Assignment Task:
In response to at least two of your peers, answer the following:
1. Did you find your peers' process and outcome metrics were linked appropriately?
2. What departments would your peers need to collaborate with to acquire the data for their process and outcome metrics?
3. Do you think it will be feasible for your peers to collect the data and track their process and outcome metrics effectively?
Sarah Discussion:
An outcome publicly reported by Children's Hospital Colorado (CHCO) is rate of central-line associated blood stream infections (CLABSI). CHCO's rate in 2023 was 5 CLABSIs in 5,380 central-line days (Colorado Department of Public Health and Environment [CDPHE], 2024). The overarching goal will be to decrease CLABSIs in patients at CHCO. An evidence-based approach to decrease CLABSIs is implementing a central line care bundle, as described by Santos et al. (2019). This bundle would include interventions like hand hygiene, daily bathing for patients with central lines, sterile dressing changes, regular multidisciplinary discussions about line necessity, and proper aseptic technique.
To measure effectiveness of this initiative, it will be important to measure the process and the outcomes. In this project, the process metric will be measured by determining compliance with the central line bundle interventions. This is considered a process metric because it is determining if the steps or parts of a process are being performed as they are planned to improve the system, as described by Institute for Healthcare Improvement (n.d.). The outcome metric will measure CLABSI rates to determine if the rate of infection is increasing, decreasing, or staying the same after the intervention. This is considered an outcome metric because it is determining if the process or system is making an impact on the overarching goal of the improvement initiative.
It is expected that compliance with the central line care bundle (process) will decrease the number of CLABSIs within the organization (outcome). Measuring bundle compliance should assist with gauging progress to decreasing CLABSI rates, since central line bundles have been shown to decrease CLABSI rates (Santos et al., 2019). It would be expected to see a high number of compliance with bundle protocols coupled with a decrease in CLABSI rates.
References:
CDPHE. (2024, July). Healthcare-associated infections (HAI) Annual Report. (pg. 80).
Institute for Healthcare Improvement. (n.d.). Model for improvement: Establishing measures.
Santos, K. M. B., Husain, S. S., Torres, V., Huang, C.-C., & Jacob, E. (2019). Multi-level intervention program - A quality improvement initiative to decrease central line-associated bloodstream infections in the pediatric acute and hematology/oncology units. Journal of Pediatric Nursing, 48, 106-113.
Tamrin Discussion:
For my quality improvement initiative focusing on Baptist Memorial Hospital, I aim to enhance patient satisfaction during ultrasound visits at the OB-GYN office by improving operational efficiency and reducing patient wait times.
Process Metric:
The process metric I would use is the percentage of ultrasound patients seen within 10 minutes of their scheduled appointment time. This metric focuses on tracking whether staff can stick to scheduled appointment times and minimize delays. Data for this metric would be collected and recorded daily. The time patients check in and when they are taken to the exam room would be vital information.
Outcome Metric:
An associated outcome metric is the patient satisfaction score related to the timeliness of service. This score would be collected through post-visit patient surveys.
Justification of Metrics:
The process metric measures the hospital's ability to provide timely services, a critical step in improving operational efficiency. Timeliness is essential in an OB-GYN office where patient volumes can fluctuate, and delays can disrupt both patient satisfaction and workflow. The outcome metric focuses on the overall patient experience, particularly how they perceive the efficiency of their care. A direct relationship exists between these metrics because improving timeliness (process) should positively impact patient satisfaction (outcome).
Linking Process and Outcome Metrics:
The process metric helps gauge progress toward the outcome metric by identifying whether interventions to reduce wait times are effective. For example, if the percentage of patients seen within 10 minutes increases steadily, we would expect corresponding improvements in patient satisfaction scores. However, if satisfaction scores do not improve despite timely services, it may indicate other underlying issues, such as how patients are treated during check-in or their experience with the ultrasound procedure. This linkage allows for targeted adjustments based on the metrics' feedback.
How the Metrics Drive Improvement Opportunities:
The process metric provides specific data that can be analyzed to identify patterns. The outcome metric reflects if these operational changes translate into a better patient experience or not. These metrics reflect improvements to both workflow efficiency and patient satisfaction.
References
Joshi, M., Ransom, E. R., Nash, D. B., & Ransom, S. B. (2022). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.
Agency for Healthcare Research and Quality (AHRQ). (2018). Using patient satisfaction surveys and process metrics for quality improvement.
Institute for Healthcare Improvement (IHI). (2023). Measures for improvement.