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 changes in little time! •The Education Blitz – teaching an entire hospital to work differently! •Results – success!

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

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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 • staff with GP responsiveness • GP’s with their call schedule and workload

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

make changes- paging system not consistent Switchboard education Re cell calls & contact # Memo to physicians Paging system issues Monitoring Eval continue

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)

QRT Education at the DGH

Education Plan… Who? Inpatient nursing staff Hospitalists On Call GP’s ICU/CCU nursing staff Respiratory Therapists

Education Plan… What? 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

Education Plan – How? 8 sessions of 2 hours over 3 weeks Lectures Case Study QRT Group discussion Education Here

Attendance Hospitalists 100% Family physicians 100% Respiratory therapists 100% ICU/CCU nurses 76% Inpatient RNs 76%

The QRT at DGH: Outcomes

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

More calls = fewer bad outcomes: Are we calling often enough? QRT Calls/1000 Admissions - Literature Review 60.0 #$%�&�'( 48.7 50.0 40.6 40.0 30.0 23.5 20.0 17.1 14.7 12.3 10.0 5.6 5.3 5.0 2.5 0.0 ) l ) y l l a ) a l l l l s a a a a a t l r n r t a t t a t e t t o e e t e e e e t e s n l d o y a t w a ( r s o m r r t c l 4 a i s a o i a u V i g w o n P t B s r e t l o e r e n l i u e r D t m e B f s B s a K a ( e ( l n l a a l o a S t J e t e o s m e n o o l l J e B

13 fewer per year Code Blue Rates Decreased 35%: 0 1 2 3 4 5 Jun-05 Jul-05 Aug-05 Sep-05 Pre QRT Oct-05 Nov-05 Dec-05 Code Blue Calls per Month Post Qrt Jan-06 Feb-06 Mar-06 Apr-06 Average pre-QRT May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Avearge post-QRT Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07

Cardiac Arrests Decreased 62%: 11 fewer per year Cardiac Arrests 6 5 4 3 2 1 0 5 6 4 5 5 5 5 6 6 6 6 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - - - r n r n c b g t c b g t c p p c c u u e e u e e u e A O A O J J D F A D F A D Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT

Non-ICU Cardiac Arrest Deaths decreased 57%: 8 fewer per year Non-ICU Cardiac Arrest Deaths 5 4 3 2 1 0 5 5 6 6 4 5 5 5 5 6 6 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - - - n n c b r t c b r t c g g p p u c u c e e u e e u e A O A O J J D F A D F A D Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT

Unplanned Transfers into ICU decreased 34%: 35 fewer per year Unplanned ICU Transfers 14 12 10 8 6 4 2 0 5 6 5 5 6 6 7 4 5 5 5 6 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - - - - - - - - - - - - - - r n r n c b g t c b g t c b p p u c u c e e e e u e u e A O A O J J D F A D F A D F Pre-QRT Post-QRT Average Pre-QRT Average Post-QRT

Improved Staff Satisfaction! Percent Positive Response (Strongly Agree or Agree), Unit Nurses, 2005 vs 2006 100% 100% 100% 100% 100% 100% 98% 100% 96% 96% 91% 91% 91% 91% 88% 87% 90% 83% 80% 75% 71% 70% 60% 56% 50% 40% 35% 30% Unit Staff 2005 Unit Staff 2006 20% 10% 0% 1 2 3 4 5 6 7 8 9 10 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

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