Using the Opportunity Estimator tool to improve engagement in a quality and safety intervention.
Division of Helath Sciences Infomatics, Johns Hopskin University School of Medicine, Baltimore, USA.Joint Commission journal on quality and patient safety / Joint Commission Resources 01/2012; 38(1):41-7, 1.
Teams throughout the United States participating in a program to reduce central line-associated bloodstream infections (CLABSIs) are using the Opportunity Estimator. This web-based tool translates CLABSI-related data into "opportunity estimates" of the patient lives and money that could be saved by reducing these infections.
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ABSTRACT: Stony Brook University Hospital (SBUH) joined a Critical Care Learning Collaborative in fall 2004. The collaborative incorporated application of central line and ventilator bundles, multidisciplinary rounding, and daily goal sheets to improve patient outcomes. In a two-year period, the initiative spread to the medical, pediatric, cardiac, and neonatal ICUs. Despite some success, the goal of eliminating central line-associated bloodstream infections (CLABSIs) was not initially realized. In response, SBUH developed a standardized central line insertion credentialing program for residents. After further review of the residual central line infection data, it was evident that many of the lines became infected after day 7 of insertion. Evaluation of the line maintenance process revealed that nursing staff were not accessing the lines using the same level of sterile technique as used during insertion. As a result, a central line maintenance protocol was developed and deployed. After cumulative efforts were undertaken, SBUH's overall CLABSI rate decreased by 59% in a five-year period and by more than 80% in the most recent 12 months. A critical feature of the approach that SBUH followed was to establish buy-in and oversight from the SICU leadership through a multidisciplinary team, which became the "learning laboratory" for many of the subsequent changes in practice. Also, the fundamental role of the Continuous Quality Improvement (CQI) Department's quality management practitioner as facilitator cannot be overstated. "Hardwiring" of process changes augmented sustainability of improvements, as did a change in the health care team's perception of central line infections--that is, from an "unavoidable complication" to "a failure."Joint Commission journal on quality and patient safety / Joint Commission Resources 02/2013; 39(2):61-9.
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ABSTRACT: Implementing change in a health care organization poses structural and cultural challenges. We developed a survey derived from an existing organizational change model and distributed it to the target population of an impending change initiative. The respondents (59.2% response rate) indicated that changes in communication protocols were necessary, believed that change would be possible, reported feeling supported during previous change efforts, and tended to think that their feedback had been valued in the past. The survey revealed that our target population was ready to change the ways in which it communicates about patient needs and care protocols. To increase the probability of successful implementation of an initiative to improve communication protocols on the unit, we will design our implementation strategy to provide both the process support and the training support that participants perceived to be lacking. By taking the "pulse" of the target population, change agents can identify more effective implementation strategies.Quality management in health care 07/2015; 24(3):129-134. DOI:10.1097/QMH.0000000000000061
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