Implementing an effective quality improvement program is not only essential to achieving accreditation by the Accreditation Association of Ambulatory Health Care but also can put surgery centers on the road toward improved patient safety and clinical outcomes. An ASC may carry out quality improvement studies and programs to improve various aspects of the facility's clinical outcomes and operations, including rates of infection or other adverse events. Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla., says the biggest learning curve for the physicians and staff was through its own quality improvement program.
"It was a big learning opportunity for the nurses, who already have a general idea for quality improvement, to focus on the format of quality improvement studies and doing them from a scientific perspective," she says. "It was getting them to understand how to hone in on a problem and become strategic on how to improve quality outcomes, financial outcomes and patient satisfaction."
Here are three steps to take for more effective quality improvement studies.
1. Discuss possible QI studies. Quality improvement programs are the most effective when physicians and staff members commit to continuously looking for areas of improvement, Ms. Bollinger says. Laser Spine Institute starts by involving nurses, physicians, administrator and other facility employees in a discussion for possible QI studies.
"I really rely on our director of nursing to communicate with the OR team and the rest of the surgical staff to talk about ideas of where we think we need to focus for improvement," she says. "Your staff knows where the process is broken, so when we brainstorm QI studies, we go to the team instead of relying on a board or administrators to tell us what to do. It's bottom-up, not top-down."
2. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," Ms. Bollinger says. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
3. Identify inefficiencies and implement change. Even though Laser Spine Institute found its compliance rate for IV antibiotic administration was better than anticipated, the results of the study prompted changes in other operational processes.
"We were able to improve some of the processes to reduce the amount of time a patient had to wait in the waiting area and make sure surgeons are in the OR are on time," Ms. Bollinger says. "We've increased communication between the pre-op and sterile corridor to make sure everyone is on the same page to help keep IV antibiotic administration on schedule with the standardized time frame."
Ms. Bollinger adds that surgery centers would benefit from reviewing new changes made in policies in procedures. "After you do a study and implement change, you always want to go back and review whether that change made a positive impact," she says.
Learn more about Laser Spine Institute.
"It was a big learning opportunity for the nurses, who already have a general idea for quality improvement, to focus on the format of quality improvement studies and doing them from a scientific perspective," she says. "It was getting them to understand how to hone in on a problem and become strategic on how to improve quality outcomes, financial outcomes and patient satisfaction."
Here are three steps to take for more effective quality improvement studies.
1. Discuss possible QI studies. Quality improvement programs are the most effective when physicians and staff members commit to continuously looking for areas of improvement, Ms. Bollinger says. Laser Spine Institute starts by involving nurses, physicians, administrator and other facility employees in a discussion for possible QI studies.
"I really rely on our director of nursing to communicate with the OR team and the rest of the surgical staff to talk about ideas of where we think we need to focus for improvement," she says. "Your staff knows where the process is broken, so when we brainstorm QI studies, we go to the team instead of relying on a board or administrators to tell us what to do. It's bottom-up, not top-down."
2. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," Ms. Bollinger says. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
3. Identify inefficiencies and implement change. Even though Laser Spine Institute found its compliance rate for IV antibiotic administration was better than anticipated, the results of the study prompted changes in other operational processes.
"We were able to improve some of the processes to reduce the amount of time a patient had to wait in the waiting area and make sure surgeons are in the OR are on time," Ms. Bollinger says. "We've increased communication between the pre-op and sterile corridor to make sure everyone is on the same page to help keep IV antibiotic administration on schedule with the standardized time frame."
Ms. Bollinger adds that surgery centers would benefit from reviewing new changes made in policies in procedures. "After you do a study and implement change, you always want to go back and review whether that change made a positive impact," she says.
Learn more about Laser Spine Institute.