Medicine and Health Sciences Commons^™

Improving Patient Experience And Education By Leveraging Technology, Cathy Palleschi, Wendy Osgood, Mark Parker, Cecilia Inman, Alicia Russell, Eileen Shanahan, Erin Pappal

Operational Transformation

It is estimated that 65% of the population are visual learners. With that in mind, a team of cardiac nurses in a large academic tertiary hospital developed a quality improvement project to hopefully improve patient engagement as well the patients’ perception that the nurses explained things in a manner that they could understand.

Baseline patient survey scores for the question, “Nurses Explained Things In A Way That I Understand”, were under the 75^thpercentile for a period of 9 months. A root cause analysis was conducted and it demonstrated numerous reasons for this score.

Several countermeasures were instituted to …

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operational Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Improving Patient Flow By Increasing Early Discharges On A Mother & Baby Unit, Faye Weir, Joy Moody, Kathleen Cyr, Cathy Palleschi, Stephen Tyzik, Joseph East, Heidi Morin, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Discharging patients early in the day has many advantages amongst which is increased bed availability. However, the experience in a large academic tertiary medical center demonstrated that most discharges occurred early to mid afternoon. A care team on a mother /baby unit established a quality improvement project to increase the number of discharges by 11AM and streamline key discharge planning activities.

A root cause analysis identified multiple barriers to attaining he established goals. To address these barriers, a multi prong approach was instituted to include a discharge education KPI for all unit staff.

Data collection post countermeasure implementation demonstrated some …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Improving The Workflow And Partnership Between Registration And Clinical Staff In An Outpatient Urgent Care Center, Melissa Fairfield, Bailey Eells, Faye Collins, Joyce Cornish, Stephen Tyzik, Joy Moody, Wendy Osgood, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

An outpatient urgent care unit was experiencing challenges in balancing the need to register patients and delivering care in the timeliest manner as possible. Upon examination, it was found that delays were being experienced in patient triage and discharge that resulted in low patient satisfaction scores.

A team of providers was established to review all process steps and a quality improvement project was created to attain a goal of 100% of the time discharge would not be delayed due to incomplete registration.

Baseline metrics demonstrated current numbers of delayed discharges, median time from door to triage as well as door …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Strengthening Safety Culture By Leveraging The Daily Management System, Suneela Nayak, Mark Parker, Erin Graydon Baker, Amy Sparks, Ruth Hanselman, Stephen Tyzik, Sydney Green

Operational Transformation

STRENGTHENING SAFETY CULTURE BY LEVERAGING THE DAILY MANAGEMENT SYSTEM

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis …

Treating Substance Use Disorders: Enhancing Attendance At The Weekly Inpatient Medication Assisted Treatment Group, Devon Gillis, Jayne Weisberg, Dena Whitesell, Amy Mcauliffe, Amy Sparks, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

Operational Transformation

At a large academic tertiary medical center, an Integrated Medication Assisted Treatment (IMAT) program has been established for those medically stable inpatients with an addiction diagnosis. Over a four month period, this program had experienced a decline in attendance and a quality improvement project was initiated is to better understand the barriers to attendance and institute a process that would reverse the decline.

A goal was established to improve attendance by medically stable patients that have consented to participate to a minimum of 50%.

A root cause analysis outlined numerous causes for low attendance and several countermeasures were established to …

A Coaching And Team Performance Evaluation Model To Build Capacity For High-Impact Lean Improvement, Ruth Hanselman, Mark Parker, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

There is abundant evidence that links a strong culture of safety with improved patient and staff experience. However, there has been no clear avenue identified as to how to achieve this metric.

A team in a large academic tertiary teaching hospital set about leveraging their daily managing system (DMS) to attain improvement in their institution’s safety. The goals of this quality improvement project were to use DMS to identify and report safety concerns and increase frontline team knowledge and comfort with reporting safety concerns during Gemba walks.

A root cause analysis identified 5 areas for improvement and several countermeasures were …

Increase Staff Utilization Of Occlusive Interface In Micro-Preemie Babies On Bcpap, Deborah A. Igo, Kimberly Kingsley, Faythe Henry, Misty Melendi, Amy Mcbee, Valerie Cook, Christopher Woods, Angela Rojecki, Lauren Walley, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operational Transformation

Premature neonates born before 26 weeks gestation present many care challenges as they need special precautions to be taken to overcome their fragility. Intubation is often needed for this patient population as their lungs are not fully developed. However, due to their high susceptibility for skin breakdown invasive ventilation often can create subsequent problems. A respiratory therapist team in an academic tertiary medical center wanted to explore the use of an occlusive interface for intubation while providing various forms of non-invasive ventilation in their NICU with the hopes for fewer complications.

The objective of this project was to reduce the …

Increasing Advanced Care Planning In An Ambulatory Care Setting, Jennifer Aronson, Elizabeth Eisenhardt, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows.

The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC.

Baseline metrics demonstrated that ACP discussion rates …

Nicotine Replacement Therapies To Decrease Withdrawal Symptoms And Improve Patient Experience, Cheryl Pawloski, Holly Stewart, Devon Gillis, Dena Whitesell, Maya Bulman, Christopher Racine, Raymond Serrano, Leslie Gatcombe-Hynes, Elizabeth Mullany, Amy Mcauliffe, Jayne Weisberg, Amy Sparks, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Operational Transformation

Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal.

A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels …

Retrospective Evaluation Of Weight Loss In Maine Medical Center Cancer Institute (Mmcci) Patients Receiving Radiation Treatment For Head And Neck Cancer, Julian Johnson, David Debartolo-Stone, Jessica Moore, Ruth Hanselman, Stephen Tyzik, Suneela Nayak, Amy Sparks

Operational Transformation

Treatment for head and neck cancer often results in weight loss as a side effect. One option to mitigate this weight loss is placement of a percutaneous endoscopic gastrostomy (PEG) tube placement. Radiation oncologists at a academic tertiary medical center discuss the option of PEG placement during patient consultation.

A retrospective evaluation of weight loss in patients receiving radiation was conducted over a two-year period. The goal of this data collection was to create a standard for oncology consultations regarding PEG tube placement.

Baseline metrics and a root cause analysis drove subsequent data collection steps. After analyzing the raw data, …

Increasing First Case On Time Starts In An Ambulatory Surgery Center, Diane Fecteau, Shannan Reid, Sydney Green, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

In an ambulatory surgical center, first case on-time starts directly affects the patient experience. In addition, in order to treat as many patients as possible, delays of first case on-time starts negatively impacts the rest of scheduled surgical patients and increases staff overtime expenditures. An ambulatory surgical team within a large urban health care system initiated a performance improvement initiative to enhance the patient experience, increase staff accountability and care team well-being.

The goal of this project was to start 70% or more first cases on time. Baseline metrics demonstrated that patients and surgeons were the largest cause of delay. …

Increasing Access To Spiritual Care Services In The Emergency Department: A Patient And Staff Support Model, Heather Weidemann, Tia Jamir, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

In trauma centers, there is evidence that interfaith spiritual care reduces emotional distress and improves health outcomes. In order to be effective in providing timely support, chaplains must be integrated into the clinical care team.

In an academic tertiary medical care center, a spiritual care team felt there were numerous missed opportunities to offer support to ED patients and its staff due to lack of being part of the care team. As a result, a performance improvement project was developed with the overall goal of integrating spiritual care into the ED clinical setting.

Baseline metrics and a root cause analysis …

A Provider-Driven Approach To Preventative Oral Care In Nursing Home Facilities, Molly Anderson, Brandon Mccrossin, Kary Franchetti, Ruth Hanselman, Suneela Nayak, Stephen Tyzik, Amy Sparks

Operational Transformation

Oral care is an essential part of preventative medicine as it minimizes risk for pneumonias and other infections. In nursing home settings, often oral health care is not routinely provided due to a number of issues. A health care system that either owns or contracts nursing home facilities initiated a performance improvement plan to address this patient care concern.

The first goal of this project was to reduce the variation in oral care between nursing home facilities within the system. The second goal was 100% of their patients will have one oral health care exam documented in EPIC once a …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operational Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Coordination Of Inpatient And Outpatient Care For Neurology Patients Undergoing Epilepsy Monitoring, Sara Schrock, Michelle Beane, Kathryn Cope, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Brendan Lilley

Operational Transformation

ORGANIZING A SYSTEM TO CONSOLIDATE EPILEPSY REFERRALS TO AN OUTPATIENT NEUROLOGY PRACTICE

An outpatient neurology practice was experiencing delayed or lost referrals for epilepsy monitoring. This delay was leading many patients to suffer unnecessary and unmanaged seizures and, in some cases, frequent trips to the emergency department.

As a result, a team consisting of the neurology practice and neuro-navigators used baseline metrics to demonstrate the current state of the problem and conducted a root cause analysis that outlined several causes. A number of countermeasures were initiated with the goal of decreasing referral misses.

Post the initiation of two KPIs, a …

Sustaining Daily Management With Gemba Walks: A Scheduling Model, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks

Operational Transformation

SUSTAINING DAILY MANAGEMENT WITH GEMBA WALKS: A SCHEDULING MODEL

At an academic tertiary care medical center, there are 110 Operational Excellence teams across 4 campuses. Every weekday, 10 GEMBA walks occur with the 11^th on Wednesdays. The expanding program has made daily leadership visits to all KPIs challenging. As a result, consideration of reduced gemba walks to departments who have met specific maturity/performance criteria.

The scope of the eight-week pilot consisted of 13 pre-identified teams that have weekly workflows. The teams must have met a baseline level of performance. Performance was scored for 9 variables measuring engagement, PDSA, use …

Reducing O Negative Blood Product Usage In A Tertiary Care Academic Medical Center, Wendy Weiler, Tracy Cook, Mmc Blood Bank, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

MANAGEMENT OF O NEGATIVE BLOOD USE

O registered blood cells are the universal donor but it comprises only 7% of the blood supply. As a result, inappropriate use can result in shortages.

At an academic tertiary care medical center, a performance improvement goal was established that O negative blood cells would make up less than 12% of all blood type transfused by the end of their fiscal year.

A root cause analysis established reasons for the use of O negative blood cells. A number of countermeasures were initiated using the plan, do, study, act (PDSA) problem solving model. Using newly …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Strategies To Improve Resource Availability For New Graduate Nurses In A Critical Care Setting, Natasha Stankiewicz, Jonathan Archibald, Shawn Taylor, Deborah Jackson, Bonnie Boivin, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Transformation

STRATEGIES TO IMPROVE RESOURCE AVAILABILITY FOR NEW GRADUATE NURSES

Due to changes in the employment arena, health care organizations are hiring new graduate RNs into acute care. At an academic tertiary medical center, new hires typically are assigned into a night shift, which traditionally has less resource availability.

The results of a recent AHRQ hospital survey on patient culture safety demonstrated that new graduates were feeling unsupported and that patient safety could be potentially compromised. A team of caregivers developed several goals to provide increased support, encouragement and education to night shift new hires. Improvement in overall patient care and …

Strategies To Improve Post-Procedural Safe Patient Handoffs, Marguerite Peggy Anderson, Tara Herman, Janice Nichols, Robyn Dixon, Elizabeth Van Der Linden, Bonnie Boivin, Stephen Tyzik

Operational Transformation

STRATEGIES TO IMPROVE SAFE PATIENT HANDOFFS AND POST PROCEDURAL FLOW

During patient transfers from one care unit to another, it is imperative for patient safety and satisfaction that timely and complete communication between staff occurs. In an academic tertiary care medical center, a team consisting of representatives from 6 patient care units used improvement methods of operational excellence to improve patient centered movement.

The goal of this project was to improve the percentages of two questions related to information sharing on the FY2018 AHRQ Culture of Patient Safety Survey. Using baseline metrics to reflect the current state of patient wait …

Interprofessional Engagement In Lean Improvement In An Academic Healthcare Organization, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks, Linda Simonsen

Operational Transformation

STRATEGIES TO INCREASE ENGAGEMENT OF PROVIDERS IN LEAN APPLICATIONS IN AN ACUTE TERTIARY CARE HOSPITAL

Engaging care providers in interprofessional LEAN applications in an academic tertiary hospital results in safe, reliable and effective patient care. An initial success measure was established to increase LEAN application engagement to 36%, with the goal of reaching 50% within 3 years of their operational excellence go-live.

A root cause analysis established several causes for low involvement. Using operational excellence strategies, a number of countermeasures were created, rolled out and completed. As a result, follow up metrics demonstrated a marked increase in the number of …

Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Transformation

STRATEGIES TO INCREASE MORNING DISCHARGES IN AN ACADEMIC TERTIARY HOSPITAL

Delays in patient discharge result in numerous negative impacts on the health care system. Amongst those are a reduced patient flow and satisfaction, long wait times, and physician/ staff frustration.

An inpatient neurotrauma unit initiated a performance improvement project that utilized a multidisciplinary approach to identify barriers to discharge and coordinate a discharge plan focused on neurospine patients.

A root cause analysis was conducted to collect reasons that these patients were not discharged by 11:00am. As a result of the findings, 4 performance improvement plans were created. Subsequent data collection …

Consistently Using A Transportation Department For Patient Discharge To Sustain Nursing Staffing Levels, Victoria Boutin, Joseph East, Stephen Tyzik, Joy Moody, Mark Parker, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES

Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor.

The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center.

Baseline metrics demonstrated the current state and a root cause …