Objectives The Consultant-led multidisciplinary (physiotherapy & nursing) Respiratory Assessment Unit (RAU) at St. James’s Hospital, Dublin, provides a range of services, including respiratory outreach to persons with... [ view full abstract ]
Objectives
The Consultant-led multidisciplinary (physiotherapy & nursing) Respiratory Assessment Unit (RAU) at St. James’s Hospital, Dublin, provides a range of services, including respiratory outreach to persons with chronic lung disease. In July 2016, a quality improvement (QI) team was formed comprising seven RAU team members and two QI coaches-in-training, in collaboration with Dartmouth College, USA. The team was formed in the context of a ‘ground-up’ approach to healthcare improvement within the Hospital. The RAU team were one of eleven multidisciplinary teams throughout the Hospital selected to develop skills in QI through coaching using the “Clinical Microsystems” QI approach (Nelson et al, 2008).
Methods
The RAU team and coaches met for one hour once weekly over a six month period. The process began by developing effective team meeting skills with agreed ground rules and roles at each meeting. A framework of assessing, diagnosing and treating the RAU “microsystem” was employed by the coaches with the RAU team. The process began with an examination of the “5P’s” (purpose, patients, professionals, processes and patterns) to understand the RAU service framework. Other QI methods and tools employed included process mapping, cause and effect diagrams and brainstorming. This ultimately led to identification of a theme (“Access”) - and a global aim statement: to increase the number of patients referred to the respiratory outreach programme by 20% within the eight month period of August 2016 to March 2017.
Change ideas to achieve this aim included increased presence of RAU staff in the Emergency Department (ED), contacting Registrar on call at start of each shift, daily education huddle with ED/medical unit staff, a campaign on social media, monthly service reports to key stakeholders, and enhanced communication with GPs of patients discharged on the outreach programme. A systematic approach was taken toward the quality improvement goal using the Dartmouth Clinical Microsystem Improvement Ramp. Small changes were tested at regular intervals using Plan-Do-Study-Act (PDSA) cycles, in order to achieve the agreed aim statement. Data pertaining to the number of referrals to the service was collected using Microsoft Excel.
Results
There was a 137% increase in referrals made to the respiratory outreach service over the 8 month period when compared to the same timeframe in 2015/2016.Mean (range) number of referrals received per month over the study period was 29 (19-38) in 2016/17 compared to 12 (6-19) in 2015/16. There was a 33% increase in the number of referrals accepted to the outreach service when compared with 2015/2016.
Conclusions
The QI coaching programme provided the RAU team with a unique opportunity to examine the service and find ways to improve it in a measured and structured manner. The increase in referrals to the outreach service well exceeded the set target. Staff were provided with a framework to address quality improvement in the service on an ongoing basis.
References
Nelson, E. et al. (2008) “Clinical Microsystems, part 1: The building blocks of health systems.”Joint Commission Journal on Quality and Patient Safety, 34(7):367-78.
Ethical approval
Ethical approval was not sought for this project.
