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 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.

scholarly journals Exploration of a quality improvement process to standardised preoperative tests for a surgical procedure to reduce waste

2021 ◽  
Vol 10 (3) ◽  
pp. e001570
Author(s):  
Rabia Shahid ◽  
Malone Chaya ◽  
Ian Lutz ◽  
Brian Taylor ◽  
Lily Xiao ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Root Cause Analysis ◽  
Quality Improvement Project ◽  
Improvement Strategy ◽  
Improvement Project ◽  
Cause Analysis ◽  
Quality Improvement Process ◽  
Root Cause ◽  
Time To Build ◽  
Unnecessary Testing

BackgroundPreoperative tests are done to determine a patient’s fitness for anaesthesia and surgery.Local problemAlthough routine tests before surgery in the absence of specific clinical indications are not recommended, we observed high volumes of routine preoperative tests were performed in our institution. We describe a process to implement a standardised preoperative investigational approach to reduce unnecessary testing before surgeries.MethodsA series of six Plan-Do-Study-Act (PDSA) cycles was conducted for root cause analysis and process mapping, development of standardised tool (GRID), collection of baseline data, education and feedback, pilot testing and implementation and uptake of GRID.Root cause analysis revealed a lack of awareness of guidelines and a lack of a standardised tool to guide preoperative testing. We undertook a pilot quality improvement project to reduce unnecessary testing before knee and hip arthroplasty by developing and implementing a standardised tool (GRID) and engaging all stakeholders.InterventionsA clinical development team (CDT) was formed, including all the stakeholders. Our CDT focused on a continuous rapid cycle improvement strategy.ResultsAfter implementation of the tool in a subgroup of patients undergoing elective hip or knee arthroplasty, unnecessary coagulation tests (activated partial thromboplastin time and the international normalised ratio), electrolyte/renal panel tests and electrocardiograms were reduced by 81% (91%–17%), 81% (41%–7%) and 68% (35%–11%), respectively. No surgery was delayed or cancelled due to tests not performed before surgery.ConclusionsA standardised preoperative investigational approach based on patients’ medical conditions rather than routine testing can reduce unnecessary tests before surgery. Further, implementing guidelines is more complex than developing guidelines. Hence, continuous PDSA cycles are essential to evaluate the processes in a quality improvement project. It can take time to build teams and have shared goals; however, once this is achieved, the success of a quality improvement project is certain.

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 1: Preparing for a quality improvement project in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 104-111 ◽  
Author(s):  
Lucas B. Chartier ◽  
Amy H.Y. Cheng ◽  
Antonia S. Stang ◽  
Samuel Vaillancourt
Keyword(s):  
Quality Improvement ◽  
Professional Training ◽  
Problem Statement ◽  
Improvement Project ◽  
Team Members ◽  
Root Cause ◽  
Change Team ◽  
Patient Safety Incidents

ABSTRACTEmergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses—Ishikawa diagrams, Pareto charts and process mapping—and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

Root Cause Analysis for Pin Leakage

2016 ◽  
Author(s):  
Zhigang Song ◽  
Jochonia Nxumalo ◽  
Manuel Villalobos ◽  
Sweta Pendyala
Keyword(s):  
Failure Analysis ◽  
Root Cause Analysis ◽  
Advanced Technology ◽  
Process Step ◽  
Cause Analysis ◽  
Hard Mask ◽  
Technology Node ◽  
Root Cause ◽  
Tools And Techniques

Abstract Pin leakage continues to be on the list of top yield detractors for microelectronics devices. It is simply manifested as elevated current with one pin or several pins during pin continuity test. Although many techniques are capable to globally localize the fault of pin leakage, root cause analysis and identification for it are still very challenging with today’s advanced failure analysis tools and techniques. It is because pin leakage can be caused by any type of defect, at any layer in the device and at any process step. This paper presents a case study to demonstrate how to combine multiple techniques to accurately identify the root cause of a pin leakage issue for a device manufactured using advanced technology node. The root cause was identified as under-etch issue during P+ implantation hard mask opening for ESD protection diode, causing P+ implantation missing, which was responsible for the nearly ohmic type pin leakage.

Root cause analysis of primary reformer catastrophic failure: A case study

2010 ◽  
Vol 30 (1) ◽  
pp. 62-65
Author(s):  
Naveed Ramzan ◽  
Shahid Naveed ◽  
Muhammad Rizwan ◽  
Werner Witt
Keyword(s):  
Root Cause Analysis ◽  
Catastrophic Failure ◽  
Cause Analysis ◽  
Root Cause

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.

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