ARE IMPROVEMENT OUTCOMES SUSTAINABLE WITHIN A DYNAMIC CLINICAL ENVIRONMENT?. Issue 11 (22nd October 2015)

• Record Type: Journal Article
• Authors: Sterrett, Emily; Kurowski, Eileen Murtagh; Ruddy, Richard; Byczkowski, Terri
• Is Part Of: BMJ quality & safety. Volume 24:Issue 11(2015)
• Page Start: 739
• Page End: 740
• Publication Date: 2015-10-22
• Subjects: Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2015-IHIabstracts.27
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: Systematic literature reviews show a paucity of publications describing the sustainability of quality improvement (QI) outcomes beyond one year. Hence, sustainability is not well understood, particularly in relation to ongoing improvement work and process changes in clinical care environment. Objectives: To evaluate the sustainability of an improved outcome resulting from a QI intervention to provide timely intravenous opioid delivery to patients with long bone fractures in a pediatric emergency department (PED) despite a dynamic QI environment. The initial QI intervention was implemented October 2007. Methods: The primary outcome was the proportion of patients with long-bone fractures receiving intravenous opioids within 45 minutes of arrival to an urban tertiary PED setting. Retrospective visit level data from 1/2007 through 6/2014 were obtained from the electronic health record. table 1 summarizes PED process changes implemented after the initial QI intervention. The effects of process changes on the primary outcome were determined using a monthly control chart (p-chart) and an interrupted autoregressive time series model. Results: Overall, improvement in the proportion of patients receiving timely intravenous opioids has been sustained for seven years since the initial implementation (figure 1). The p-chart, which is further supported by the results from the interrupted time series analysis (table 2), shows special cause variation attributable to two additional process changes related to physician responsibilities and staffing. Conclusions: Our initial improvement gains were robust despite multiple process changes in the care environment. Changes in physician staffing and physician responsibilities in a PED may be especially important to consider for future improvement initiatives.Figure 1 Table 1. Table 2