Primary Drivers Secondary Drivers - PowerPoint Presentation

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Primary Drivers

Secondary Drivers

By March 31st 2019, 85% of the inpatient echocardiograms ordered at Burnaby Hospital will have appropriate indications.

Physicians (Internal medicine, Hospitalists, Neurologists, ER)

Preprinted orders

Echocardiogram booking Process

Lack of knowledge of (Evidence based guidelines)what is appropriate recommendations for echocardiogram in different diseasesof recent echocardiogram investigations of when echocardiogram is recommended to be completed byLack of reflection on how investigation incorporates patients goals of care and how results will impact managementEchocardiogram is an outpatient investigation for most diseasesEcho booking form not helpfulMRP to order echo

Stroke, congestive heart failure, acute mi-tick box

Little to no information provided by booking physician on indication(area of interest), timeline for completion or location for test (inpatient or outpatient)Unit clerk process for selecting the urgency of echoTriaging not clinically based

Structure

IT- Meditech/UCI

Difficulty/time consuming

finding previous echo reportsAvailability of booking formsOrder entry process for unit clerks

Operating norms

Belief that

u

nable to get rapid outpatient echocardiogram

Evidenced based guidelines-not known adhered to

Fear of missing something

Do it as inpatient easier for patient all “tests done one stop”

Education on echocardiogram indications for

(CHF

, MI, endocarditis stroke, syncope, murmurs) (department meetingsEducation on most appropriate physician to order echocardiogram Create a Standard Echocardiogram booking form (previous echo, indication, location and timeline for completion) with education cheat sheet on back of formAvoidance of duplication of service previous echoIndividual feedback of appropriate ordering

Add a line for indication Education on back of PPO

Computer auto notifies on order entry of previous echocardiogramMedical imaging notifies MD of previous echo with guideline recommendationsOne location for easy access to formsTeaching session on changing printersUnit clerk education

Create a Triage process for echocardiogram booking

Change Ideas

Aim

Physician

Quality Improvement Driver Diagram

Appropriate ordering of Inpatient Echocardiogram

PQI Project Lead: Dr. Sarah Ostler

Outcome Measures:-Ratio of inappropriate/appropriate echocardiograms ordered-Total number of inpatient echocardiograms ordered-LOS for inpatients who have echocardiogram ordered-Percentage of echocardiograms done in hospital/out patient

Balancing Measures:-outpatient echocardiograms wait time-number of outpatient echocardiogram ordered-Patient physician satisfaction

Process Measures:Time to order to test completion-time to discharge after reportingPercentage of echocardiogram rebooked

Secondary Drivers

By March 31st 2019, inpatient echocardiograms at Burnaby Hospital will decrease by 15%.Physicians’ Education and standard practice (Internal medicine, Hospitalists, Neurologists, ER)

Defects in Echocardiogram booking Process

Lack of knowledge of

what is appropriate recommendations for echocardiogram in different diseases (Evidence based guidelines)when recent echocardiogram investigations were done

when echocardiogram is recommended to be completed by2. Lack of reflection on how investigation incorporates

goals of care ate and how results will impact management3. Lack of understanding/awareness that Echocardiogram is usually an outpatient investigation for most diseases4. Echo booking form not user friendly5. Understanding BH resources: MRP to order echoNo standard process for triaging echo orders (resulting in frequent rebooking)Inappropriate method of assigning test urgency via Unit clerk

Inefficiency of existing Communication tools (Booking Forms)

Current Booking Form lacks key information fieldsTest prioritization not indicated

Type of echocardiogram (TEE, TTE) not

orderedPrevious echo not listed

Outpatient or inpatient indicated 2. Booking form availability

Outdated knowledge/ Culture

Outdated Beliefs that inpatient echocardiogram are executed more timelyF

ear of missing somethingDo it as inpatient easier for patient all “tests done one stop”

Awareness of more effective ways to better utilize of BH recourses

Education on echocardiogram indications for

(CHF

, MI, endocarditis stroke, syncope, murmurs) at various department meetings

Education on most appropriate physician to order echocardiogramCreate a Standard Echocardiogram booking form that is physicians friendly and easy to follow (previous echo, indication, location and timeline for completion) with education cheat sheet on back of formEmphasizing the importance of avoiding the duplication of service by reviewing previous echoIndividual feedback of appropriate ordering

Redesign Booking Form to include necessary fields

Education on back of PPO

Mistake proofing booking process: Computer auto notifies on identifying previous echo’s Medical imaging notifies MD of previous echo with guideline recommendationsOne location for easy access to formsTeaching session on changing printersUnit clerk education

Education around understanding processes and utilization of available BH resourcesCreate a Triage process for echocardiogram booking

Change Ideas

Aim

Physician

Quality Improvement Driver Diagram

Reducing Inpatient Echocardiogram at Burnaby Hospital

PQI Project

Lead: Dr. Sarah OstlerOutcome Measures:Ratio of inpatient to outpatient echocardiograms ordered per monthNumber of inpatient echocardiograms

Balancing Measures:- # critical to flow Echo tests booked for inpatients above 70-Patient physician satisfactionProcess Measures:% of echo orders rebooked% of orders received utilizing new form fields% of orders requesting inpatient% of orders received out patient % of orders received for patients older than 85Decrease in urgent echocardiograms booked

Primary Drivers