10/26/2016 Dan Bronson-Lowe, PhD, CIC Baxter Healthcare Generates knowledge Structured study design Generalizable results Example RCT of different central line dressings and CLABSI 3 10/26/2016 1
10/26/2016 Evaluates knowledge Provides foundation for high-quality practice Focused on specific practice question Example Assess research and expert opinion about timing of central line dressing changes 4 10/26/2016 Incorporate knowledge Make changes to improve processes/outcomes Focused on specific group Example Modify timing of central line dressing changes and assess the impact 5 10/26/2016 Plan Act Study Do 6 10/26/2016 2
10/26/2016 Identify / Describe the problem Generate a Hypothesis Select a Change / Intervention Prepare for Implementation 7 10/26/2016 8 10/26/2016 9 10/26/2016 3
10/26/2016 Project Ideas CAUTI, CDI, or SSI rates are high Hand hygiene or flu vaccination rates are low PPE isn’t being used in isolation rooms right Terminal cleaning of rooms is mediocre Too much time is being spent compiling data for internal meetings/dashboards/etc. (Complete Section A) What do you really want to look at? Process Outcome 11 10/26/2016 Plan: Data Collection What kind of analysis are you going to do? What can you actually obtain? Examples: ◦ Observations ◦ Surveys ◦ Clinical Chart Reviews ◦ Administrative / Claims 4
10/26/2016 Reliable Reliable but not Valid and Valid 13 10/26/2016 Data Collection Tool Measuring Devices Collection Process / Procedures Training 14 10/26/2016 Sample Population The Joint Commission PI Project Guidelines 3 Population Sample Size <30 All 30 - 100 30 101 - 500 50 >500 70 15 10/26/2016 5
10/26/2016 Selection bias Interviewer bias Recall bias (Complete Section B) Implement the change Collect data 18 10/26/2016 6
10/26/2016 Analyze the data Assess the impact of the change 19 10/26/2016 Display data to make process performance visible Determine the impact of change Determine if the impact is sustained 4 20 10/26/2016 21 10/26/2016 7
10/26/2016 22 10/26/2016 Run Chart: Number of Runs Test for Random Data 4 Run Chart: Number of Runs Test for Random Data 4 Total number of Total number of data points on data points on Lower limit for Lower limit for Upper limit for Upper limit for the run chart the run chart the number of the number of the number of the number of that do not fall that do not fall runs (less is too runs (less is too runs (more is too runs (more is too on the median on the median few) few) many) many) 12 12 3 3 11 11 18 18 6 6 14 14 24 24 8 8 18 18 30 30 11 11 21 21 36 36 13 13 25 25 +1 23 10/26/2016 24 10/26/2016 8
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10/26/2016 Something didn’t work. What? Suggestions The changes weren’t followed ◦ Education? Ability? Logistics? The changes didn’t impact the outcome The outcome got worse The changes were followed and the outcome got better… but something detrimental happened as a consequence (Complete Section C) Communicate the findings Refine the change Prepare for the next PDSA cycle 29 10/26/2016 There’s no such thing as a problem without a gift for you in its hands. You seek problems because you need their gifts. - Richard Bach, Illusions (Complete Section D) 10
10/26/2016 Plan Study Do 31 10/26/2016 32 10/26/2016 33 10/26/2016 11
10/26/2016 Plan Act Study Do 34 10/26/2016 12
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