Measurable outcomes of quality improvement using a daily quality rounds checklist

Teixeira, Pedro G.R.; Inaba, Kenji; DuBose, Joseph J.; Melo, Natália; Bass, Margarita; Belzberg, Howard; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e31829d27b6

Cited by 35 publications

(17 citation statements)

References 14 publications

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“…Evidence suggests that DVT screening may be unnecessary and not cost-effective in patients who receive appropriate prophylaxis 15–17 . Furthermore, trauma centers are increasingly providing appropriate prophylaxis to trauma patients as efforts to reduce venous thromboembolism have received greater attention 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism

Dietch¹,

Edwards²,

Thames³

et al. 2015

Surgery

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Background Disparate lower extremity ultrasound (LUS) screening practices among trauma institutions reflect lack of consensus regarding screening indications and whether screening improves outcomes. We hypothesized that LUS screening for DVT is not associated with reduced incidence of pulmonary embolism (PE). Methods The 2012 ACS National Trauma Data Bank Research Data Set was queried to identify 442,108 patients treated at institutions reporting at least one LUS and at least one DVT. Institutions performing LUS on more than 2% of admitted patients were designated high screening (HS) facilities and remaining institutions were designated low screening (LS) facilities. Patient characteristics and risk factors were used to develop a logistic regression model to assess the independent associations between LUS and DVT, and between LUS and PE. Results Overall, DVT and PE were reported in 0.94% and 0.37% of the study population, respectively. DVT and PE were more commonly reported in HS than LS (DVT: 1.12% vs. 0.72%, p<0.0001; PE: 0.40% vs. 0.33%, p=0.0004). Multivariable logistic regression demonstrated that LUS was independently associated with DVT (OR=1.43, CI 1.34-1.53) but not PE (OR=1.01, CI 0.92-1.12) (c-statistic 0.86 and 0.85, respectively). Sensitivity analyses performed at various rates for designating HS facilities did not alter the significance of these relationships. Conclusions LUS in trauma patients is not associated with a change in the incidence of pulmonary embolism. Aggressive LUS DVT screening protocols appear to detect many clinically insignificant DVTs for which subsequent therapeutic intervention may be unnecessary, and the use of these protocols should be questioned.

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Section: Discussionmentioning

confidence: 99%

Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism

Dietch¹,

Edwards²,

Thames³

et al. 2015

Surgery

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“…A systematic review performed by Lane et al (2013)[ 4 ], which was recently updated[ 5 ], identified 13 best practices for ICU patient care rounds. These included implementing interprofessional rounds (physician, nurse, and pharmacist at minimum)[ 6 – 15 ]; standardizing practices[ 16 – 19 ]; defining roles for all participants[ 20 – 23 ]; using a structured tool[ 24 – 35 ]; reducing time spent on non-essential activities[ 17 , 18 ]; minimizing interruptions[ 36 – 38 ]; developing and documenting daily goals[ 22 , 31 , 39 , 40 ]; considering the best location of rounds (bedside vs. conference room) to optimize patient-centeredness and efficiency[ 36 , 41 – 43 ]; and establishing both an open and collaborative discussion environment[ 16 , 42 – 44 ]. All of these best practices were reported to potentially improve rounds either by increasing provider satisfaction, reducing rounding time, or improving patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

A Survey of Rounding Practices in Canadian Adult Intensive Care Units

et al. 2015

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ObjectiveTo describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement.DesignMixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7).Measurements and Main ResultsMedical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient’s bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥1 interruption for ≥50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning.ConclusionsThere is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality.

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“…As a well-known example, after its worldwide introduction, the Surgical Safety Checklist by the World Health Organization has been recognised as a generally effective measure in order to increase patient safety in the operating room [ 14 ]. In 2013, a Quality Rounds Checklist could sustainably increase compliance with evidence-based standards and decrease complications in a trauma intensive care unit [ 34 ]. Through its multifaceted character they might be a cornerstone to improve patient safety sustainably.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

et al. 2015

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IntroductionSurgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention.MethodsAll hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate.ResultsImmediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available.DiscussionImmediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program.ConclusionSpecific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

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Measurable outcomes of quality improvement using a daily quality rounds checklist

Abstract: Therapeutic study, level IV.

Cited by 35 publications

References 14 publications

Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism

Rate of lower-extremity ultrasonography in trauma patients is associated with rate of deep venous thrombosis but not pulmonary embolism

A Survey of Rounding Practices in Canadian Adult Intensive Care Units

Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

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