CWC campaign recommendations; (2) testing, refining and implementing a modified Canadian CT Head Rule checklist; (3) developing CWC-themed head injury–specific patient handouts; and (4) feedback on CT scan group ordering rates to providers. Our primary outcome measure was the number of CT scans performed for patients with head injuries. Process measures included the number of checklists completed and ED length of stay (LOS). Our balancing measure was return ED visits within 72 hours (with or without admission).Baseline CT scan rates prior to our interventions was 46.1%. Our QI initiative resulted in a ‘shift’ in the Statistical Process Control chart of the weekly CT scan rates, associated with the first and second PDSA cycles, resulting in a 13.9% reduction in CT rates during the initial 3 months, and a sustained reduction of 8% at 16 months (p<0.05). Mean ED LOS for all patients with head injuries decreased by 1.5 min (p=0.74). 33% of checklists were completed. 72-hour return visits did not change significantly (p=0.68).Through provider and patient education, and the creation of a user-friendly evidence-based tool, our local QI initiative was successful in achieving long-term reduction in CT rates for patients presenting to EDs with head injuries.

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