Quality Improvement Team Scenario

  Quality Improvement Team Scenario Order Description   A defining characteristic of quality improvement is to demonstrate that the strategy for change works to bring about a measurable difference in process or outcome. Measurement for improvement monitors systems and processes over time (dynamic, continuous measurement); whereas traditional statistics are usually used to identify differences between groups (static, cross-sectional). The two main measurement tools are run charts and statistical process control charts. Run charts and control charts use the principle of replication to demonstrate whether a change has occurred from preintervention (baseline phase) to postintervention (implementation phase). Applying the rules for interpretation can help determine whether the variation in a process is due to common or special causes. These rules include identification of runs, trends, and out-of-control points. The interpretation of this variability directs action on the processes of a system. Measurement for improvement and the interpretation of the variability in processes or outcomes is a key to the success of quality improvement efforts in health care. Study Questions You are a member of your unit's cardiothoracic surgery quality improvement team. Surgery has always been fascinating to you, and heart and lung surgery is the most interesting of all. You enjoy the clinical work, and this hospital is a new member of a regional consortium that is focused on improving all aspects of their coronary artery bypass graf (CABG) surgeries. What an opportunity to combine your love of surgery as a discipline and learn to improve care for surgical patients! Throughout the first week, you notice that the team waits for a serum potassium level before the patient can come off the heart/lung bypass machine. This is important because patients who are on the bypass machine for a longer period have more complications. In the first six cases this week, it has taken between 12 and 40 minutes for the "stat" potassium level to be reported by the lab. Everyone in the operating room (OR) "knows that the lab is slow," but you wonder what is really happening with this process. One morning later this week, the first case of the day for your team is canceled. Instead of catching up on some reading, you decide to follow a stat potassium sample from the other OR to the lab and back. You make some notes and create a deployment-type flowchart of the sample's journey (see Figure 7-9 on page 117) 1. How can you use the information in the XmR chart shown in Figure 7-10 to describe the current system? a. Are there any signals that there may be special cause variation in the process? b. What does it mean to have common cause variation in this process? c. If no changes are made to the system, how long do you anticipate it would take for the next stat potassium sample to be reported? After you review the process diagram and the chart with the team, everyone is impressed with your knowledge and assessment of the system. One of the nurse anesthetists recommends that the lab call directly to the OR instead of relaying the message through the surgical clerk. The lab agrees to try this change for a week, and stat potassium turnaround times from the eight cases that week are added to the XmR chart (see Figure 7-11 on page 119). 2. What has happened to the performance of the system? a. Are there any signals that there may be special cause variation in the process? b. Is the system functioning at its goal of a stat potassium turnaround time of less than 15 minutes? How can you tell? c. What happened to the UCL and LCL? Why? d. What else does this chart tell you?