Quality Improvement or Research—Deciding Which Road to Take

Abstract

C ritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources. Additionally, they are expected to identify and implement the latest evidence-based practices (EBPs) into their own clinical practice. Ideally, advanced practice nurses would be present at every institution to assist department managers and bedside nurses with quality improvement and research projects specific to their department and organizational needs. Unfortunately, out of 4999 registered community hospitals in the United States (January 2014), only 395 (8%) have American Nurses Credentialing Center Magnet status.1 Although not a direct measure of the availability of nursing research resources at every type of institution, the low percentage underscores the important fact that many critical care units are on their own when it comes to implementing a quality improvement or clinical research project.This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing projects within their own units. The purpose of this first article is to provide a broad overview of the differences between quality improvement and research, as well as a discussion of the factors that should be considered when deciding which road to take. Future articles will discuss (1) how to identify worthwhile projects; (2) project design, implementation, and documentation; and (3) how to publish quality improvement activities by using the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines. Quality ImprovementCritical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources while implementing the latest evidence-based practices into their own clinical practice. This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing system process or performance improvement projects within their own units. Part 1 is designed to answer the question "What method is better for measuring real-world patient outcomes-quality improvement or clinical research?" A broad overview of the differences between quality improvement and clinical research is provided. A newly published checklist to differentiate between attributes of each process is introduced, and readers can test their own knowledge between quality improvement and research with a quick quiz of studies recently published in Critical Care Nurse. (Critical Care Nurse.

Proper Skin Preparation and Electrode Placement Decreases Alarms on a Telemetry Unit

“…These projects typically improve patient care in specific settings with minimal risk to patients. 54,55 While QI does not require the oversight that research does, nurses should take advantage of all the resources available at their facility, such as consulting their IRB committee. 54 Obtaining IRB review, even if it is considered exempt from full review, signifies that the project meets ethical standards.…”

“…54,55 While QI does not require the oversight that research does, nurses should take advantage of all the resources available at their facility, such as consulting their IRB committee. 54 Obtaining IRB review, even if it is considered exempt from full review, signifies that the project meets ethical standards. 55 This study exemplifies how nurses have the ability to use a QI project to make a significant improvement in the care of their patients and meet the needs of the Joint Commission national patient safety goals.…”

Critical Thinking Tools for Quality Improvement Projects

“…Some hospitals, especially those that have received or are seeking Magnet designation, have hired nurses with advanced degrees to guide bedside caregivers in research, evidence-based practice, and QI initiatives. 7 For nurses who work in hospitals but do not have advanced education related to QI, navigating the many critical thinking and evidence-based practice tools to improve patient care can be daunting.…”

Research versus Quality Improvement in Healthcare

“…[7][8][9] However, QI projects are datadriven and focus on showing sustained improvement to a specific process and system or outcomes within a healthcare organization using, if possible, the research evidence generated as the basis for developing the improvement interventions. [10] A QI project does not aim to generate new knowledge as a research project does, rather, it generates several learning lessons as to what actually works and does not work and why. A QI project produces empirical evidence to benefit other organizations within a similar context and setting, which are interested in replicating the change to improve a process or system using the rapid PDSA cycle approach.…”