What Is Quality Improvement in HEA?
Healthcare quality improvement is the process of continually assessing and enhancing the effectiveness, safety, and efficiency of healthcare services given to patients. Actions include analyzing data, identifying improvement areas, and installing evidence-based solutions to enhance the quality of patient care.
Examples of Quality Improvement Projects in Overall Patient Care
Blue Cross Blue Shield of New Mexico performed a quality improvement project to improve how it processed complaints from its members about quality-of-care issues at health facilities. Other projects include the following:
- The Safer Care Patient-Centered Checklist: This was an intervention to promote safe, high-quality practice and improved outcomes. This project was conducted by the University Hospital Southampton National Health Service Foundation Trust in the UK.
- Quality Improvement and Person-Centeredness: This was a test of the “Always Event” concept, a method in healthcare settings in which you identify care issues that are important to patients and families and encourage medical providers to focus on those issues. The test was conducted by the National Health Service in Lanarkshire, UK.
- The Improvement of Order Sets: This project was undertaken by Boston Medical Center, the Graduate Medical Education Program, to create a standard process to increase quality and utilization.
- The Implementation and Improvement of a Pediatric Rapid Assessment Clinic: Brock University in St. Catherines, Ontario, Canada implemented this project in a large community hospital system, namely St. Catherines Site.
- The Improvement of the Quality and Impact of Interdisciplinary Rounds: Tulane Medical Center at Tulane University conducted this study.
- The Improvement of the Consistency and Efficiency of Medicare Annual Wellness Visits: The Tulane University School of Medicine conducted this study.
Examples of Quality Improvement Projects in Patient Screening and Other Diagnostic Procedures to Detect Disease
Stanford University Healthcare instituted a quality improvement project to improve the breast positions in mammograms in order to detect breast cancer. This project helped increase the accuracy of Stanford’s mammograms by 36 percent, meaning that breast cancer was detected earlier in many cases. Other projects include the following:
- A Resident-Led Quality Improvement Initiative: The Louis Stokes VA Medical Center in Cleveland, Ohio undertook this project to improve outpatient colorectal cancer screening rates.
- The Improvement of Metabolic and Diabetes Screenings: This was an effort to improve metabolic and diabetes screenings for patients in Missouri who received Medicaid and Medicare services and had a mental illness and at least three chronic health conditions. The initiative significantly increased the percentage of patients who had appropriate screening.
Examples of Quality Improvement Projects in the Long-Term Management of Diseases
Blood pressure control reduces the chance of serious complications associated with diabetes. The Huron Valley Physicians Association in Ann Arbor, Michigan implemented a quality improvement project to better monitor and control the blood pressure of patients with diabetes. Other projects include the following:
- The Cholesterol (LDL) Screening after an Acute Coronary Event: The Dean Health System in Madison, Wisco
nsin implemented this project.
- The Improvement of Congestive Heart Failure Discharge Teaching Efficiency: Mountain States Health Alliance’s Indian Path Medical Center conducted this study.
- The Improvement of Quality of Care for Diabetes in an Outpatient Setting: Austin (Texas) Diagnostic Clinic conducted this study.
- The Reduction of Time to First Antibiotic Dose in Pneumonia Patients: El Camino Hospital in Mountain View, California implemented this project.
- The Optimization of Patient Outcomes and the Reduction of Cost through the Enhanced Management of Invasive Fungal Infection: The Barts Health National Health Service Trust in London implemented this project.
- The Improvement of the Cancer Patient Experience with a Rapid Access Multidisciplinary Palliative Assessment and Radiotherapy Treatment Clinic: University Hospital in Southampton, UK undertook this project.
- The Dementia “Golden Ticket,” an Emerging New Model of Care: Buxted Medical Centre in Uckfield, UK undertook this project.
- Home Monitoring to Support Patients during Chemotherapy: The Christie NHS Foundation Trust in London did this project.
- The Diabetes Passport to Health: The Development and Piloting of a Self-Management Tool for High-Risk Patients: Emory University in Atlanta conducted this study.
- The Increase of Appropriate Statin Use in the Primary Care Clinic: The Louis Stokes VA Medical Center in Cleveland, Ohio undertook this project.
Examples of Quality Improvement Projects in Managing Pregnancies and Improving Perinatal Outcomes
Identifying and managing pregnancy risks early in a woman’s pregnancy is vital for the health of the mother and unborn baby. The National Health Service in Scotland implemented a quality improvement program that engages women in the development of a system that will assess and manage those risks. Other projects include the following:
- Home Monitoring of High Blood Pressure in Pregnancy: An Innovative App to Monitor Women’s Health during Pregnancy: St George’s University Hospitals National Health Service Foundation Trust in London conducted this project.
- A Nurse-Driven Quality Improvement Program to Improve Perinatal Outcomes: In Bethesda, Maryland, a nursing team joined forces with a managed care organization to develop and implement a quality program that would improve perinatal outcomes for pregnant women enrolled in the managed care organization.
Examples of Quality Improvement Projects in Reducing Medical Errors, Medication Errors, and Adverse Drug Events
Communication errors are one of the leading causes of medical errors — this translates to poor patient outcomes, longer hospital stays, and increased costs. Duke Children’s Hospital in Durham, North Carolina. worked on a quality improvement project to improve communication among medical professionals during the providers’ daily rounds. Other projects include the following:
- The Addressing of Risks for Error in the Process of Administering Dialysis: This study involved a Utah hospital.
- The Targeting of Wrong Dose Medication Errors: This study involved a California hospital.
- The Addressing of Infusion Drug Errors: This study involved an 11-bed pediatric intensive care unit in a children’s hospital.
- The Systematic Analysis for Improvement in the Ordering and Administration of Potassium Chloride and Potassium Phosphate: This study involved three Canadian hospitals.
- The Addressing of Medication Order Errors with Pediatric Oncology Patients: This study involved a Maryland academic medical center.
- Error Detection Associated with Medication Administration: Baccalaureate nursing students at Pennsylvania University conducted this study.
- The Addressing of Medication Errors and Adverse Drug Events (ADEs): The increased pharmacist staffing on patient care units that review orders reduced errors by 45 percent.
- The Addressing of Errors Associated with Chemotherapy: A standardized procedure for changes in chemotherapy was established at a Netherlands hospital in order to prevent prior changes in chemotherapy that staffers made without the knowledge of nurses or other medical providers.
- The Addressing of Adverse Drug Events Associated with Patient-Controlled Analgesia: Quality improvement changes at a California hospital included using a standard dosage protocol, ensuring that patient-controlled pumps were programmed correctly, and monitoring patients who were using the pumps.
- A Transition of Care Pharmacy Program: This quality improvement program encourages pharmacists at Stanford Health Care to participate in daily rounds and reconcile medications on patient admission and discharge. Pharmacists also provide in-depth medication education to patients when they are discharged from the hospital.
Examples of Quality Improvement Projects in Reducing Hospital-Acquired Infections, Injuries, and Other Illnesses
Nationwide Children’s Hospital in Columbus, Ohio embarked on a quality improvement program to try to prevent all hospital-acquired harm to patients — a significant problem at all U.S. hospitals. This quality improvement structure was expanded to create more than 150 patient harm-related projects. Over a three-year period, the hospital reduced its preventable harm events by 55 percent and its risk-adjusted mortality rate by almost 40 percent. Other projects include the following:
- “Lose the Tube”: The Reduction of the Use of Catheters and Incidences of Catheter-Associated Urinary Tract Infections: Mount Sinai Hospital in New York City conducted this improvement program.
- The Reduction of Central Line Associated Bloodstream Infection in Unfunded Dialysis Patients: The University of Texas Southwestern Medical Center implemented this program.
- The Development of a Standardized Process for the Review of Key Indicators Associated with Surgical Site Infections: The University of Texas Southwestern Medical Center implemented this program.
- The Addressing of Medical Provider Noncompliance with Infection Control Measures: A Netherlands hospital undertook this project.
- The Reduction in the Rate of Colon and Vascular Surgical Site Infections: At a West Virginia medical center, surgical site infection rates decreased by 91 percent, with an estimated potential annual savings of more than $1 million.
- A Program to Improve Hand Washing and Proper Hand Hygiene: Increased education and other interventions significantly increased compliance.
- A Reduction in the Number of In-Facility Falls and Injuries due to Falls: At 100 acute and long-term United States VA facilities, researchers implemented a quality improvement program that led to 34 percent of those facilities reporting a reduction in the number of falls and 38.9 percent reporting a reduction in major injuries due to falls.
Improving the Treatment of Sepsis
Thibodaux Regional Medical Center in Louisiana embarked on a quality improvement program to reduce the number of patients who die from sepsis at its hospital. The quality improvement team implemented new protocols that followed best practices, improved the hospital’s analytics systems, and helped educate medical providers with data. After the team instituted the improvements, sepsis rates at the hospital declined to half the national average.
To learn more about the Thibodaux quality improvement program, check out “CQI in Healthcare: Principles, Process, and Tools.”
Examples of Quality Improvement Projects in the Continuity of Care for Patients
About one third of the residents of long-term care facilities transfer to a hospital every year — many not able to communicate their medical needs. Communication and transfer reports between caregivers at each facility is often poor, resulting in unnecessary tests, increased hospital stays, and other issues. The University of Toronto hospital embarked on a quality improvement program to improve those communications. Other projects include the following:
- The Improvement in the Continuity of Maternity Care: The Naval Hospital in Camp Pendleton, California implemented this program.
- The Provision of Complete Discharge Instructions to the Heart Failure Patient: Spectrum Health in Grand Rapids, Michigan undertook this project.
- Early Experience with the Implementation of the I-PASS Handoff Bundle: Boston Medical Center’s Graduate Medical Education Program conducted this study.
- The Improvement of Patient Understanding at Discharge: Medical Student Enhanced Patient Education: Boston University conducted this quality improvement program.
- The Improvement of Patient Handoffs in OR-ICU and OR-OR Settings: The University of Texas Southwestern Medical Center conducted this quality improvement program.
Reducing Unnecessary Antibiotic Use
Stanford Healthcare implemented a quality improvement program to reduce the use of unnecessary antibiotics. The use of such antibiotics often doesn’t help patients, exposes them to unnecessary risks, and fosters the development across the world of drug-resistant bacteria.
Since 2012, Stanford has reduced its use of certain antibiotics by 50 percent and has stopped using an expensive antibiotic medicine that was sometimes administered to treat respiratory virus infections in certain patients. Stanford determined that there were no benefits to patients using the medicine.
Examples of Quality Improvement Projects in Reducing the Use of Expensive Technology and Care When It Won’t Help the Patient
The University of California at San Diego hospital implemented a quality improvement program to reduce the number of heart patients in special telemetry beds (which allow for continuous heart monitoring) when the patients received no benefit from that constant monitoring. Other projects include the following:
- The Reduction of the Overuse of Cardiac Telemetry through the Implementation of Guideline-Specific Electronic Order Sets: Boston Medical Center implemented this program.
- The Reduction of Continuous Pulse Oximetry Use: Cincinnati Children’s Hospital initiated this campaign for patients with asthma and bronchiolitis.
- The Detection of the Overuse of Renal Ultrasound to Diagnose Obstructive Acute Kidney Injury: Researchers at the Icahn School of Medicine at New York City-based Mount Sinai Hospital implemented this program.
Examples of Quality Improvement Projects in Reducing Unnecessary Medical Procedures that Can Increase Patient Risks and Medical Costs
Restricting blood transfusions to only patients who unquestionably need them results in better outcomes for all patients. Rush University Hospital in Chicago implemented a quality improvement program to decrease the number of blood transfusions it performed every year. In the 13 months following the implementation of the change, blood transfusions were reduced by 36 percent. Other projects include the following:
- The Reduction of Unnecessary Lab Orders on the Inpatient General Internal Medicine Service: Boston University conducted this study.
- A Resident-Led QI Initiative to Reduce Serum Folate Testing in a Primary Care Clinic: The Louis Stokes VA Medical Center in Cleveland, Ohio implemented this initiative.
- The Reduction of Unnecessary Routine Post-Operative CBCs in the Pediatric Intensive Care Unit: The Children's Hospital of Philadelphia implemented this initiative.
Examples of Quality Improvement Projects in Surgical Outcomes
A multidisciplinary team at Stanford Healthcare — including surgeons, nurses, anesthesiologists, physical therapists, and others — worked on quality improvement initiatives to improve patient care before and after surgery. The initiatives tried to better manage pain in patients, reduce opiate use, and get patients walking and moving more quickly after surgery. The overall goal was to reduce the stress of surgery and promote quicker surgical recoveries.
Other projects include the following:
- Post-Operative Venous Thromboembolism Prevention in Thoracic Surgery: Implementing the Caprini Risk Assessment Model: Boston University implemented this project.
- The Effect of a “SMaRT” Enhanced Recovery Pathway for Elective Laparoscopic Colorectal Surgery: The University of Texas Southwestern Medical Center conducted this study.
Examples of Quality Improvement Projects in Managing and Increasing Efficiencies for Patient Service: Appointments, Discharges, Follow-Up Care, and Emergency Department Service
Delays in discharging patients from a hospital at the appropriate time is frustrating to patients and costly for both patients and hospitals. Cincinnati Children’s Hospital Medical Center worked on a quality improvement project to improve the process and allow for discharges soon after medical providers determine that patients are ready to be discharged. After the hospital implemented the project, at least four fifths of patients were discharged within two hours of meeting the medical criteria for discharge — which also meant an estimated $5.9 million in yearly cost savings. Other projects include the following:
- The Formalization of Communication in Discharge Planning: Tulane University implemented this project.
- The Use of Electronic Data to Identify Bottlenecks in Secondary Care on Weekends and Improve Patient Flow: Royal Derby Hospital in the U.K. initiated this project.
- The Decrease of the Failed Appointment Rate for Flexible Sigmoidoscopy: Harbor-UCLA Medical Center implemented this project.
- The Surprising Complexity of Decreasing Patient Visit Times at a Student-Run Clinic: Emory University conducted this study.
- The Decrease in Patient Visit Durations at a Student-Run Free Clinic through a Clinic Flow Intervention: The University of Texas Southwestern Medical Center implemented this program.
- A Program to Decrease Total Patient Time Spent During a Routine Clinic Appointment: This program included interventions to properly direct non-English-speaking patients to a check-in desk. These interventions increased the efficiency with which these patients saw providers and finished appointments.
- The Reduction of Time in the Emergency Department for Minor Illness and Injuries: A Maryland Hospital implemented this program.
Examples of Quality Improvement Projects in Operational Efficiencies in a Medical Facility
A student-run, free health clinic at the University of South Florida worked on a quality improvement project to increase the efficiency of patient care. The clinic had a four-month wait time for routine appointments. The project’s aim was to increase efficiency and reduce the time it took for medical providers to see patients and complete patient visits. Other projects include the following:
- Lean Principles in the Anesthesiology Technician Workflow: Decreasing Waste to Improve Value-Added Time: Tulane University implemented this project.
- The Optimization of the Efficient Use of Intensive Care Unit Patient Rooms: Stanford Healthcare implemented this project.
To learn more about quality improvement projects in nursing care and get a specific guide on improved nursing care, check out “Quality Improvement in Nursing 101: Strategies, Examples and Tools.”
Hypothetical Example Projects from the American College of Physicians
The American College of Physicians offers some guidance on quality improvement projects, including a number of example projects that medical facilities throughout the U.S. could tackle. Example projects include the following:
- Document that your providers have checked with patients as to whether they’ve had an influenza vaccination.
- Make a list of diabetic patients from 19 to 59 years old and determine whether or not they’ve had a Hepatitis B vaccination.
- Conduct a review of your facility’s healthcare workers to determine whether or not they’ve had immunizations for hepatitis B, measles, mumps and rubella, and varicella.
- Provide information to pregnant women about the Tdap vaccine, which contains vaccines for tetanus, diphtheria, and pertussis.
- Identify patients who have started the series of vaccinations against the human papillomavirus (HPV) and send those patients a reminder to get the follow-up dose.
- Use Medicare’s Hospital Compare data to track your organization’s rates of vaccinations for influenza and pneumococcal pneumonia.
To learn more about steps to implement a quality improvement program, features of an effective program, and how to measure results, check out “A Business Guide to Effective Quality Improvement in Healthcare.”
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