IHP 604 6-2 Memo Evaluation Methods
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Feb 20, 2024
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Evaluation Methods
6-2 Memo: Evaluation Methods Matthew Graves Southern New Hampshire University IHP 604
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To: Medical Executive Committee (MEC) From: Matthew Graves, Quality Department Date: January 20, 2024 Subject: Evaluation Methods for Reducing Infection Rates in Urology Surgery I am writing to you today to propose evaluation methods for a quality improvement initiative aimed at reducing antibiotic-resistant urinary tract infection (UTI) rates in post-
operative urosurgery patients. As you know, our recent OPPE process identified two urology surgeons with a concerning trend of post-operative infections. This issue not only compromises patient safety and quality of care, but it also has significant financial and reputational implications for our hospital. Evaluation methods at 3, 6, and 12 months
Beginning with a plan do study act (PDSA) framework is the best evaluation technique for a firm since it creates a feedback loop for continual learning and improvement. Measurement of findings throughout the study phase helps the team make future decisions and adjustments to reduce infection risk. Although the proper implementation of a PDSA framework does not guarantee the success of a quality improvement program, it does assist the team in adapting and learning more quickly, resulting in the desired outputs on schedule (Plan-Do-Study-Act (PDSA) Directions and Examples, n.d.-b). Starting with a PDSA cycle may be beneficial for the initial evaluation method. Additional surveillance, chart reviews, and peer review are critical during this time period to aid in the reduction of infection rates. Closely monitoring UTI rates enables
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early discovery of changes and prompt intervention if improvements are not on track. Identifying contributing elements in patient records allows interventions to be targeted more accurately, resulting in greater efficacy. Feedback from peers can identify areas for improvement in surgical technique or other procedures, perhaps leading to faster correction of infection concerns. It is crucial in the six-month timeframe to utilize tracer methods. Some benefits that this can influence is they air healthcare facilities track pathogens, identifying high-risk areas and practices. They can mark surfaces, equipment, and hands, allowing hospitals to identify areas needing interventions, such as hand hygiene stations or improved cleaning protocols. Also adding process mapping and patient satisfaction surveys will aid in identifying systemic issues contributing to infections, enabling comprehensive adjustments and improving patient experience and adherence to protocols (Tracer Methodology Fact Sheet, n.d.-b). During the 12-month timeframe, The Root Cause Analysis (RCA) framework is a valuable tool for reducing infection rates in hospitals. It helps identify the underlying factors contributing to infections, allowing for systemic issues to be addressed. This approach also helps prioritize interventions, ensuring the most critical factors are addressed, thereby maximizing the effectiveness of quality improvement efforts. The RCA framework aids in developing targeted interventions to address root causes identified through RCA, ensuring evidence-based, clear links. It also facilitates monitoring and evaluating progress over time, ensuring interventions achieve desired outcomes and make necessary adjustments (Singh, 2023). RCA has been effectively used to reduce infection rates in healthcare settings. For instance, a hospital implemented a new cleaning protocol for a contaminated medical device, resulting in a significant decrease in infection rates. Additionally, a multi-pronged intervention involving
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education, reminders, and monitoring improved hand hygiene compliance, thereby reducing infection rates (Singh, 2023). Justify an evaluation method
The 3-month surveillance method involves chart review and peer review are utilized to identify early detection of UTI rates, identify contributing factors like comorbidities, surgical techniques, or antibiotic choices, and provide feedback from other urology surgeons to identify potential issues early on, leading to faster corrections (Coury, et al., 2017). The PDSA framework aids in the infection control initiative. During the initial “plan” stage, the process involves analyzing surveillance data, chart reviews, and peer feedback to identify patterns in infection rates and contributing factors. Potential interventions, such as surgical techniques, antibiotic protocols, and patient education, are then brainstormed. A detailed plan is then developed, outlining timelines, responsibilities, and resources needed. During the “do” stage, it is crucial to implement planned interventions, such as training staff, updating protocols, or patient education, and continue to collect data on infection rates, patient outcomes, and process measures to track their impact. During the “study” stage, the data collected during the implementation phase should be carefully analyzed to assess the effectiveness of interventions in reducing infection rates. During the “act” stage involves refining interventions based on findings, such as modifying protocols, providing additional training, or addressing challenges. A sustainability plan is developed to ensure successful interventions are sustained over time, involving ongoing monitoring, training, and reinforcement. (Coury, et al., 2017) Utilization of tracers in month six are crucial to identify specific infection transmission pathways, use tracer substances to simulate pathogen movement, mark potential sources, and
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visualize pathways. Assess the effectiveness of interventions using tracers, measure impact, quantify effectiveness, and identify gaps. Measure the extent of tracer spread before and after interventions and compare before and after to measure their impact on infection control measures. Visualize pathways to reveal specific transmission pathways and identify areas for further refinement or additional measures. Systematic tracers can also be implemented to identify compliance standards that may also be contributing to the influence of infections. It is crucial to identify the process in place to ensure that flaws are being assessed and fixed. In the 12-month timeline, RCA can identify root causes of persistent infections by examining patterns, interviews, and processes. It can also identify systemic issues like inadequate training, equipment failures, or communication breakdowns. If interventions don't achieve expected results, RCA can identify implementation barriers or unanticipated consequences. Refinement allows for targeted adjustments to address underlying causes and improve intervention outcomes. RCA helps identify root causes of infections' costs, such as prolonged hospital stays or additional treatments, and optimize resource allocation. This approach prioritizes interventions that yield significant cost savings, improving overall cost-
effectiveness (RCA2: Improving Root Cause Analyses and Actions to Prevent Harm, n.d.). RCA promotes continuous improvement by addressing root causes and preventing recurring infections. Lessons learned can be integrated into ongoing training, protocols, and monitoring systems for a more resilient infection control program. The RCA process fosters a culture of safety by engaging staff, promoting transparency, and addressing unintended consequences. It encourages open communication about findings, fostering trust and responsibility. By applying RCA in month 12, the initiative can understand why certain infections persist, evaluate intervention effectiveness, optimize resource allocation, facilitate continuous improvement, and
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build a culture of safety, ensuring long-term success in infection control (RCA2: Improving Root Cause Analyses and Actions to Prevent Harm, n.d.). Why evaluation methods change
The evaluation methods for healthcare quality improvement initiatives, especially those focusing on infection rates, should adapt over time based on observed rate changes and the initiative's implementation stage. Quality improvement initiatives require time to adapt to organizational and cultural changes. Infection rates can be adapted based on their decline, plateaued, or increasing. If rates consistently decline, focus on maintaining progress and incorporating successful interventions. If rates stagnate, intensify evaluation efforts using process mapping and tracer methods. If rates increase, initiate rapid response measures with increased surveillance, immediate RCA, and swift adjustments to interventions or protocols. Microsystem approaches focus on small, efficient changes, addressing feedback and principles throughout the process. The evaluation process should involve healthcare personnel, communicate the rationale behind changes, and be flexible to adapt to emerging data and challenges. This foster shared ownership and effective implementation of revised interventions, ensuring transparency and stakeholder buy-in. It is crucial to remail flexible and open to change within the organization to influence different types of frameworks to mold to the scenarios and data at stake.
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Resources Coury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., D'Agostini, B., Taplin, S. H., Green, B. B., & Coronado, G. D. (2017). Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC health services research
, 17
(1), 411. https://doi.org/10.1186/s12913-017-2364-3
Plan-Do-Study-Act (PDSA) Directions and Examples
. (n.d.-b). Agency for Healthcare Research and Quality. https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html RCA2: Improving root cause analyses and actions to prevent harm
. (n.d.). Institute for Healthcare Improvement. https://www.ihi.org/resources/tools/rca2-improving-root-cause-
analyses-and-actions-prevent-harm Singh, G. (2023, May 30). Root cause analysis and medical error prevention
. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK570638/ Tracer Methodology Fact Sheet
. (n.d.-b). The Joint Commission. https://www.jointcommission.org/resources/news-and-multimedia/fact-sheets/facts-
about-tracer-methodology/