Pediatric Ambulatory Care Quality Improvement Maria Diaz, MD Pediatric Ambulatory Care St. Barnabas Hospital 10-28-2009

Overview Definitions Aims for improvement in health care Why is QI important for residents ?. Benefits of QI projects. How to start a QI project. Model for Improvement. PDSA cycle. Examples of success using QI. References.

Definitions Quality: Meeting the needs and exceeding the expectations of those we serve. Delivery all and only the care that the patient and family needs.

Definitions Improvement: It is not, Yelling at people to work harder, faster, or safer. Creating order sets or protocols and then failing to monitor their use or effect. Traditional QA. Research (but they can co-exist nicely)

Definitions Healthcare Quality Improvement: is the body of knowledge, attitudes, and skills necessary to efficiently influence and continuously improve the multiple elements of care delivery within a medical practice.

Six specific aims for improvement. Health care should be: Safe: Avoid injuries to patients from the care that is intended to help them. Effective: Avoid overuse of ineffective care and underuse of effective care. Patient-Centered: Providing respectful, responsive, individualized care.

Six specific aims for improvement. Health care should be: Timely: Reducing waits and harmful delays in care. Efficient: Avoiding waste of equipment, supplies, ideas and energy. Equitable: Providing equal care regardless of personal characteristics, gender, ethnicity, geographic location, and socio-economic status.

The Goal for Quality improvement in health care is TO PROVIDE THE RIGHT CARE FOR EVERY PATIENT, EVERY TIME!!

Why is Quality Improvement important for YOU??? Why should you care? Why WE care?

One of the Competencies: Practice Based Learning and Improvement Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Benefits of resident involvement in Quality Improvement. Patient care outcomes Resident learning and professional development Resident engagement and satisfaction Faculty and other team member engagement and satisfaction.

How do I start a QI project?

Model for Improvement The model has two parts: Three fundamental questions, which can be addressed in any order. The Plan-Do-Study-Act (PDSA) cycle to test and implement changes in real work settings.

What are we trying to accomplish? Setting Aims The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected.

How will we know that a change is an improvement? Establishing Measures Use quantitative measures to determine if a specific change actually leads to an improvement

What changes can we make that will result in improvement? Selecting Changes All improvement requires making changes, but not all changes result in improvement. Therefore we must identify the changes that are most likely to result in improvement.

The Model for Improvement Setting Aims Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected. Establishing Measures Teams use quantitative measures to determine if a specific change actually leads to an improvement. Selecting Changes All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement. Testing Changes The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.  

Testing changes: The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.

Wheels in Motion: Continuous Quality improvement

Implementing Changes After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team can implement the change on a broader scale — for example, for an entire pilot population or on an entire unit.

Spreading Changes After successful implementation of a change or package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization or in other organizations.

Quality Improvement

How hospitals and clinics have shown success using QI. Mortality has declined. Rates of adverse events have decreased. The cost of care in ICU has seen a gradual decline. Critically ill patients have been recognized early by medical response teams.

References Road Map for Quality Improvement. Manoj Jain, MD MPH. Institute for Healthcare Improvement. www.ihi.org American Medical Association. www.ama-assn.org.

Wait until you finish your residency!!

Be Happy!!