MSN-FP6016 : Quality Improvement Initiative Evaluation

Quality Improvement Initiative Evaluation

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Quality Improvement Initiative Evaluation

Systems of healthcare delivery aiming at improving patient experience can sometimes encounter daunting challenges that reflect the need to align changes in behaviors and practices across various levels and sections of the healthcare institution. As a result, healthcare institutions can create principles and approaches to quality improvement that are already familiar to many healthcare providers involved in clinical quality improvement, thus bringing the issue of quality improvement. Quality improvement is a vital element of every healthcare institution that wants to enhance the quality of care and improve patient experience (Mortimer et al., 2018). Besides, due to the advancements in technology, the healthcare environment has become dynamic and continuously change as technology makes people transform and get better to enhance the services they offer over time (Kruse & Beane, 2018). As a result, healthcare organizations find it necessary to find ways to continuously improve the health of patients through the provision of more patient-centered interventions. 

According to Gupta & Rokade (2016), quality improvement initiatives lead to positive feedback from the patients resulting in goodwill of the service providers in the market. This provider goodwill directly results in the expansion of the healthcare sector. Quality improvement initiatives also align the healthcare institution's objectives with the patients’ expectations, making them feel at peace within the healthcare environment (Mortimer et al., 2018). More important, because today’s patients know their rights and are knowledgeable about their health, healthcare institutions must always strive to continuously improve their healthcare service to attract and retain more patients who seek healthcare services. Notably, in most cases, quality improvement initiatives are often directed towards the patients' well-being (Gupta & Rokade, 2016). As a result, this paper intends to evaluate and discuss the efficiency of the hospitalist skilled nursing facility (SNF) quality improvement initiative in improving patient outcomes by reducing the rate of readmission at my current place of work. 

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Analysis of the Quality Improvement Initiative

My current healthcare organization designed a quality improvement initiative aimed at reducing the number of hospital readmissions. The stakeholders in the hospital realized that medical readmission is common and is costly to oh patients and the hospital. Moreover, research indicates that medical readmissions in the US have become a significant problem in recent years. For instance, according to El Morabet et al. (2018), statistics show that medical readmissions affect 20% of Medicare beneficiaries within 30 days after being discharged from the hospital. The annual cost of medical readmissions is about $17 billion (El Morabet et al., 2018). Due to this increased medical readmissions, nurses have been encountering an increased workload, which results in other problems like compassion fatigue and high turnover rates for the hospitals. Besides, increased readmissions also lower the quality of life of the patient while raising the expenses healthcare payers have to reimburse providers. Specifically, the elderly individuals are at increased risk of hospital-acquired infections and loss of functions when they are readmitted to the hospital after discharge. Therefore, due to the healthcare issues and increased cost of care associated with hospital readmissions, the hospital saw the need to lower the rates of readmissions.

A team was created and task with the responsibility to start the initiative, which began with the crafting of reforms that aimed at decreasing the confusion in prescription and dispensing of drugs to enhance the safety of patients. The team noted that hospital readmissions in the hospital result from limited access to physicians and compromised information exchange during care transition. Within the facility, inappropriate drug prescription was attributed to 5% to 30% of the readmissions (Lemor et al., 2019). Therefore, there was a necessity to implement quality improvement measures to avert readmissions from drug intake. 

The quality improvement team implemented a two-step review on medication during hospital admission and at discharge. The team also introduced documentation of home medication and medication reconciliation during admission as proposed by Braet, Weltens, & Sermeus (2016). Further, the team then implemented the hospitalist SNF model to improve the quality of services offered during medication dispensation and reduce readmission rates (Petigara, Krishnamurthy, & Livert, 2017). This quality initiative entailed utilizing the selected quality team to follow patients discharged to one SNF.

However, the team also realized that the hospital was understaffed, which could potentially contribute to the medication errors witnessed in the facility. The team noted that one pharmacist attended to many patients beyond his capacity and worked in long shifts that resulted in fatigue, potentially leading to medication errors. According to (Da Silva & Krishnamurthy, 2016), working for long hours can contribute to job dissatisfaction and lower the motivation of health care providers to do their work competently. Besides, in my state, the requirements for pharmacists are as well less strict, thus leading to the recruitment of less qualified and less experienced pharmacists who cannot also comprehend drug interactions well. In my state, most pharmacists are unlicensed and without continued education but are permitted to assign duties and responsibilities to nurses (Da Silva & Krishnamurthy, 2016). As a result, the probability of employing a less qualified candidate to dispense medication is high and can potentially lead to errors in medication. 

Evaluation of the Success of the Initiative

The initiative was successfully implemented and was attributed to a decline in the number of hospital readmissions. The success of the initiative was evaluated using the rate of decrease in readmission of patients. The rate of readmission declined gradually throughout the implementation period. For instance, when the initiative was started, the readmission rate from the SNF was 40.32% and declined to 19.05% after 6 months, and a further 10.04% after 12 months. This decline rate showed that the initiative is successful in improving the quality of care and lowering the rates of hospital readmissions. The readmission rate was reduced by enhancing the transition of care between health care facilities and improving the patients’ accessibility to hospital physicians (Petigara, Krishnamurthy, & Livert, 2017). In short, the most successful thing that happened during the implementation of this quality initiative was the initiative's capacity to reduce the readmission rates.

Additional Indicators and Protocols to Improve and Expand Quality Outcomes

The implemented quality initiative has helped the hospital to make tremendous milestones in reducing the rates of hospital readmissions. Besides, additional indicators that can be used to enhance further and expand quality outcomes were also evident. For instance, quality improvement can also be guaranteed through standardization of care. Care standardization ensured the other processes involved in patient care within the healthcare system were measured based on set standards and continuously aimed to surpass that specified standard. The other indicator is the Model for Improvement, which can ensure continuous, high-quality patient outcomes. The model also offers an approach for constructing improvement projects and entails two parts where the first part has three questions while the second part is the Plan-Do-Study-Act (PDSA) cycle. The first part of the model with the three questions asked what needed to be achieved, how to tell if there is an improvement, and the appropriate changes to guide the improvement. The PDSA cycle was used to comprehend the effects of the changes made prior to implementing them and adopting the healthcare system changes. In my current healthcare system, the PDSA cycle can help the interprofessional team identify the processes, system features, and patients linked with anon-standardized behaviors. This continuous cycle can make the behaviors more aligned, systematic, and easy to understand. For instance, the interprofessional team can incorporate the standard behavior of double-checking medication during admission and discharge and ensured continuity of care while adhering to the hospitalist SNF quality improvement model (Petigara, Krishnamurthy, & Livert, 2017). The other indicator is telehealth technology, which can also expand quality outcomes using biometric and video devices to monitor and provide care remotely, especially to patients with mobility issues (Kruse & Beane, 2018). Moreover, telehealth also permitted face-to-face and real-time interaction between physicians and patients and can lower readmissions. 

Conclusion

Overall, quality improvement initiatives are vital if a healthcare institution wants to realize high-quality patient care. Even though many hospitals have quality improvement strategies, they are unlikely to improve the quality of care if there is a lack of communication and interprofessional collaboration. Notably, hospital readmission is still a significant health problem that many hospitals in the US have to deal with to ensure quality patient outcomes. Besides, hospital readmissions can result from poor communication, limited access to physicians, and medication errors attributed to understaffing. More importantly, other improvement indicator protocols like Model for Improvement telehealth and standardization of care can assist in improving and expanding quality outcomes by reducing medication errors. 

References

Braet, A., Weltens, C., & Sermeus, W. (2016). Effectiveness of discharge interventions from hospital to home on hospital readmissions: a systematic review. JBI Evidence Synthesis, 14(2), 106-173.

Da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of Community Hospital Internal Medicine Perspectives, 6(4), 31758. doi:  10.3402/jchimp.v6.31758

El Morabet, N., Uitvlugt, E. B., van den Bemt, B. J., van den Bemt, P. M., Janssen, M. J., & Karapinar‐Çarkit, F. (2018). Prevalence and preventability of drug‐related hospital readmissions: A systematic review. Journal of the American Geriatrics Society, 66(3), 602-608. https://doi.org/10.1111/jgs.15244

Gupta, K. S., & Rokade, V. (2016). Importance of quality in health care sector: a review. Journal of Health Management, 18(1), 84-94.

Kruse, C. S., & Beane, A. (2018). Health information technology continues to show positive effect on medical outcomes: systematic review. Journal of medical Internet research, 20(2), e41.

Lemor, A., Hernandez, G. A., Patel, N., Blumer, V., Sud, K., Cohen, M. G., & Alfonso, C. E. (2019). Predictors and etiologies of 30‐day readmissions in patients with non‐ST‐elevation acute coronary syndrome. Catheterization and Cardiovascular Interventions, 93(3), 373-379. 

Mortimer, F., Isherwood, J., Wilkinson, A., & Vaux, E. (2018). Sustainability in quality improvement: redefining value. Future healthcare journal, 5(2), 88. 

Petigara, S., Krishnamurthy, M., & Livert, D. (2017). Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities. Journal of Community Hospital Internal Medicine Perspectives, 7(2), 66-69. https://doi.org/10.1080/20009666.2017.1313492