7. Quality and Safety Flashcards
six dimensions of healthcare quality
* \_\_\_\_ * \_\_\_\_ * \_\_\_\_ * \_\_\_\_ * \_\_\_\_ * \_\_\_\_-centered
safe timely effective efficient equitable patient
What is a system
How to improve:
• Must have a desire to ____
• ____
• ____
improve
ideas
execution
3 questions and 4 steps
- what are we trying to accomplish? (1)
- how will we know a change is an improvement? (2, 4)
- what change will we make? (3)
- set an ____
- establish ____
- develop ____
- test ____
aim
measures
changes
change
Step 1: Set an Aim ● What are we trying to accomplish? ○ How \_\_\_\_? ○ For \_\_\_\_? ○ By \_\_\_\_?
good
whom
when
Step 2: Establish Measures How will we know a change is an improvement? ■ \_\_\_\_ measures ■ \_\_\_\_ measures ■ \_\_\_\_ measures
outcome
process
balancing
Step 2: Establish Measures ○ Outcome measures \_\_\_\_ are we going? ○ Process measures \_\_\_\_ are we doing? ○ Balancing measures What \_\_\_\_ is happening?
where
what
else
● Change = ____?
improvement
Step 3: Developing changes
○ Eliminate \_\_\_\_ ○ Improve workflow ○ Optimize \_\_\_\_ ○ Enhance the provider-patient relationship ○ Change the work \_\_\_\_ ○ Manage time ○ Manage \_\_\_\_ ○ Improve the design of products ○ Design systems to prevent \_\_\_\_
* \_\_\_\_ improves the work environment * Fix errors and prevent - \_\_\_\_
waste inventory environment time errors music redundancy
Step 3: Developing changes
● Improve workflow
Ensure rescue drugs are kept in a ready to ____ state
● Optimize inventory
Ensure rescue drugs are ____ available
● Change the work environment
Have a licensed dental
____ on staff
● Manage variation
Update office protocols to be consistent with ____
guidelines for conscious sedation of pediatric patients
● Design systems to prevent errors
Create ____ for your
protocols, make them readily available and easy to use
go consistently anesthesiologist ADA checklists
Step 4: Testing changes
Linking PDSA Test Cycles
Can link different ____ cycles together
Based off of small ____ changes
PDSA
incremental
Using Data for Improvement
Research
Data collection:
Gather enough data to ____ study for effect and control for all known confounders
Quality improvement
Data collection:
Gather just ____ data to inform improvement, and only collect data on ____ confounders as needed (i.e., balancing measures)
authoritatively
enough
1-2
• Level 1: Project‐level measures: ○ Outcomes § Reduced \_\_\_\_ § No \_\_\_\_ • Level 2: Process‐level measures Processes • Availability of rescue drugs; did yoga teacher show up? • \_\_\_\_ • School budget ; \_\_\_\_ staff satisfaction
stress
deaths
balancing
clinic
How would you measure this?
• Many ways to measure “access”
– Number of ____ to third next available
appointment
– Number of ____ in reception area
– % of “good” or “very good” answers on ____
– Average # ____ clinicians are available
days
minutes
surveys
hours
Which is a complete definition?
• ____ index
• Percentage of patient encounters in compliance with ____ protocol
• Number of ____ available
plaque
oral hygiene
toothbrushes
Which is a complete definition?
• Plaque index
– Which ____ will you use? ____ will measure it?
• Percentage of patient encounters in compliance with oral hygiene protocol
– How do you define a “patient encounter”? How will you ____ the percentage? What if a patient is discharged mid-day?
• Number of toothbrushes available
– What ____ are you including in the count of toothbrushes? How do you define “available” — what if the dispenser is ____, but the
closet is full?
index who calculate area empty
Key questions for measurement
• What is the \_\_\_\_ you need to collect? • Who is \_\_\_\_ for collecting the data? • How \_\_\_\_ will the data be collected? • How will the data be \_\_\_\_? Make measurement as \_\_\_\_ as possible!
data responsible often collected simple
Simplify through sampling
• Simple ____ sampling
• ____ stratified random sampling
random
proportional
Using data for improvement
Research
Results evaluation:
____- and post-assessment
Quality Improvement
Results evaluation:
regular assessment with ____ charts
pre
run
Getting better or worse?
• ____ chart
run
Using data for improvement
Research
Method:
One ____ test with a ____ hypothesis; control ____ as much as possible
Quality improvement
Method:
rapid ____ tests with a hypothesis that cahnges as learning takes place; no effort to control ____
large
fixed
bias
sequential
bias
Building Degree of Belief
- Iterative test cycles; can be ____
- Increase size: ____X rule
- Broaden scope: Test in many different ____
concurrent
5
conditions
no improvement - make the next test cycle ____
improvement - increase ____ or scope of next test cycle
smaller
size
Patient safety
• Patient safety:
– “The absence of ____ to a patient during the process of health care” (WHO)
• Harm:
– “____ physical injury resulting from or contributed to by medical care that requires additional monitoring, treatment, or hospitalization, or that
results in death” (IHI Global Trigger Tool)
• There is always the possibility of a complication, why you have a patient sign a ____
preventable harm
unintended
consent form
Redefining harm
• Today’s “unpreventable events” are only an innovation away from being preventable.
• Providers once accepted a small number of central line-associated bloodstream infections (CLABSIs) as an unavoidable complication of care — i.e., not “____.”
• Broadening the definition helps providers think more critically about systems of care.
harm
