Improving WeeFIM score completion rates: An interdisciplinary inpatient rehabilitation unit quality improvement project

2021 ◽  
pp. 1-8
Author(s):  
Ashlee Jaffe ◽  
Maura Powell ◽  
Tami Konieczny ◽  
Carlene Osweiler ◽  
Genna Kreher
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Inpatient Rehabilitation ◽  
Visualization Tool ◽  
Completion Rates ◽  
Intervention Period ◽  
Rehabilitation Unit ◽  
Improvement Project ◽  
Comprehensive Therapy ◽  
Therapy Services

PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation units. This Quality Improvement (QI) project aimed for 95%of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0%to 95%during the intervention period. On-time discharge completion rates increased from 0%to 89%during the intervention period. This change has been sustained over 2 years with on-time admission and discharge scores averaging 79.4%and 77.9%respectively, and 96.4%of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.

The Journey of the Purple Butterfly: A Quality Improvement Initiative

2021 ◽  
pp. 104990912110141
Author(s):  
Jessica O’Brien Gufarotti ◽  
Anna Krakowski
Keyword(s):  
Quality Improvement ◽  
Interdisciplinary Team ◽  
Urban Setting ◽  
Quality Improvement Initiative ◽  
Communication Tool ◽  
Patient Centered ◽  
Improvement Project ◽  
Comfort Care ◽  
Team Members ◽  
Job Duties

Introduction: Dying in the hospital is not always a good experience for patients and their families. To be more in line with evidence-based practices for healthcare workers to effectively support high quality end of life care, the project team implemented a standardized communication tool to alert interdisciplinary team members of patients on comfort care measures. Methods: Purple Butterfly was a quality improvement project that was implemented at a diverse community hospital in the urban setting. Clinical and non-clinical interdisciplinary team members participated in a pre- and post- implementation survey to assess the need for a standardized communication tool that would alert them of patients who transitioned to comfort care. Results: Pre-implementation, 37% of survey respondents (n = 60) reported they were always aware of the presence of a patient on comfort care measures prior to entering the room. After implementation of a standardized communication tool, 100% (n = 43) of respondents at 9 months, reported that they were always aware of the presence of a patient on comfort care measures prior to entering the room. Additionally, 9 months post-intervention 100% of respondents reported that knowing this contextual information supported them in performing their job duties in a compassionate, patient-centered fashion. Conclusion: Implementation of a standardized communication tool increased awareness for team members, about the presence of patients on comfort care measures prior to entering the room and supported team members to perform their job duties in a compassionate, patient-centered fashion supportive of this patient population.

Staged Interventions to Improve Quality and Reduce Cost of Care in Patients with Suspected Heparin-Induced Thrombocytopenia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2262-2262
Author(s):  
Bethany T Samuelson ◽  
Meredith Holmes ◽  
Andrew White ◽  
Emily Glynn ◽  
Daniel B Martin ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Conflicts Of Interest ◽  
Cost Of Care ◽  
Enzyme Linked Immunosorbent Assay ◽  
Intervention Period ◽  
Order Entry ◽  
Improvement Project ◽  
Heparin Induced Thrombocytopenia ◽  
Elisa Testing ◽  
Computer Based

Abstract Background Heparin induced thrombocytopenia (HIT) is a rare but often considered diagnosis that requires treatment, in the form of costly parenteral anticoagulants, while awaiting the results of confirmatory testing. We hypothesized that improving the accuracy and consistency with which a patient's risk of HIT was determined, through the use of Computer-based Provider Order Entry (CPOE) interventions, would lead to decreased cost of care. Methods This study was conducted out of two affiliated US academic medical centers with a shared electronic medical record (EMR). A series of staged interventions, including provider and pharmacist education, real-time alerts and a CPOE based decision support tool were implemented as part of a multidisciplinary quality improvement project between January 1, 2013 and December 31, 2013. All inpatients ³18 years of age who underwent laboratory testing for HIT and/or were started on bivailrudin therapy for suspected HIT between January 1, 2012 and December 31, 2014 were included. For the purposes of our study, we defined the pre-intervention period as January 1 through December 31, 2012 and the post-intervention period as January 1 through December 31, 2014. The primary outcome was mean monthly bivalirudin expenditure at each institution. The secondary outcomes were number of HIT enzyme-linked immunosorbent assay (ELISA) and serotonin release assay (SRA) tests sent per month. Results We observed a statistically significant reduction in mean monthly bivalirudin expenditures from $64,178 to $17,704 (p = 0.0002) at one of the included centers and a decrease that approached significance from $28,275 to $16,708 (p = 0.100) at the other. Statistically significant reductions were also noted in mean monthly ELISA testing rates from 38.1 to 19.8 (p=0.01) and mean monthly SRA testing rates from 9.4 to 3.1 (p=0.0001) across both centers. Discussion Our findings suggest that the use of a computer-based order entry intervention, as part of a multidisciplinary quality improvement effort, can effectively reduce cost and decrease rates of lab testing in the management of heparin-induced thrombocytopenia. Such interventions are relatively low cost and of low complexity in institutions with established order entry systems and have the potential for a lasting impact on cost and quality of care. Disclosures No relevant conflicts of interest to declare.

Poster 146: ProKids - Increasing Admissions to Acute Pediatric Inpatient Rehabilitation: A Quality Improvement Project

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S50-S50
Author(s):  
Erin M. Conlee ◽  
Amanda B. Theuer ◽  
Noelle B. Henning ◽  
Linda M. Pirius ◽  
Katie E. Cossette ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Inpatient Rehabilitation ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Pediatric Inpatient

scholarly journals 54 A Quality Improvement Project on the Recording of Stool Charts

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
D Perera ◽  
M Kaneshamoorthy ◽  
Z Burdon ◽  
A O'Brien
Keyword(s):  
Quality Improvement ◽  
Variable Number ◽  
Quality Improvement Project ◽  
Completion Rates ◽  
Short Term ◽  
Improvement Project ◽  
Key Stakeholders ◽  
Sustained Change ◽  
Multidisciplinary Staff ◽  
Prompt Action

Abstract Introduction Change in bowel movement is a common complaint in frail patients, which can be indicative of conditions such as constipation, infection or malnutrition. Without prompt action, this can result in increased length of stay. The recording of stools can be variable. This quality improvement project was to improve stool chart completion rate and staff confidence. Methods We conducted two Plan-Do-Study-Act cycles over three months. We surveyed multidisciplinary staff confidence using Likert scales covering each element on the Bristol stool chart. We then reviewed patient stool charts. The first intervention was a poster. The second intervention was the addition of a sticker to the charts to help staff more easily identify them in the patient’s bedside notes. Staff-wide emails were sent to inform every one of the interventions and key stakeholders including ward managers were asked to hand this over. Results 44 multidisciplinary staff were interviewed and 217 individual stool charts assessed over a 3 month period. 43% of stool charts were not filled in as directed after the first cycle. Posters improved staff confidence in filling out the charts from 72.3% to 92.3% after the second cycle, while 61% of stool charts came to be filled in correctly - over the initial 57%. Healthcare assistants consistently scored the highest in terms of believing charts to be up to date being whereas doctors remained the most cynical. There was little sustained change in stool chart completion rates after three PDSA cycles. Eventually, after both interventions, completion rates returned to baseline. Conclusions Stool chart completion rates can be improved in the short term, but sustainability is a challenge. Factors contributing to this include the variable number of agency nurses. Further improvements include teaching at the nursing induction.

scholarly journals Practice-Based Learning and Systems-Based Practice: Detection and Treatment Monitoring of Generalized Anxiety and Depression in Primary Care

2010 ◽  
Vol 2 (3) ◽  
pp. 474-477 ◽  
Author(s):  
Melanie Zupancic ◽  
Siegfried Yu ◽  
Rajeev Kandukuri ◽  
Shilpa Singh ◽  
Anna Tumyan
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Care Setting ◽  
Primary Care Setting ◽  
Routine Screening ◽  
Anxiety And Depression ◽  
Generalized Anxiety ◽  
Intervention Period ◽  
Improvement Project ◽  
Treatment Changes

Abstract Objectives Quality assurance/quality improvement projects are an important part of professional development in graduate medical education. The purpose of our quality improvement study was to evaluate whether (1) the Generalized Anxiety Disorder (GAD-7) scale questionnaire increases detection of anxiety and (2) the Quick Inventory for Depressive Symptomatology Self Report (QIDS-SR) increases detection of depression in a primary care setting. We also aimed to determine whether monitoring patients with depression or generalized anxiety using the QIDS-SR and GAD-7 scales influences treatment changes in the primary care setting. Methods Patients seen in a general internal medicine clinic between August 2008 and March 2009 were asked to fill out the QID-SR questionnaire and GAD-7 as part of a resident quality improvement project. We measured the prevalence of anxiety and depression during 6 months prior to the use of the GAD-7 and QIDS-SR instruments during the intervention period. We also compared the frequency of treatment changes initiated both 12 months prior to and during the intervention period. The aforementioned measures were performed with use of a retrospective chart review. Results The prevalence of anxiety was 15.2% in the pre-intervention period and 33.3% in the intervention period, and the prevalence of depression was 38.9% in the prescreening period and 54.8% during the screening period (P value for both was <0.001). The change in anxiety therapy was 21.6% in the prescreening period and 62.2% in the screening period (P  =  .028). The change in depression therapy was 23.2% in the pre-intervention period and 52.1% in the intervention period (P  =  .025). Conclusion Routine screening for depression and anxiety may help clinicians detect previously undiagnosed anxiety and depression and also may facilitate identification of needed treatment changes. Further work is needed to determine whether routine screening improves patient outcomes.

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