Monday, October 26, 2015

Weekly Tidbit #5 - Reliability

by Paul Uhlig

This week's Tidbit is the first of a series of Tidbits exploring the topic of reliability.
Attached with this email are measures made during the first year of implementing collaborative care by a cardiac surgery care team. The team was interested in improving its reliability to consistently meet all of the quality standards of the Society of Thoracic Surgeons National Database.
At the request of the team, a dashboard of quality measures was prepared each week by the quality department of the hospital for use in the weekly reflection meeting. The care team used this data as a point of reference as it implemented collaborative care and made changes in its care routines.
If you look at this data, as the team did every week, you will see steady improvement in measures of preoperative beta blocker use, discharge beta blocker use, discharge statin use, and discharge aspirin use. Reliability increased to 100%, and fall outs stopped. Although standing order sets were in place that should have resulted in this care, it was only after collaborative care was instituted that these results were achieved.
How did this happen? Every day on rounds the care team discussed aspirin, statin, and beta blocker use with each patient and family by including these as items in the safety checklist--the "action" part of collaborative care. And, every week, the team reviewed its performance for the week before in its weekly team meetings, making refinements to care routines informed by this ongoing flow of information--the "reflection" part of collaborative care. Gradually these measures became part of the tacit knowledge and shared expectations in the care environment.
In addition to the changes shown in this data, implementation of collaborative care created opportunities for team conversations that resulted in revised routines and protocols for many additional aspects of care, including postoperative blood glucose control, scheduling methods, a preoperative risk assessment protocol, preoperative evaluations. a preoperative testing clinic, and new patient education materials.
In coming Tidbits we will consider additional examples of reliability, and how this can be achieved through collaborative care.
PS: I am sorry to report that Vicki's husband, who had been transferred to another hospital, died this week of complications during his subsequent care. Vicki receives copies of our Tidbits and has stayed in touch. All of our thoughts go out to her.
She wrote,
            Darrell was so courageous and lived and died with love and grace.
            I told you in a previous e-mail that I would consider you a friend forever no matter how it all turned out. You were there for me and my family at a time when we needed a compassionate, educated, and calming presence. Thank you so very much for all your help. I am sincerely grateful. May God honor you in all your endeavors.

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