Quick Response Team Making a Difference in Patient Outcomes Lori - - PowerPoint PPT Presentation
Quick Response Team Making a Difference in Patient Outcomes Lori Sanderson Karen Mumford Capital District Health authority Dartmouth Nova Scotia Presentation Overview The History of the QRT Change Management making big
Quick Response Team “Making a Difference in Patient Outcomes”
Lori Sanderson Karen Mumford Capital District Health authority Dartmouth Nova Scotia
Presentation Overview
little time!
to work differently!
The History of the QRT
November 2004 – working group to re-evaluate our response to inpatient emergencies December 2004 – literature review, decision to use QRT December 2004 – IHI meeting; 100,000 Lives Campaign, Capital Health signs up January 2005 – DGH suggested as pilot site for QRT, proposal in development February 2005 – proposal submitted to the Executive Management Team
History of QRT
April 2005 – Safer Healthcare Now launch September 9 2005 – Executive approval for QRT at DGH September 27 2005 – inaugural meeting of the QRT implementation steering committee November 30 2005 – new GP call system, first QRT call December 2005 –continued phasing in QRT January 2006 – QRT fully implemented, ongoing evaluation and trouble-shooting
Change Management: Making Big Changes in Little Time
Making the Status Quo Unacceptable
Use logic and data – Study occurrence reports and critical incidents Appeal to Emotion – Build an awareness of the problem – Share stories of unsatisfactory events – Satisfaction
Reducing the “Activation Energy”
Use logic and data – Acknowledge the potential for problems – Document and evaluate all QRT calls – Fix problems as they arise Appeal to Emotion – Appeal to our sense of pride: Pilot site for the district – Being part of a trend: IHI and SHN initiatives – “Optional” participation for GP’s Education sessions – Easy access – Paid Demonstrate new ways of working together – Implementation team as a model – Accept concerns as opportunities to improve Reframe resistance: – Accept and acknowledge different points of view
Making the New Way Visible and Attractive
Use logic and data – Literature review to prove that QRT’s work Appeal to Emotion – Explain how the new system would prevent problems – Create an expectation that the problem must be “fixed” – Survey the staff to confirm that the new way is seen as being better Educational focus – Emphasis on this being an opportunity to learn new techniques, and to learn from each other Demonstrate new ways of working – PDSA cycles – Include front-line workers in planning and implementation – “Role playing” during education sessions – New GP call system
Other Important Factors
Executive Support
– Expectation to solve the Problem – Financial commitment – Data collection support
The Implementation Team
– Multidisciplinary – Frontline 7 administration – Met often – Work divided into manageable piece – Task orientated
QI / Learning Emphasis
– Emphasis on PDSA cycles
Paging system issues Memo to physicians Switchboard education make changes- paging system not consistent
Monitoring Eval continue
Re cell calls & contact #
Overcoming Specific Obstacles
Skepticism
–Explore reasoning –Build into evaluation –Use education to show how it can work
Conflicting Responsibilities
–ICU Nurses fear of abandoning their patients –GP’s “opt out” (surgical call or QRT or own call schedule)
Inpatient nursing staff Hospitalists On Call GP’s ICU/CCU nursing staff Respiratory Therapists
Safer Healthcare Now! Why have a team Who is the team When to call the team What does the team do Roles of team members How long will the team stay SBAR communication QRT record QRT evaluation form
Education Plan… When?
Prior to go live date for each unit Afternoon and evening sessions
8 sessions of 2 hours over 3 weeks Lectures Case Study Group discussion QRT Education Here
Hospitalists 100% Family physicians 100% Respiratory therapists 100% ICU/CCU nurses 76% Inpatient RNs 76%
The literature says that Quick Response Teams…..
Reduce cardiac arrests Improve survival from cardiac arrests Reduce hospital mortality rates Reduce unanticipated ICU/CCU admissions Reduce ICU and hospital days in survivors of cardiac arrest Reduce respiratory failure, stroke, ARF, and sepsis in post-op patients Improve the early documentation of “No Code” status Improve nurse satisfaction Facilitate learning Improve relations between staff members
QRT Calls/1000 Admissions - Literature Review
2.5 5.0 5.3 5.6 14.7 17.1 23.5 12.3 40.6 48.7 0.0 10.0 20.0 30.0 40.0 50.0 60.0 K e n w a r d e t a l B e l l
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e t a l D e V i t a e t a l J
e s e t a l ( s t a r t ) J
e s e t a l ( a f t e r 4 y e a r s ) B e l l
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More calls = fewer bad outcomes: Are we calling often enough?
#$%&'(
Code Blue Calls per Month
1 2 3 4 5 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 Pre QRT Post Qrt Average pre-QRT Avearge post-QRT
Code Blue Rates Decreased 35%: 13 fewer per year
Cardiac Arrests
1 2 3 4 5 6 D e c
F e b
A p r
J u n
A u g
O c t
D e c
F e b
A p r
J u n
A u g
O c t
D e c
Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT
Cardiac Arrests Decreased 62%: 11 fewer per year
Non-ICU Cardiac Arrest Deaths
1 2 3 4 5 D e c
F e b
A p r
J u n
A u g
O c t
D e c
F e b
A p r
J u n
A u g
O c t
D e c
Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT
Non-ICU Cardiac Arrest Deaths decreased 57%: 8 fewer per year
Unplanned ICU Transfers
2 4 6 8 10 12 14 D e c
F e b
A p r
J u n
A u g
O c t
D e c
F e b
A p r
J u n
A u g
O c t
D e c
F e b
Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT
Unplanned Transfers into ICU decreased 34%: 35 fewer per year
Improved Staff Satisfaction!
Percent Positive Response (Strongly Agree or Agree), Unit Nurses, 2005 vs 2006
83% 35% 100% 56% 71% 88% 87% 98% 100% 75% 96% 91% 96% 91% 100% 100% 91% 100% 100% 91%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 2 3 4 5 6 7 8 9 10 Unit Staff 2005 Unit Staff 2006
1- I can get assistance from a physician in a timely manner during the day 2- I can get assistance from a physician in a timely manner at night/w eekends 3- I can get assistance from a RN/RT in a timely manner during the day 4- I can get assistance from a RN/RT in a timely manner at night/w eekends 5- Communications to and from those assisting are efficient in facilitating the delivery of care 6- Those assisting are know ledgeable and efficient in assessing and implementing care needs 7- Those w ho assist are courteous and helpful 8- The patient outcome is improved because of the assistance I receive 9- I w ork collaboratively w ith those assisting 10- I feel comfortable and confident in managing patients in crisis
The QRT: What’s next?
Spreading the good news – celebrate! Switchboard changes – more reliable paging – Twice daily test pages Ongoing education for new and existing staff – call earlier, call more often – save more lives! Spreading the changes elsewhere in Capital Health