Poster Day 2024: Abstracts: Quality Improvement

Falls with significant injury are reportable to the Centers for Medicare and Medicaid Services; therefore, healthcare organizations prioritize quality improvement processes, policies, and monitoring to improve patient safety and care. Following a data review showing the organization had 10 falls with significant injuries in the inpatient setting during 2020, a falls risk assessment screen for specific, identifiable patient fall risk factors replaced the numerical scoring tool to identify falls risk currently used. The 2021 yearly organizational fall rate and falls with significant injury decreased slightly. Inconsistencies found in the application of risk screening across nursing shifts lead to an emphasis on bedside nurse engagement and standard fall risk screening across shifts. In 2022, the organization still only realizing slight improvements implemented fall prevention interventions based on identified specific patient risk factors, fall mats, and the addition of a virtual sitter program. By 2023, data showed overall fall events reduced by 20%; with falls with significant injury reduced to four. A rising number of falls with significant injury in 2024 initiated a call to action engaging nursing leaders to design corrective action plans, resulting in a 40% reduction in fall events and as well as impacting falls with significant injury.

Bill Roberts, PharmD

Devesh Dahale, MS, MBA, CPHQ, CPXP

Transition from alteplase to tenecteplase: We began with a review of pertinent published literature on this topic. Next we conducted a safety analysis and then added the drug to the formulary. The order set for stroke thrombolytic treatment was modified appropriately.

Introducing Pharmacist in ED: We began piloting deployment of a pharmacist to the ED. The coverage at that time was 8 hours daily on weekdays, but we elected to look at delivery times with and without the ED pharmacist to determine any benefit from that initiative on the process.

3 of 10 steps were eliminated with the change from alteplase to tenecteplase. For nursing, steps in the administration process were reduced from 6 to 2.

Average thrombolytic delivery time decreased from 7.8 minutes to 5.2 minutes (overall)

Thrombolytic door to needle times within 45 minutes increased from 38% to 74%.

Switching the thrombolytic from alteplase to tenecteplase had profound implications on the pharmacy mixing and delivery process for eligible ischemic stroke patients.

The additional intervention of having a pharmacist in the ED augmented timesaving in the thrombolytic mixing and delivery process.

  The study found a significant association between continuous IV fluid administration and respiratory failure and aligns with existing literature on the risks of fluid overload. These findings underscore the need for vigilant fluid management to prevent respiratory complications and to improve patient outcomes; potentially reducing healthcare costs through decreased complications, shorter hospital stays, and lower readmission rates. This can be accomplished by establishing a daily reminder system to notify physicians 24-48 hours after fluid initiation to re-evaluate the need for fluids.

Lara McCall, BSN, CCM; Devesh Dahale, MS, MBA, CPHQ, CPXP

Patient flow is at the heart of hospital management. It is imperative to understand and improve flow to accomplish the hospital’s mission of providing acute care services to the community in a timely manner.

The goal of this project was to improve patient flow in the inpatient setting. The objective measure for the purpose was determined to the average length of stay (ALOS).

We created a multi-disciplinary team to work on this project. Four key drivers were stablished: appropriate admissions, optimized treatment, early and timely disposition and coordinated discharge. We implemented several interventions including increasing the use of disease specific admission order sets, an expected date of discharge based unit huddle review, a weekly complex care patient huddle, and algorithms for CDU (clinical decision unit) admission criteria and maximized the use the discharge lounge whenever applicable. We utilized Epic to capture various different types of barriers (unit huddle, social determinants of health and external) to flow within patients.

A standardized and structured unit huddle resulted in efficient utilization of time for review of patients (reduced from 60 minutes to 15 minutes) ALOS reduced from 5.3 to 5.15. A formal communication system for information flow between the unit care team, ancillary departments, the physicians and administration was set up using criteria and forums.

Patient flow is SYSTEM property. Structure beats chaos. Technology is only as good as how well you can leverage it. Communication is currency of flow in systems. Barrier identification is the pre-requisite to effective solutions.

Priya Pohani1, Kiran Lukose, M.D. 2, Raed Al-Yacoub, M.D. 2, Umar Ghaffar, M.D.2, Nila Radhakrishan, M.D. 2, and Frederick Southwick, M.D. 2,3 

1. Alabama College of Osteopathic Medicine, Dothan, Alabama

2. Division of Hospital Medicine, University of Florida College of Medicine, Gainesville, FL

3. Corresponding author

Health care organizations have started implementing principles of Highly Reliable Organizations (HROs) to create a system for managing the unexpected. Those working in HROs apply 5 principles. Hospital Medicine Divisions require these skills to anticipate and manage unexpected surges in patient volume and additional challenges as seen during the COVID-19 pandemic.

We created a questionnaire to explore the 5 components of HROs and determine how our providers can better manage the unexpected. We applied standard qualitative analysis identifying recurrent themes using N-Vivo software, and accumulating representative quotes related to the 5 elements of HROs. As more narratives were analyzed, new codes were grouped into thematic categories by applying comparative analysis.