Quality improvement projects are essential for ambulatory surgery centers to resolve issues and improve the patient experience. They are also required for accreditation and certification. But what constitutes a good quality improvement project?
The project should have an impact on improving patient safety, satisfaction, process efficiency or case cost, says Surgical Care Affiliates Director, Accreditation and Survey Readiness Jan Allison. Other traits of a productive quality improvement project include:
• Sufficient preparation to define the problem by data collection, analysis and benchmarking;
• Strong project goals and objectives;
• A dedicated team to identify and implement potential sustainable solutions
• Post-solution data to determine whether the solution was effective
If the first solution isn't effective, continue to search for different ways to solve the problem. Communication between project leadership and staff is critical to realizing benefit from the change.
"One of the most effective QI projects I've seen was ensuring adequate hydration of patients during their course of stay in the ASC," says Ms. Allison. "A concern was voiced regarding patients who had afternoon surgery experiencing a higher rate of dizziness, nausea and vomiting, which often resulted in prolonged recovery, increased overtime for nurses, potentially negative impact on patient satisfaction, increased risks for post-op complications and safety after discharge, and increased utilization of costly antiemetic medications."
The ASC took on this problem systematically. They used a hydration formula from the American Society of Anesthesiologists to obtain data from a retrospective study of 100 general anesthesia adult patient charts and found patients were discharged with one-liter fluid deficit on average.
"To improve the situation, we educated the staff on the risks of hypovolemia and shared the findings from the data collection, the formula and the plan for improving hydration in patients prior to discharge," says Ms. Allison. "A grid was created for ease in determining the patient's fluid requirements based on the weight and NPO status of the patient. A restudy showed no patients were discharged with fluid deficit and the rate of dizziness, nausea and vomiting were significantly decreased."
The center also experienced a cost savings from using less antiemetic medications as well as less overtime for staff. This project made a huge impact on the surgery center's quality and bottom line. Another small quality improvement project Ms. Allison finds particularly important revolves around physician compliance with medical record documentation. The ASC physicians had a trend of noncompliance with completion of History and Physicals (H&Ps) during surveys.
"H&Ps provide clear documentation of medical information so that others involved in the patient's care will be informed of any potential issues of concern," says Ms. Allison. "An H&P is an important documentation that is reviewed during verification of the patient's correct procedure and site to avoid a wrong site surgery. An H&P may assume legal significance and provide a basis for health insurance benefit payments."
An incomplete H&P leads to delays and cancellations, lost revenue and unsatisfied patients. However, it can be avoided with appropriate physician engagement, education and monitoring to drive compliance.
Large quality improvement projects are also necessary for the center to stay updated.
A group of SCA ASCs are currently involved in a large, ongoing project to drive higher rates of influenza vaccinations in their facilities. Leaders identified influenza vaccinations as a meaningful topic because they could keep staff healthy, minimize sick days and reduce the risk of passing the flu to patients and others at the center.
"These facilities will provide comprehensive education to not only staff but to allied health workers, physicians and anesthesia providers prior to the influenza season," says Ms. Allison. "They'll also use marketing tools such as posters throughout the facility. Compliance with vaccination will be monitored and for those who refuse the vaccine, barriers will be identified to determine if there are opportunities to overcome these barriers to increase vaccination coverage."
There is a variety of issues ASCs can tackle individually, but finding the most important issues is sometimes challenging. Ms. Allison recommends these steps for developing and implementing an effective quality improvement project:
1. Drive a culture of patient safety by inviting ideas and listening to teammates, physicians, anesthesiologists and patients who have concerns.
2. Identify key patient safety indicators to monitor on a regular basis.
3. Find staff members who will commit to designated roles on the quality council and educate the council to run an effective QAPI project. Make sure they have the right tools and understanding of how quality improvement projects benefit patients, the center and their teammates.
4. Measure quality council activity progress and ask the council to provide regular reports to stay updated on the current status.
5. Provide quality feedback and assistance with problem-solving to the quality council as needed.
Once the center has identified and addressed a problem, it's important to maintain momentum and avoid going back to old ways.
"Ensure the QAPI program is well-organized and the program activities are recurring on a scheduled basis," says Ms. Allison. "Keep staff actively engaged. When it becomes clear their voice or concern was heard and acted upon and there is evidence of measurable improvement in the services targeted by the project, staff feel ownership in the program and it drives a desire and commitment for continuous improvement."
You can also expand data collection beyond outcomes to prepare for other audits as well. "Results from audits performed related to the infection control processes, medication safety, environmental safety and medical record documentation can identify if best practices are not being followed and if there is an opportunity to improve and prevent the outcomes from occurring," says Ms. Allison.
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The project should have an impact on improving patient safety, satisfaction, process efficiency or case cost, says Surgical Care Affiliates Director, Accreditation and Survey Readiness Jan Allison. Other traits of a productive quality improvement project include:
• Sufficient preparation to define the problem by data collection, analysis and benchmarking;
• Strong project goals and objectives;
• A dedicated team to identify and implement potential sustainable solutions
• Post-solution data to determine whether the solution was effective
If the first solution isn't effective, continue to search for different ways to solve the problem. Communication between project leadership and staff is critical to realizing benefit from the change.
"One of the most effective QI projects I've seen was ensuring adequate hydration of patients during their course of stay in the ASC," says Ms. Allison. "A concern was voiced regarding patients who had afternoon surgery experiencing a higher rate of dizziness, nausea and vomiting, which often resulted in prolonged recovery, increased overtime for nurses, potentially negative impact on patient satisfaction, increased risks for post-op complications and safety after discharge, and increased utilization of costly antiemetic medications."
The ASC took on this problem systematically. They used a hydration formula from the American Society of Anesthesiologists to obtain data from a retrospective study of 100 general anesthesia adult patient charts and found patients were discharged with one-liter fluid deficit on average.
"To improve the situation, we educated the staff on the risks of hypovolemia and shared the findings from the data collection, the formula and the plan for improving hydration in patients prior to discharge," says Ms. Allison. "A grid was created for ease in determining the patient's fluid requirements based on the weight and NPO status of the patient. A restudy showed no patients were discharged with fluid deficit and the rate of dizziness, nausea and vomiting were significantly decreased."
The center also experienced a cost savings from using less antiemetic medications as well as less overtime for staff. This project made a huge impact on the surgery center's quality and bottom line. Another small quality improvement project Ms. Allison finds particularly important revolves around physician compliance with medical record documentation. The ASC physicians had a trend of noncompliance with completion of History and Physicals (H&Ps) during surveys.
"H&Ps provide clear documentation of medical information so that others involved in the patient's care will be informed of any potential issues of concern," says Ms. Allison. "An H&P is an important documentation that is reviewed during verification of the patient's correct procedure and site to avoid a wrong site surgery. An H&P may assume legal significance and provide a basis for health insurance benefit payments."
An incomplete H&P leads to delays and cancellations, lost revenue and unsatisfied patients. However, it can be avoided with appropriate physician engagement, education and monitoring to drive compliance.
Large quality improvement projects are also necessary for the center to stay updated.
A group of SCA ASCs are currently involved in a large, ongoing project to drive higher rates of influenza vaccinations in their facilities. Leaders identified influenza vaccinations as a meaningful topic because they could keep staff healthy, minimize sick days and reduce the risk of passing the flu to patients and others at the center.
"These facilities will provide comprehensive education to not only staff but to allied health workers, physicians and anesthesia providers prior to the influenza season," says Ms. Allison. "They'll also use marketing tools such as posters throughout the facility. Compliance with vaccination will be monitored and for those who refuse the vaccine, barriers will be identified to determine if there are opportunities to overcome these barriers to increase vaccination coverage."
There is a variety of issues ASCs can tackle individually, but finding the most important issues is sometimes challenging. Ms. Allison recommends these steps for developing and implementing an effective quality improvement project:
1. Drive a culture of patient safety by inviting ideas and listening to teammates, physicians, anesthesiologists and patients who have concerns.
2. Identify key patient safety indicators to monitor on a regular basis.
3. Find staff members who will commit to designated roles on the quality council and educate the council to run an effective QAPI project. Make sure they have the right tools and understanding of how quality improvement projects benefit patients, the center and their teammates.
4. Measure quality council activity progress and ask the council to provide regular reports to stay updated on the current status.
5. Provide quality feedback and assistance with problem-solving to the quality council as needed.
Once the center has identified and addressed a problem, it's important to maintain momentum and avoid going back to old ways.
"Ensure the QAPI program is well-organized and the program activities are recurring on a scheduled basis," says Ms. Allison. "Keep staff actively engaged. When it becomes clear their voice or concern was heard and acted upon and there is evidence of measurable improvement in the services targeted by the project, staff feel ownership in the program and it drives a desire and commitment for continuous improvement."
You can also expand data collection beyond outcomes to prepare for other audits as well. "Results from audits performed related to the infection control processes, medication safety, environmental safety and medical record documentation can identify if best practices are not being followed and if there is an opportunity to improve and prevent the outcomes from occurring," says Ms. Allison.
More articles on surgery centers:
32 statistics on ASC accounts receivable
5 orthopedic-driven ASC supply chain management trends
36 joint venture ASC administrators to know
