Phyllis Wright-Slaughter is a senior data architect working with the Michigan Value Collaborative.
A recent article in the New York Times reported on the success of a checklist for blood clot prevention at Johns Hopkins Hospital in Baltimore. Through the collection of data on trauma patients, a team led by a trauma surgeon found that women had a “considerably” greater danger of dying from preventable blood clots. The team found that 45% of female patients did not receive proper blood clot prevention compared to 31% of males.
To address this disparity and improve rates for all patients, the team developed and implemented a computerized checklist. Every physician was required to review the checklist for all patients seen in the ER. After the checklist was implemented, the number of patients receiving proper clot prevention treatment greatly increased for both men and women. In fact, incidents of potentially preventable blood clots for medical patients decreased to 0.
Why was the checklist such a great success? The article notes several reasons:
- The checklist breaks down decisions at critical points and habitual biases are removed from the process
- The checklist reduces the human judgement factor for treatment decisions
Checklists have been put to good use by MVC hospitals as well. At the November 2016 Semi-annual MVC meeting, Michelle Moccia from St. Mary Mercy Hospital Livonia presented on the development of checklists for use by skilled nursing facilities and EMTs when transporting patients to the Emergency Room. By providing ER staff with critical patient information, these checklists improved the coordination of treatment and patient experiences. Read more about Michelle’s presentation here.
Questions or comments? We’d love to hear from you! You can comment on this article, or use the form at the bottom of the page
Phyllis is a Senior Data Architect working with the Michigan Value Collaborative.
Health care quality improvement and reducing episode costs for inpatient care are currently the focus of many state and national programs, including the MVC. The Center for Studying Health System Change (HSC) conducted interviews with hospital executives in Detroit, Memphis, Minneapolis-St. Paul and Seattle. The focus of these interviews was the hospital’s quality improvement activities and the role of nurses in these activities. Although the focus was on nurses and nursing teams, the comments and recommendations can be applied to other staff (Physician Champions, Pharmacists, Respiratory Therapists, etc.) who can affect the quality of care provided in a hospital – essentially everyone.
Here are the major points from this paper:
- Quality Improvement demands are increasing – true in 2008 when this article was written and even more so now. The roles on nurses and other staff also increase.
- Improving hospital quality requires a supportive hospital culture. Strategies that can lead to a supportive culture include:
- active and supportive hospital leadership
- active and ongoing staff engagement through setting expectations for staff and holding everyone accountable for individual roles
- inspiring and using physicians and nurses to champion efforts
- providing ongoing, visible and useful feedback
- It’s important to pinpoint challenges faced by the hospital, and be creative in addressing them. Challenges faced include:
- Limited resources: engaging all staff and not just department leadership can help
- Growing demands for data collection, and understanding how to use data to improve patient care
- Reporting and tracking quality improvement activities
- Need to improved training and education
With an integrative approach that includes all hospital staff, hospitals can meet the challenges and opportunities of improving quality and episode costs. MVC is a proud partner of Michigan hospitals and excited to continue to support improvement efforts going on around the state.
Reference: “The Role of Nurses in Hospital Quality Improvement”, HSC Research Brief No. 3, March 2008 (http://www.hschange.org/CONTENT/972/ )
See also this article in health affairs on the nurses roles in improving hospital quality and efficiency.
Questions or comments? We’d love to hear from you! You can comment on this article, or use the form at the bottom of the page.