(From left) Sohera Syeda, MD, Boston, reviews her poster presentation Monday with Jeremy Richards MD, MA, Boston, and J. Daryl Thornton, MD, MPH, who was the poster session co-chair.
When a patient transfers from the hospital to home, maintaining seamless care is paramount. One Monday morning poster discussion session looked at how clinicians can integrate best practices.
In B23 “Quality Improvement: Using Research Methods, Clinical Support Tools and Teamwork to Improve Assessment and Treatment of Lung Disease,” several researchers showed how they have made great strides in quality improvement.
Studies show that successfully integrated interventions improve the quality of care given to patients with pulmonary and critical care illnesses by tying everything together, said co-chair J. Daryl Thornton, MD, MPH, of Case Western University.
“Many of these studies are multidisciplinary, which is what makes it so nice. It’s not just one successful intervention, but clinicians are bundling several together,” said Dr. Thornton, who shared the results of two of the studies.
Researchers at Children’s Hospital in Aurora, Colo., implemented a quality improvement project to evaluate asthma action plan (AAP) use and increase compliance with standards from The Joint Commission (JC).
In “Using Quality Improvement Methods, Clinical Decision Support Tools and a Multidisciplinary Team to Improve Compliance with Joint Commission Asthma Action Plan Standards,” the team implemented a series of quality improvement cycles. This included a data registry, clinical workflow evaluations, an adjusted AAP electronic medical record (EMR) template, education for nurses and respiratory therapists, improved identification of patients and provider communication, repeat clinical workflow evaluations, an EMR asthma medication alert and incentives for resident teams.
In January 2008, the creation of AAPs was 60 percent for inpatients, and the number of JC-compliant action plans was zero. The percentage of AAP creation was 89.7 percent by August 2010.
“What’s so dramatic is that initially, patients weren’t getting asthma action plans at all, and then they implemented their multidisciplinary team and brought it up all the way to 90 percent, which was outstanding,” said Dr. Thornton, whose co-chairs were Lynn Gerald, PhD, of the University of Arizona in Tucson, and Peter Lenz, MD, of the University of Cincinnati.
In another study, “Use of an Electronic Medical Record to Improve the Transition of Patients on Chronic Warafarin Therapy Following Hospitalization,” researchers at the University of Texas Medical Branch in Galveston piloted a tool to improve the transition of patients on chronic warfarin therapy following hospital discharge from a single inpatient medical-surgical unit.
A physician discharge checklist was introduced into the EMR, coupled with a nursing discharge checklist, which emphasized dosage reconciliation, drug interactions, clinic follow-up and completion of patient education. The EMR was also employed to schedule clinic follow-up visits and to track the INR value at the first clinic visit post-hospitalization and the time to the first clinic visit.
A total of 63 patients were included in the intervention. Post-intervention, the proportion of patients with an in-range INR at the first clinic visit post-hospitalization increased from 35.8 percent to 60.3 percent. There was an increase in the proportion of patients who had a follow-up visit with INR measurement within three to five days of hospital discharge (20.5 percent versus 44.4 percent) and a decrease in the proportion of patients whose follow-up visits occurred greater than five days post-discharge (69.2 percent versus 41.3 percent).
“They identified the problem, and they found it was on multiple levels,” Dr. Thornton said. “Then they implemented several interventions simultaneously and involved many different caregivers to make improvements.”