scholarly journals Quality improvement primer part 2: executing a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (4) ◽  
pp. 532-538 ◽  
Author(s):  
Lucas B. Chartier ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Improvement Project ◽  
Emergency Department Setting ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
Final Article

ABSTRACTThe topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement. We will review what makes a good aim statement, the various categories of measures that can be tracked during a QI project, and the relative merits and challenges of potential change concepts and ideas. We will also present the Model for Improvement’s rapid-cycle change methodology, the Plan-Do-Study-Act (PDSA) cycle. The final article in this series will focus on the evaluation and sustainability of QI projects.

Using Lean methodology to improve the time to antibiotics in oncology patients on chemotherapy who present to the ED with neutropenic fever.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 31-31
Author(s):  
Brian J. Byrne ◽  
Frederick Bailey ◽  
Pat Montanaro ◽  
Patricia Anne DeFusco
Keyword(s):  
Quality Improvement ◽  
Substantial Improvement ◽  
Neutropenic Fever ◽  
Medical Emergency ◽  
Antibiotic Administration ◽  
Improvement Project ◽  
The Third ◽  
Pdsa Cycle ◽  
Time To Antibiotics ◽  
American Society

31 Background: Neutropenic fever is a medical emergency. Delays in treatment can lead to increase in morbidity, mortality, and increase length of stay. The American Society of Clinical Oncology currently recommends that antibiotics be prescribed within 60 minutes of triage. Literature review shows through a multidisciplinary effort involving the ED, lab, oncology, and pharmacy significant improvement in time to antibiotics can be achieved. Since many patients with neutropenic fever present with sepsis, these guidelines also will need to be followed. Methods: Three PDSA cycles were conducted. The first involved education of the ED staff on the importance of treating neutropenic fever and using the correct antibiotic. The second PDSA cycle involved the laboratory and the calling of critical white counts and low neutrophil counts. The third PDSA involves patient education on the importance of temperature monitoring and reporting they are on chemotherapy to ED staff. Results: Baseline data show only 33% of patients receive the correct antibiotic and the average time to administration is 3 hours and 41 minutes. Results of the quality improvement project show a substantial improvement in time to antibiotic administration to 1 hour 58 minutes and an increase in the percentage of patients who receive the correct antibiotic. The time from the specimen received in the lab until critical called also improved from 1 hour 14 minutes to 18.5 minutes. Conclusions: This quality improvement led to a significant improvement in time to correct antibiotics, but several additional steps need to be taken to meet ASCO guidelines. [Table: see text]

Ninety to Nothing: a PDSA quality improvement project

2018 ◽  
Vol 31 (4) ◽  
pp. 361-372 ◽  
Author(s):  
Gayle Linda Prybutok
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Patient Care ◽  
Care Delivery ◽  
Quality Improvement Project ◽  
Care Hospital ◽  
Emergency Department Care ◽  
Improvement Project ◽  
Content Type

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

scholarly journals Quality improvement primer part 3: Evaluating and sustaining a quality improvement project in the emergency department

CJEM ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 261-268 ◽  
Author(s):  
Lucas B. Chartier ◽  
Samuel Vaillancourt ◽  
Amy H. Y. Cheng ◽  
Antonia S. Stang
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Stakeholder Engagement ◽  
Improvement Project ◽  
Cause Analysis ◽  
Root Cause ◽  
The Third ◽  
Academic Fields ◽  
Measurement And Evaluation

AbstractQuality improvement (QI) and patient safety are two areas that have grown into important operational and academic fields in recent years in health care, including in emergency medicine (EM). This is the third and final article in a series designed as a QI primer for EM clinicians. In the first two articles we used a fictional case study of a team trying to decrease the time to antibiotic therapy for patients with sepsis who were admitted through their emergency department. We introduced concepts of strategic planning, including stakeholder engagement and root cause analysis tools, and presented the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles as the backbone of the execution of a QI project. This article will focus on the measurement and evaluation of QI projects, including run charts, as well as methods that can be used to ensure the sustainability of change management projects.

scholarly journals A Quality Improvement Project Regarding Breastfeeding Practices Among Postnatal Mother of Infants Who are Admitted in SNCU of A Selected Health Care Setting

2020 ◽  
Vol 2 (1) ◽  
pp. 49-56
Author(s):  
Papiya Bera Saha ◽  
Smritikana Mani ◽  
Govinda Chandra Das
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Family Members ◽  
Improvement Project ◽  
Team Members ◽  
The Third ◽  
Breastfeeding Practices ◽  
Pdsa Cycle ◽  
The Family ◽  
Breastfeeding Practice

Breast milk is unquestionably the best milk for the baby. From 1sthour  to first six months of life, infants should be exclusively breastfed to achieve growth & development, but most of the time this objective is not fulfilled. So to improve the practice  of breastfeeding we collected  the baseline data  from selected unit ,we observed that the breastfeeding rate of the postnatal  mothers is only 48%. Even after a lot  of effort ,we could not achieve breastfeeding practice in our SNCU before starting our project. Then we started structured and plannedprogramme in the form of PDSA cycle for 45 days. The study was adopted to increase  breastfeeding  practice rate from 48% to 80% in 6 weeks among mother in the infants of SNCU. In this  QI project  applied on 25 postnatal mother of infants who are admitted in SNCU of RG Kar Medical College & Hospital,Kolkata. Data was collected by valid feeding register and  observation checklist. For the implementation of the project, a team was formed & a meeting was carried out  among  the team members. The team found the root cause analysis by fishbone model. The team members decided to carry out PDSA cycles at the interval of 15 days for carrying out three consecutive cycles, Where the first cycle deals with motivating the health care staffs ,mothers in SNCU as well as postnatal ward, the second cycle deals with  providing IEC materials  and privacy of themother during breastfeeding and the third PDSA cycle deals with involving  the family members of the mother. After 1st PDSA cycle we have achieved an increase of  only 4% of breastfeeding practice rate  in the selected unit.After 2nd PDSA cycle we have achieved an increased rate of 14% of breastfeeding practice. The team observed even after 2nd PDSA cycle we did not achieve our goal, then after involving the family members in the third PDSA cycle ,we  have observed a dramatic increase in the breastfeeding practice rate  upto 80%. The study concluded that  simple planned QI group effort  can improve the breastfeeding practice  rate in the  any unit.   Keywords: quality improvement, breastfeeding practices, postnatal mother, PDSA, SNCU, health care settings

scholarly journals ‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

2018 ◽  
Vol 7 (3) ◽  
pp. e000196 ◽  
Author(s):  
Rhea O’Regan ◽  
Ross MacDonald ◽  
James G Boyle ◽  
Katherine A Hughes ◽  
Joyce McKenzie
Keyword(s):  
Quality Improvement ◽  
Nursing Staff ◽  
Quality Improvement Project ◽  
Care Bundle ◽  
Staff Education ◽  
Pressure Relief ◽  
Improvement Project ◽  
The Third ◽  
Inpatient Diabetes ◽  
Pdsa Cycle

AimsThe Scottish Inpatient Diabetes Foot Audit conducted in 2013 revealed that 57% of inpatients had not had their feet checked on admission, 60% of those at risk did not have pressure relief in place and 2.4% developed a new foot lesion. In response, the Scottish Diabetes Foot Action Group launched the ‘CPR for Feet’ campaign. The aim of this project was to raise awareness of the ‘Check, Protect and Refer’ (CPR) campaign as well as improve the assessment and management of inpatients with diabetes.MethodsA quality improvement project underpinned by Plan-Do-Study-Act (PDSA) methodology was undertaken. The first and second cycles focused on staff education and the implementation of a ‘CPR for Feet’ assessment checklist using campaign guidelines, training manuals and modules. The third and fourth cycles focused on staff feedback and the implementation of a ‘CPR for Feet’ care bundle.ResultsBaseline measurements revealed 28% of patients had evidence of foot assessment. Medical and nursing staff reported to be largely unaware of the ‘CPR for Feet’ campaign (13%). Fifty-two per cent of inpatients with diabetes had their feet assessed and managed correctly following the second PDSA cycle. After completion of the third and fourth PDSA this number improved further to 72% and all staff reported to be aware of the campaign.ConclusionsThe introduction of a ‘CPR for Feet’ care bundle improved the assessment of inpatients with diabetes.

Lessons learned in establishing a quality improvement project to reduce hospital acquired infections in the neonatology ward at a referral hospital in Rwanda

2016 ◽  
Vol 24 (4) ◽  
pp. 341-348 ◽  
Author(s):  
Naasson Gafirimbi ◽  
Rex Wong ◽  
Eva Adomako ◽  
Jeanne Kagwiza
Keyword(s):  
Quality Improvement ◽  
Lessons Learned ◽  
Referral Hospital ◽  
Quality Improvement Project ◽  
Injection Technique ◽  
Improve Quality ◽  
Improvement Project ◽  
Content Type ◽  
Hospital Acquired

Purpose Improving healthcare quality has become a worldwide effort. Strategic problem solving (SPS) is one approach to improve quality in healthcare settings. This case study aims to illustrate the process of applying the SPS approach in implementing a quality improvement project in a referral hospital. Design/methodology/approach A project team was formed to reduce the hospital-acquired infection (HAI) rate in the neonatology unit. A new injection policy was implemented according to the root cause identified. Findings The HAI rate decreased from 6.4 per cent pre-intervention to 4.2 per cent post-intervention. The compliance of performing the aseptic injection technique significantly improved by 60 per cent. Practical implications This case study illustrated the detailed application of the SPS approach in establishing a quality improvement project to address HAI and injection technique compliance, cost-effectively. Other departments or hospitals can apply the same approach to improve quality of care. Originality/value This study helps inform other hospitals in similar settings, the steps to create a quality improvement project using the SPS approach.

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