Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, - PowerPoint PPT Presentation

Canadian Society of Internal Medicine Annual Meeting 2017 Toronto, ON Extended Workshop Peter Wu, MD, MSc, FRCPC Department of Medicine University of Toronto November 1, 2017

CSIM Annual Meeting 2017 The following presentation represents the views of the speaker at the time of the presentation. This information is meant for educational purposes, and should not replace other sources of information or your medical judgment.

CSIM Annual Meeting 2017 Conflict Disclosures “I have no conflicts to declare”

How to think critically about QI projects

Learning Objectives • Establish an approach to appraising quality improvement studies

Learning Objectives • Establish an approach to appraising quality improvement studies • Focus on the how

Learning Objectives • Establish an approach to appraising quality improvement studies • Focus on the how • Apply to your own projects

GENERAL STRUCTURE • Introduction – Problem and Aim • Methods • Results • Conclusion

“Focus more on the blueprint of success, rather than the success itself” -Kaveh Shojania

GENERAL STRUCTURE • Introduction – Problem and Aim • Methods • Results • Conclusion

How? • Define and measure the problem • Characterize the problem • Develop the intervention • Deploy the intervention

PDSA as a tool

PDSA Tomolo AM et al. Postgrad Med J 2009;85:530–7

PDSA • Less than half of studies meet minimum requirements for PDSA • Less than 20% fully document iterative cycles • Only 15% report data-driven change at at monthly or more frequent intervals

How? • Define and measure the problem • Characterize the problem • Develop the intervention • Deploy the intervention

Defining and measuring the problem

• Benzodiazepine use at 6 months

Defining and measuring the problem • Not always so easy

Defining and measuring the problem • Not always so easy • Incident reports

• Not incident reports alone • Active surveillance • Intensive

Defining and measuring the problem • Can you clearly articulate your problem? • Can you measure it? Accurately, easily?

How? • Define and measure the problem • Characterize the problem • Develop the intervention • Deploy the intervention

Characterizing the problem • Not only what, but why • Diagnostic work • Leads to intervention

Developing the intervention • Not always a “light-switch” • Multifaceted • Should be revised and revisited

Interventions • Too Soon • No theory (“Magical Thinking”) • Too good to be true • Active ingredient(s)

• Many patients had catheters without indication • Inserted in ED • Often triggered by order set

• Many patients had catheters without indication • Inserted in ED • Often triggered by order set • Nurses communicate • Some even prompt to discontinue

• Many patients had catheters without indication • Inserted in ED • Often triggered by order set • Nurses communicate • Some even prompt to discontinue

Characterizing the problem • Do you know why it happens? • What are the “root-cause(s)”? • Have you done enough diagnostic work?

Developing the intervention • What is the “theory” behind the intervention idea? • How is it linked to your diagnostics? • How might it change?

How? • Define and measure the problem • Characterize the problem • Develop the intervention • Deploy the intervention

Deploying interventions

• Mailing recruitment • Telephone call • In-home interview with study team • Booklet (information, tapering suggestion)

• 2-hour workshop • 1-hour role play and simulation • Faculty development • Direct observation • Branding

Deploying interventions

Deploying interventions

Deploying interventions We hope that these findings from Ontario will lead to greater attention not just to the intervention but also to the implementation process.

Deploying interventions • Characterized where protocol failed and tailored intervention • Increased protocol adherence from 51.3% to 85.7% • Reduced surgical site infection rates

Deploying the intervention • Is the intervention highly adoptable? • Is it sustainable? • (Were people engaged appropriately?)

GENERAL STRUCTURE • Introduction – Problem and Aim • Methods • Results • Conclusion

Did the change result in improvement? Jobson M et al. Pediatrics 2015;135:e187-95

Did the change result in improvement? • Compared to controls, intervention not associated with reduction in ED LOS • Multiple simultaneous interventions

Did the change result in an improvement? • How will you know? (Ability to measure) • Controls

Objectives • How to think critically about QI projects

Objectives • Focus on the how • Problem, Diagnostics, Development/Deployment • Did it work?

Objectives • Focus on the how • Problem, Diagnostics, Development/Deployment • Did it work? • Adoptable?

Thank you