CONTINUOUS QUALITY IMPROVEMENT
Continuous Quality
Improvement
@ Stony Brook Medicine
Continuous Quality Improvement (CQI) is:
• A journey to satisfy the needs and exceed the expectations
of our customers
• A means of performance improvement
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Aligned with our Mission to improve the lives of our
patients, families, and communities, to educate skilled
healthcare professionals and to conduct research that
expands clinical knowledge
What does CQI Encompass?
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Patient care
Patient satisfaction
Patient safety
Employee safety
Employee satisfaction
Regulatory agency requirements
Administrative/financial functions
CQI Principles
• All work is a part of a process
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Quality is achieved through people
Decision making is done with facts
Patients and customers are our first priority
Quality requires continuous improvement
CQI focuses on the process not the person
Find a process to improve
• Administration, Clinical Service Groups, other
Committees charter a CQI team
• Criteria used to prioritize opportunities for
improvement
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High Risk
High Cost
High Volume
Problem Prone
Patient Safety related
Core Measures of Excellence are a variety of evidence-based, scientificallyresearched standards of care which have generally been shown to result in
improved clinical outcomes for patients. Those areas reviewed include:
Surgical: (SCIP) timeout/ timeliness of antibiotics / blood glucose control / urinary
catheters, death among surgical inpatients with serious treatable complications, Iatrogenic
pneumothorax rates, post op respiratory failure, Pulmonary embolism, DVT, wound
dehiscence, accidental puncture / lacerations, hip fracture mortality
Abdominal Aortic Aneurysm Repair mortality rates
Children’s Asthma: specific medication use
Stroke, Acute Myocardial Infarction & Heart Failure (drugs during admission and
upon discharge, specific procedures)
Community – Acquired Pneumonia: immunizations, blood cultures, antibiotic
choices
Emergency Department – departure/admit times, timeliness to diagnosis, pain
management
Imaging Efficiency: MRI for Lumbar spine; mammography follow up, use of
contrast material
Central line associated bloodstream infection
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Core Measure of Excellence
•CMS (the Center for Medicare & Medicaid Services) established the
(Core) Measures in 2000 and began publicly reporting data relating
to the (Core) Measures in 2003
•CMS ties some parts of reimbursement to reporting the data; in
the future reimbursement will be tied to how well we do in
delivering the elements of care (Value-Based Purchasing)
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Methodology for Improving a Process
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Find a process to improve
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Organize a team that knows the
process
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Clarify current knowledge of the
process
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Understand causes of process
variation
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Select the process to
improvement
How does FOCUS PDCA help us to Adhere
to the Simple Rules of Work?
• Patients First
• Prevent Failure (a breakdown in operations or
functions)
• Use World Class Processes
• Redesign the Process to meet the best standard of care
without compromise to the patient
• Encourage Growth in Knowledge
• Use Resources Wisely
Examples of CQI projects
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Early recognition of sepsis through the electronic medical record
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BOOST: identification of the elderly high risk patient & medication reconciliation
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Surgical Booking sheet discrepancy’s
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ED to Medicine bed time / ED to CACU flow
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Preventing Central Line and Catheter Associated Urinary Tract Infections
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Reducing “Door to Balloon Time”
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Improve the care of patients with Heart failure
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Avoiding Readmissions within 30 days
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Inducing Hypothermia post cardiac arrest
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Medication Reconciliation upon admission in the ED
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Time to pain medication for long bone fractures
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Minimizing pain during procedures for the pediatric patients - “Ouch less”
Reducing CLBSI’s (Central Line Blood Stream Infections)
Efforts to improve the
quality of care also can
reduce the cost of care
Sentinel Event
• A sentinel event is an unexpected occurrence involving death or
serious physical or psychological injury, or the risk thereof.
• Examples include:
--Suicide
--Rape
--Loss of limb
-- Elopement
--Death
Root Cause Analysis
• A process for identifying the contributing factors that underlie
variations in performance; includes the occurrences of the sentinel
events, adverse event or close calls.
• Process that features interdisciplinary involvement of those closest to
and/or most knowledgeable the situation to find out:
--What happened?
--Why did it happen?
--How can we prevent it?
--How do we know we made a difference
Failure Mode and Effects Analysis (FMEA)
• Proactive risk assessment
• A team based, systematic, and proactive approach for identifying the
ways a process or design can fail, why it might fail, and how it can
be made safer.
Joint Commission Requirement
• What performance improvement initiative has our department
implemented recently?
• Hint: It MUST be supported by data (graphs)
CONTINUOUS QUALITY IMPROVEMENT
How to contact the CQI Department
• If you have any questions or ideas for a potential CQI project in
your department, please call us at:
(631) 444-9975
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