Quality Improvement Proposal The Road to Evidence-based Practice Process

Quality Improvement Proposal The Road to Evidence-based Practice Process

Implementation of SBAR During Handoffs as a QI initiative


Continuous care of patients in the cardiac step-down units necessitates effective communication between the multidisciplinary team involved, including neurological nurses, occupational therapists and wound care specialists, thus maintaining safety and quality care amidst shift adjustments and handoffs. The complexity of the cardiac units suggests that the handoff process is robust spanning through various concepts such as sign-outs and shift reports thus complicating the exchange of critical patient information. Currently, the unit uses a standardized approach in care handoff thus the patient details are passed down to the oncoming staff in averagely elaborate handover sheets. This strikes a substantial challenge on patient safety which is a fundamental concern in patient care. Quality Improvement Proposal The Road to Evidence-based Practice Process

Quality Improvement Proposal The Road to Evidence-based Practice Process

The lack of an effective handover plan has exhibited several wastes necessitating quality improvement proposal to ensure optimal patient outcomes. Firstly, medical errors are prone to arise as the caregivers may issue treatment on inaccurately delivered patient information. During the handoffs, which occur frequently within the unit not only between regular shifts but also among part-time therapists and nurses, medical alterations may be birthed thus impacting the quality of care accorded.

The poor quality of care thus leads to increased hospital stay within the unit as the recovery process needed to transfer the patients to the general wards is reduced. Lengthened hospital stays mount considerable financial burdens on the patients and their families as they have to use out-of-pocket payments to complement the insurance reimbursements that may only cover some period of hospitalization. Quality Improvement Proposal The Road to Evidence-based Practice Process

Secondly, medical errors due to lack of effective handoffs births high-risk events factored on the chances of facilitating morbidities thus increasing the mortality rates within the unit. Cardiac patients are vulnerable thus even little infections may lead to sentinel events. Healthcare evaluation implicates medical errors during handoffs in approximately 80% of healthcare sentinel events (Cobb, 2021 Quality Improvement Proposal: The Road to Evidence-based Practice Process). This is evidenced by the Institute of Medicine publication “To err is Human: Building a Safer Health System” which clarifies the gaps related to patient safety thus insisting on redesigning complex care systems to ensure proper workflow between the numerous caregivers actively involved in patient care.

Necessity for Quality Improvement and The Expected Outcomes

I propose the conceptualization of Situation-Background-Assessment-Recommendation (SBAR) tool as a communication framework for both outgoing and incoming caregivers to share the patients’ conditions and appropriate medical and care therapy. The objectivity of the tool allows for the assessment of expectations and care plan which is fundamental in cementing a culture of patient safety (Abbaszade et al., 2021). The patient needs will therefore be communicated and cared for effectively across the continuum as they are prepared for discharge from the units to the general wards hence freeing space for more patients from the Intensive Care Units. Quality Improvement Proposal The Road to Evidence-based Practice Process

The first expected outcome is shortened hospital stay. Through initiating background-supported care, the patients will accurately be treated thus eliminating lengthened stay attributed to morbidities due to inaccurate care plans. The caregivers will therefore be able to attend to the patients based on appropriate priority of care thus hastening recovery. Consequently, the patients who recover fast are also discharged promptly from the unit. The objective is therefore set at obtaining a 50% reduction in the average length of hospitalization period within the unit. Quality Improvement Proposal The Road to Evidence-based Practice Process

The other expected outcome is the improvement in the overall quality of care provided to the patients. Through the establishment of discretionary yet so detailed communication among caregivers within the facility, the staff will develop a high regard for the observation of patient safety during care. The developed perception further improves their commitment to offering quality care thus professional responsibility is maintained amidst shift adjustments. The objective related to the outcome, therefore, is halving the mortality rates within the care units. Generally, all these outcomes are aimed at eliminating sentinel events besides reducing the cost of care through the establishment of an informed patient-centered care plan facilitated by the SBAR communication tool.

Literature Analysis

Raeisi, Rarani and Soltani (2019) explicitly explore the challenges presented during the handover process in patient care. The systemic review conducted in compliance with Preferred Reporting Item for Systemic Reviews and Meta-analysis singled out poor communication as the major setback regarding patient safety during care shifts. This is because in all complex care units, aggravated patient conditions are encountered thus for appropriate follow-up procedures on medication and appropriate management of care to be realized, all the systems and professionals have to be synchronized through effective communication. The finding impacts practice considerably as it sets the tempo for various healthcare facilities to explore avenues of creating a smooth care hand-over process.

Furthermore, poor communication during handoffs is associated with falters to the attentiveness and diligence that healthcare professionals partake in to improve patient outcomes. The problem lies in the misalignment of communication between the sender and the receiver, creating a potential for harm given the criticality of healthcare. The robust process established to conceptualize a systemic, data-driven solution to the menace by the Joint Commission Center for Transforming Healthcare was a real-time procedural flow of patient-specific information from a preceding caregiver to the next (Alert, 2017). Therefore, in several Medicine Workshops and Medical Research Council programs, the dominant theme has been quality improvement initiatives to reduce the wastes caused by ineffective communication during handoffs. Quality Improvement Proposal The Road to Evidence-based Practice Process

Lastly, the adoption of evidence-based approaches in healthcare has pushed many literal studies to explore the proposed initiative thus evidencing its effectiveness in achieving the outlined outcomes. In several studies, the SBAR tool emerges as one of the best countermeasures outlined for the facilitation of the concise transfer of patient information from the outgoing caregiver to the next (Shahid & Thomas, 2018 Quality Improvement Proposal: The Road to Evidence-based Practice Process). With the availability of situational analyzed information coupled with the relevant recommendation, the caregiver taking over continues with appropriate care plan thus safety is enhanced by systemic continuity of patient care.

Implementation Steps of Quality Improvement


This will involve a focused analysis of the current standardized handoff strategy used in the facility which is the transfer of patient information through the patient sheet. A focused analysis would provide a clarified view of the ambiguities associated with inaccurate and omitted patient data during the process. Quality Improvement Proposal The Road to Evidence-based Practice Process

Rationale: The assessment of the desired outcomes including reduction in the length of hospital stay, readmission rates among patients in the facility and mortality rates among admitted patients will be done against the outcomes associated with the ongoing methodology.


The analysis phase will involve an in-depth evaluation of the targeted outcomes by a dedicated implementation team. The objectives have to be achievable, specific and relevant to patient care.

Rationale: Directionality is fundamental to construct a measurable and relevant initiative. Moreover, it is upon the evaluation of the outcomes that the success of the initiative will be determined. This necessitates the use of a dedicated team to come up with the implementation plan.


The implementation team then would initiate a development phase where a pilot section of the unit will be randomly subjected to the use of the SBAR communication tool while another control group uses the standardized methodology during care handoffs. Quality Improvement Proposal The Road to Evidence-based Practice Process

Rationale: The control trial establishes findings to support wholesome adoption of the intervention in the unit.

Execution and evaluation

The program will then be implemented in two phases. The first phase, partial adoption, will run for three months after which the outcomes will be measured to determine the efficiency of the initiative. The program would then proceed to the full-blown implementation phase with the outcomes tested after defined timelines to justify the efficiency of the initiative in improving patient outcomes.

Rationale: The end game of the initiative is the execution of a sustainable change not just in the unit but within the whole healthcare facility focused on establishing a culture of patient safety. Therefore, if the desired objectives are met, the current system will be out-phased and replaced by the use of SBAR communication during patient handoffs. This will justify the adoption of the culture within the facility concurrent with the running of an awareness program. The awareness program will be focused on educating the staff on the quality improvement initiative. Quality Improvement Proposal The Road to Evidence-based Practice Process

Evaluation of the Quality Improvement Initiative

Mixed method analysis would be used to simplify the rather overwhelming initiative thus facilitating its spread for the facility to reach a level of sustainable implementation.

Quantitative evaluation

This would involve numerical analysis of the set objectives with the variables dependent variables being mortality rates and the average length of hospitalization period. The independent variable in the randomized control trial is the nature of handoffs with the experimental group using the SBAR communication tool while the control group using the hospital standard procedure. The null hypothesis would therefore be the use of SBAR communication tool result in improved patient outcomes. To ascertain or refute the hypothesis multiple linear regression analysis would be the statistical tool used. This is attributed to its effectiveness in relating multiple dependent variables to the experiment-adjusted variable. The t-value would then be analyzed to support the null hypothesis.

Qualitative evaluation

The qualitative analysis would probe the general feeling on the effectiveness of the proposed quality improvement initiative among healthcare workers. A three-point scoring scale would be used in surveying the opinion of the caregivers. The alternatives would be the proposed intervention is highly effective, fairly effective or less effective in patient care compared to the standard practice of care handoffs. Conclusively, the initiative has objective and measurable outcomes coupled with strong literature review backing thus has a high probability of soaring the facility to levels of patient safety sustainability. Quality Improvement Proposal The Road to Evidence-based Practice Process

Quality Improvement Proposal: The Road to Evidence-based Practice Process References

Quality Improvement Proposal The Road to Evidence-based Practice Process Instructions

Identify a quality improvement opportunity in year organization or practice. In a 1250-1500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply \”the road to evidence-based practice process.
1. provide an overview of the problem and the setting in which the problem or issue occurs.
2. Explain why a quality improvement initiative is needed in this area and the expected outcome.
3.Discuss how the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes. Include a minimum of three peer-reviewed sources published within the last 5 years, not included in the course materials or textbook, that establish evidence in support of the quality improvement proposed.
4. discuss steps necessary to implement the quality improvement initiative. provide evidence and rationale to support your answer.
5. explain how the quality improvement initiative will be evaluated to determine whether there was improvement.
6. support your explanation by identifying the variables, hypothesis test, and statistical test that you would need to prove that the quality improvement initiative succeeded.
Need APA format. solid Academic writing is expected, and documentation of sources should be presented using APA formating guidelines. Quality Improvement Proposal The Road to Evidence-based Practice Process
Comments / Note