HLT 362 Week 4 Quality Improvement Proposal Discussion

Quality Improvement Proposal Discussion

Quality Improvement

Answers

  1. How much a surgical site infection (SSI) costs varies according to the degree of the infection as well as the site of surgery. However, it should cost at least $25,000. If it involves a prosthetic implant, the cost can rise to more than $90,000. As a whole, the United States healthcare incurs between $3.5 to $10 billion yearly on SSIs (Iskandar et al., 2019 Quality Improvement Proposal Discussion).

Quality Improvement Proposal Discussion

  1. SSIs impact the patient negatively, both mentally and physically. The patient will experience a period where they will be unable to report to their workplaces, leading to loss of earnings during that time. It can also lead to patient mortality. There are high chances that the patient will experience pain and anxiety. The patient’s family will also be affected. They might have to spare time to look after the individual during the recovery time. The condition will also take an emotional toll on them.
  2. Steps to be used in quality improvement
  • List down the improvement opportunities according to their priority.
  • Outline the improvement objectives.
  • Collect and organize the necessary data.
  • Pick the root cause
  • Come up with potential solutions
  • Pick the best solution
  • Implement the identified solution and then evaluate the outcome.
  1. Tools utilized for quality improvement are standalone strategies that assist an individual comprehend, analyze, or communicate the efforts involved. Quality Improvement Proposal DiscussionQuality Improvement Proposal Discussion

A Pareto Chart is an effective quality improvement tool in this scenario. It highlights the most important factor among a set. During quality control, it displays the most common defects sources, the type of defect that occurs the highest, or the most mentioned reasons attributed to customers’ complaints.

  1. To get the best post coronary artery bypass graft (CABG) guidelines, Carmen can look into the pieces of advice provided by the Center for Disease Control and Prevention (CDC). There are a few precise official recommendations involving wound practices for CABG surgeries. Most suggest a change of bandages at least once a day or as frequently as possible. CDC advises that the wound be protected for 24 to 48 hours using a sterile dressing and that the hands of the person doing the dressing should always be clean (Purba et al., 2020 Quality Improvement Proposal Discussion).
  2. To share the learned information regarding her experience, Carmen can write a journal that can be accessed by healthcare personnel, illustrating her discoveries. She can also post the information online on various platforms, including social media.

Quality Improvement Proposal Discussion References

  • Iskandar, K., Sartelli, M., Tabbal, M., Ansaloni, L., Baiocchi, G. L., Catena, F., Coccolini, F., Haque, M., Labricciosa, F. M., Moghabghab, A., Pagani, L., Hanna, P. A., Roques, C., Salameh, P., Molinier, L. (2019). Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria. World Journal of Emergency Surgery, 14(1), 50. https://doi.org/10.1186/s13017-019-0266-x
  • Purba, A. K. R., Luz, C. F., Wulandari, R. R., van der Gun, I., Dik, J. W., Friedrich, A. W., & Postma, M. J. (2020). The Impacts of Deep Surgical Site Infections on Readmissions, Length of Stay, and Costs: A Matched Case–Control Study Conducted in an Academic Hospital in the Netherlands. Infection and Drug Resistance, 13, 3365. https://dx.doi.org/10.2147%2FIDR.S264068

HLT 362 Week 4 Quality Improvement Proposal Example

Research makes a significant contribution to the improvement of patient care in a variety of settings. Healthcare research generates new knowledge about the impact of a certain drug, intervention, or procedure on patient care. Furthermore, healthcare professionals may utilize research-generated information to develop and amend policies to improve patient care. However, although research is necessary to assess the efficacy of a specific intervention, to remain relevant and suitable in the long run, the intervention’s quality must be regularly monitored, heralding the concept of quality improvement. 

According to Helbig (2022), quality improvement refers to systematic and consistent efforts to improve healthcare services and the health status of a certain target population. Most of the time, it entails refining what currently exists rather than introducing anything new. In light of the definition, this paper aims to identify a healthcare problem that may require a quality improvement initiative and then, borrowing from the literature, discuss the quality improvement initiative, demonstrating its outcomes and the necessary steps for implementation and evaluation.

Overview of the Problem and the Setting: Healthcare-Associated Infections

While individuals attend hospitals searching for treatment and a solution to their health issues, they and the care staff are exposed to various illnesses in the hospital setting. Nosocomial infections, often known as healthcare-associated infections (HAIs), are infections acquired during treatment but were not present at the time of admission (Suetens et al., 2018). HAIs are classified into four types: central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), skin and soft tissue infections (SSI), and ventilator-associated pneumonia (VAP) (Suetens et al., 2018). HAIs are a significant burden in my practice environment, an intensive care unit, claiming the lives of critically ill patients and placing a significant financial cost on them and their families.

The prevalence of HAIs varies by type, geographical location, and care environment. According to the findings of two European point prevalence surveys conducted from 2016 to 2017, the prevalence of patients with at least one HAI in the European Union/European Economic Area (EU/EEA) was 5.9%, ranging from 3.7% in long-term care units to 4.4% in primary care units, 7.1% in tertiary care units, and 19.2% in intensive care units (Suetens et al., 2018). Giuliano et al. (2018), while citing a 2015 report, note that the prevalence of HAIs among hospitalized patients in the United States is roughly 3.2%. Hand washing has long been an efficient method of preventing infections; nonetheless, its usage and compliance are important predictors of the development of HAIs. Consequently, a quality improvement plan is required to enhance hand washing adherence, hence lowering HAI rates and enhancing the quality of care for the targeted group.

An Explanation of Why the Quality Improvement Initiative is needed and the Expected Outcomes

The data on the prevalence of HAIs provide sufficient urgency to seek an intervention to lessen the burden on patients and the healthcare system as a whole. According to the International Nosocomial Infection Control Consortium 2012-2017 report, the pooled crude death rate for adult and pediatric patients with CLABSI in the ICU was 41.6%, 36.6% for adult and pediatric patients with VAP, and 26.0% for adult and pediatric patients with CAUTI (Rosenthal et al., 2020). Benenson et al. (2020) evaluated the resource utilization and cost related to HAIs and found that direct expenditures were greater for cases than controls with CLABSI ($6400 vs. $2376), Clostridium difficile infection ($1357 vs. $733), and SSI ($6761 vs. $5860), with all data being statistically significant. 

Furthermore, even though hand hygiene has been practiced since antiquity, the World Health Organization estimates only approximately a 9% compliance rate during the treatment of critically ill patients in low-income nations and seldom topping 70% in high-income ones (OECD, 2020). Consequently, there is a demand for increased efforts to enhance hand-washing behaviors all around the globe, and an electronic recording and reminder system is employed in this assignment. The expected outcomes are (1) to monitor and report handwashing compliance activity and (2) to minimize HAI rates.

How Results of Previous Research Demonstrate Support for the Quality Improvement Initiative and Projected Outcomes

With the cognizance of suboptimal hand washing among healthcare personnel, many researchers have looked into approaches to improve hand washing compliance (HHC). Iversen et al. (2020) conducted a prospective observational study at two Danish university hospitals using a Sani nudge, a novel monitoring system, as one technique for system-based monitoring of hand-washing adherence. The device used sensors located on alcohol-based sanitizers, healthcare staff name badges, and patient beds to evaluate hand hygiene opportunities and sanitation. Following the application of the Sani nudge, the system recorded an HHC of 52% and 36% among nurses in hospitals A and B, respectively, with the lowest compliance reported in patient rooms and the greatest compliance observed in staff restrooms. The method was utilized efficiently to monitor HHC at the individual and group levels, boosting knowledge of compliance behavior.

In addition to monitoring the HHC, HAI rates before and after the system-based monitoring intervention may be recorded and compared. In a pre and post-intervention study, Akkoc et al. (2021) used an electronic hand hygiene recording and reminder system to prevent HAIs at a tertiary referral center. The study was conducted in an anesthetic and reanimation critical care unit, where HHC was evaluated and compared using conventional and computerized methods. The study’s findings were as follows: the rate of HAIs was much lower in the electronic hand hygiene and reminder system period compared to the conventional hand hygiene observation period, with the author concluding that the intervention is effective in reducing HAIs. In a different study, Pong et al. (2019) discovered that aggregate dispenser usage increases and decreases over many weeks after withdrawal whenever an electronic monitoring system is introduced. The findings of the three studies imply that an electronic recording and reminder system is an effective method of monitoring HHC and lowering HA rates.

Steps Necessary to Implement the Quality Improvement Initiative

Implementing the quality improvement project necessitates employing a well-structured plan, one of which is the FADE approach. FADE (focus, analysis, development, execution, and evaluation) is a quality improvement strategy that provides a blueprint for implementing a desired quality improvement initiative. The focus stage is identifying the problem or process that requires improvement (Helbig, 2022), much as it was determined that HAIs are a concern and that patients will benefit from improved hand-washing compliance. Analysis refers to the gathering and synthesis of data to provide a clear baseline against which the results of the quality improvement project will be assessed. The action plan is created during the development phase, which may include the procurement of essential equipment such as electronic recording and reminder systems. Finally, the plan is executed and evaluated to see whether it achieved the desired results.

Evaluation of the Quality Improvement Initiative

In healthcare, evaluating an intervention, therapy, or procedure is critical for establishing if the desired outcomes have been attained. Quality indicators are collected periodically while evaluating a quality improvement program so that healthcare organizations may respond if inefficiencies exist (Helbig, 2022). For example, computer-generated hand washing compliance and HAI rates will be two essential quality measures applicable for hand washing. The electronic system may calculate the compliance rate for a certain time, in this example, a month, by aggregating the total number of offhand hygiene events for that month and dividing it by the entire number of healthcare personnel working in a specific setting during the same period. 

This is shown by the Iversen et al. (2020) study, in which a system was able to record the HHC of nurses in two hospitals, enhancing the understanding of hand washing and the motivation to improve. Second, the HAI rate is another quality measure for determining whether the hand washing quality improvement initiative is effective or not. The infection surveillance and control unit will calculate the HAI rate by dividing the number of HAIs by the number of discharges, including fatalities for adults and children. Due to the data obtained for quality measurements, nurses will be able to change their hand-washing practices and improve the quality of care provided to patients.

Variables, Hypotheses Test, and Statistical Tests to prove that the Quality Improvement Initiative Succeeded

Regarding the proposed quality improvement, the electronic recording and reminder system for hand washing is the independent variable (cause). In contrast, the dependent variables (effect) are hand washing compliance among healthcare personnel and HAI rates. A relevant, simple hypothesis test would be to use an electronic recording and reminder system to promote hand-washing compliance among healthcare professionals. On the other hand, a complex hypothesis test might look like this: an electronic recording and reminder system increases hand-washing compliance among healthcare staff and decreases HAI rates in the critical care unit. A statistical test of significance helps determine the association between hand-washing compliance and the reduction of HAI rates. The correlation coefficient determines the degree and direction of a linear link between two variables (Helbig, 2022). The data will be used to decide whether to continue, enhance, or discontinue the current quality improvement initiative.

Conclusion

As a tool continually used to improve patient care, research is an unavoidable topic in healthcare. Through research, a new understanding of the impact of medication, procedure, or specific care approach is developed. However, since healthcare is a highly regulated industry, each medication, procedure, or method of care used must be shown to fulfill the needed level of quality. As a result, continuous quality evaluation is required to establish the necessity for quality improvement initiatives. As observed in the HAI, where hand washing is the basic preventative strategy, boosting hand washing compliance via technology resulted in considerably higher compliance and a reduction in HAI rates.

References

Akkoc, G., Soysal, A., Gul, F., Kepenekli Kadayifci, E., Arslantas, M. K., Yakut, N., Bilgili, B., Ocal Demir, S., Haliloglu, M., Kasapoglu, U., & Cinel, I. (2021). Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system. Journal of Infection in Developing Countries, 15(12), 1923–1928. https://doi.org/10.3855/jidc.14156

Benenson, S., Cohen, M. J., Schwartz, C., Revva, M., Moses, A. E., & Levin, P. D. (2020). Is it financially beneficial for hospitals to prevent nosocomial infections? BMC Health Services Research, 20(1), 653. https://doi.org/10.1186/s12913-020-05428-7

Giuliano, K. K., Baker, D., & Quinn, B. (2018). The epidemiology of nonventilator hospital-acquired pneumonia in the United States. American Journal of Infection Control, 46(3), 322–327. https://doi.org/10.1016/j.ajic.2017.09.005

Helbig, J. (2022). Applied statistics for health care. Gcumedia.com. https://lc.gcumedia.com/hlt362v/applied-statistics-for-health-care/v1.1/#/chapter/4

Iversen, A.-M., Kavalaris, C. P., Hansen, R., Hansen, M. B., Alexander, R., Kostadinov, K., Holt, J., Kristensen, B., Knudsen, J. D., Møller, J. K., & Ellermann-Eriksen, S. (2020). Clinical experiences with a new system for automated hand hygiene monitoring: A prospective observational study. American Journal of Infection Control, 48(5), 527–533. https://doi.org/10.1016/j.ajic.2019.09.003

OECD. (2020). Key facts and figures. In OECD Employment Outlook. OECD. https://doi.org/10.1787/a900334c-en

Pong, S., Holliday, P., & Fernie, G. (2019). Effect of intermittent deployment of an electronic monitoring system on hand hygiene behaviors in healthcare workers. American Journal of Infection Control, 47(4), 376–380. https://doi.org/10.1016/j.ajic.2018.08.029

Rosenthal, V. D., Bat-Erdene, I., Gupta, D., Belkebir, S., Rajhans, P., Zand, F., Myatra, S. N., Afeef, M., Tanzi, V. L., Muralidharan, S., Gurskis, V., Al-Abdely, H. M., El-Kholy, A., AlKhawaja, S. A. A., Sen, S., Mehta, Y., Rai, V., Hung, N. V., Sayed, A. F., … International Nosocomial Infection Control Consortium. (2020). International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. American Journal of Infection Control, 48(4), 423–432. https://doi.org/10.1016/j.ajic.2019.08.023

Suetens, C., Latour, K., Kärki, T., Ricchizzi, E., Kinross, P., Moro, M. L., Jans, B., Hopkins, S., Hansen, S., Lyytikäinen, O., Reilly, J., Deptula, A., Zingg, W., Plachouras, D., Monnet, D. L., & Healthcare-Associated Infections Prevalence Study Group. (2018). Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveillance: Bulletin Europeen Sur Les Maladies Transmissibles [Euro Surveillance : European Communicable Disease Bulletin], 23(46). https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516

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