Evaluating Quality Improvement Initiatives in Nursing: Enhancing Patient Safety and Healthcare Outcomes Research Paper

A healthcare organization that cares about the quality of its services would include quality improvement in everything it does. Due to the industry’s constant development and technological advancement, healthcare continues to improve over time and become more effective for each unique patient. Therefore, providing more patient-centered approaches to healthcare treatments is critical to improving patients’ health sustainably. Growing patient satisfaction with service providers is a direct result of those providers’ efforts to improve quality, which benefits the providers’ reputation and bottom line (Gupta & Rokade, 2016). When the goals of the facility and those of the patients are aligned, everyone can take it easy. Patients these days are more educated than ever before. They know what services are available to them, what rights they have as patients, and what the standard of care is like (Gupta & Rokade, 2016). Therefore, hospitals should continually seek to improve their healthcare offerings to attract more patients needing treatment.

Healthcare organizations may benefit from using tried-and-true principles and procedures for quality improvement that are already familiar to the majority of physicians actively involved in clinical quality improvement. Patients’ well-being is often at the forefront of quality improvement efforts. On the other hand, the healthcare sector, including hospitals, medical practices, and insurance companies, needs widespread reform. It is feasible to guarantee that the finished product fulfills the requirements of all end users if one takes the time to gather input from a wide variety of stakeholders within the healthcare business. This study will evaluate Easton Hospital’s Skilled Nursing Facility (SNF) quality improvement initiative to see how successfully it has reduced patient readmission rates and improved patient outcomes.

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Analysis

The goal of Easton Hospital’s quality improvement program was to reduce patient readmissions. The United States has a severe issue with medical readmission, which impacts many parts of the healthcare system. Medicare patients had a 20% readmission rate within 30 days after discharge, costing the program over $17 billion yearly (El Morabet et al., 2018). If the nurses already had a full caseload before the readmissions, they would have to cope with even more patients. The cost to healthcare providers rises as patients’ quality of life declines. Reducing readmission rates is especially important for the elderly, who are at a higher risk of developing infections while in the hospital and experiencing functional decline due to hospitalization. Repeated hospitalizations are a sign of subpar care, thus a high incidence of them is problematic.

The system altered the prescription and distribution procedures to decrease the likelihood of errors that may endanger patients. Problems with care coordination and communication during patient transitions have been linked to increased readmission rates (Petigara et al., 2017). El Morabet and colleagues posit that medication mistakes are associated with between 4.5% to 24.0% of hospital readmissions (2018). Because of this, it was crucial to set up safeguards against medication use leading to readmission. The hospital now conducts a two-stage medication evaluation before and after a patient is discharged (Da Silva & Krishnamurthy, 2016). It also mandated the recording of medications taken at home and the rechecking of prescriptions upon hospital admission. For this reason, Easton Hospital adopted the hospitalist SNF model to boost service quality and decrease hospital readmissions. To implement this plan, a hospitalist-led team would accompany newly-discharged patients to a single SNF (Petigara et al., 2017). Residents doing their rotations with elderly patients were also part of the team.

Medication mistakes were likely exacerbated by the shortage of personnel at Easton Hospital. A single pharmacist can get exhausted when caring for many patients throughout many shifts (Da Silva & Krishnamurthy, 2016). The healthcare industry is notorious for its long hours, which have been linked to burnout and decreased productivity. In addition, Pennsylvania has lighter criteria for pharmacists, which may result in hiring individuals who are neither as well trained nor as adept at recognizing the effects of drug interactions. It is legal in Pennsylvania for pharmacy technicians to work without a license, not be required to participate in ongoing education, and to delegate work (Da Silva & Krishnamurthy, 2016). As a result, hiring someone with less experience increases the likelihood of prescription mistakes.

Evaluation of the Success of the Initiative

As a result of this initiative’s implementation, the number of readmissions has decreased. Patient readmission rates were the primary metric to measure the program’s performance. Repeat hospitalizations fell by a steadily decreasing proportion over time. The SNF readmission rate was 32.32 % in June 2014, 23.966 % by December 2014, and 16.06 % between January and June of the following year after the implementation (Petigara et al., 2017). This data confirmed the program’s efficacy in enhancing care quality and decreasing readmissions. The method reduced readmissions by facilitating smoother transfers of care between hospitals and making doctors more easily accessible (Petigara et al., 2017). There was no disruption to service throughout the transition, thus no patient information was lost. The same medical team was responsible for the treatment of patients at both locations.

One of the most encouraging results of the quality initiative’s rollout has been a decrease in readmission rates. It was an educational opportunity for the residents to learn about the challenges associated with transition care (Petigara et al., 2017). This was crucial for enhancing future care transitions. Reasons for readmission for the lesser proportion of patients who were still readmitted after the intervention are potential additional outcome indicators. Findings like this would help identify preventative steps that guarantee never having to go through readmission again.

The project also improved conditions for healthcare workers. They improved their work and participated in more initiatives to boost patients’ health outcomes. During the admittance procedure, the nursing team checked and recorded all medications to ensure they could intervene as required (Da Silva & Krishnamurthy, 2016). Professionalism was also maintained in double-checking patients’ medications before release. The nurse and the licensed prescriber checked and documented the discharge meds before the patient was released (Da Silva & Krishnamurthy, 2016). Also, the setting encouraged teamwork among medical experts. Teaching rounds included intensive care unit staff and clinical pharmacists (Da Silva & Krishnamurthy, 2016). Improved health outcomes were the direct consequence of enhanced teamwork.

Interprofessional Views on the Effectiveness and Results of the Initiative

The effort was carried out with the aid of interprofessional cooperation, encompassing many different professional teams. They found several things that may make their job easier. Incentives, both monetary and otherwise, may serve as facilitators. It helped to choose a target already included in the company’s long-term strategy or that would boost the achievement of other, more meaningful goals (such as improved clinical outcomes) for the organization’s employees. To better serve patients, medical professionals from various fields may join forces using the IPC model (Petigara et al., 2017). It enables experts to provide holistic responses to patients’ healthcare and social system concerns. Physicians’ input was crucial to the analysis’s direction. They saw the difficulty facing the medical center and developed a plan to remedy it. Experienced doctors like them knew that the best way to save patients from being readmitted was to provide a smooth transition between care settings. Reducing hospital readmissions by eliminating communication failures between hospitals and care providers is the goal of effective continuity of care after discharge (Hesselink et al., 2014). The explanation for the decrease in readmission rates should be better understood with their insight into the significance of continuity of care.

Quality Outcomes Improvement and Expansion Through Additional Indicators and Protocols

Quality outcomes may be enhanced and expanded by using available indicators. Improvements in quality may be guaranteed in part by adopting uniform standards. Everyone in the healthcare system will be able to work together more effectively to accomplish their goals if everything in the system is evaluated according to a single standard. The Model for Improvement might be implemented to maintain consistently excellent patient outcomes. Using the PDSA cycle and three questions provides a structure for arranging development projects. The Model for Improvement begins with the question, “What is to be achieved? ” “How will we know there has been an improvement?” and “What adjustments will be required to bring about this improvement?” (AHRQ, 2020).

In addition, according to AHRQ, the Model for Improvement may gauge the results of proposed modifications before implementing them company-wide when using the PDSA cycle. (2020). Also, the cycle may be helpful in the healthcare system for pinpointing the processes, system features, and patients linked to an out-of-the-ordinary practice. Behavior is more synchronized and methodical due to the cyclical nature of the process. To implement the hospitalist SNF quality improvement approach, a hospital can implement practices like routinely monitoring medications at entry and discharge and guaranteeing patients continuous care. This would establish a benchmark for quality treatment by providing notifications anytime a patient’s information has not been checked before release.

Additionally, telehealth technology may be utilized to improve patient outcomes in terms of quality. It refers to monitoring and providing medical treatment at a distance via biometric and video technologies (Bowles et al., 2015). The elderly and patients who live a significant distance from healthcare facilities are two groups who may benefit from the use of telehealth technology. It makes it possible for doctors and patients to communicate in real-time and face-to-face, and it has been shown to reduce the number of people who need to be admitted to hospitals (Bowles et al., 2015). As a result, the hospital may also integrate this to improve the quality of its effects.

Conclusion

Quality improvement initiatives are essential to provide patients with the care they deserve. The vast majority of hospitals already have quality improvement programs, but they are more likely to be improved after experiencing dangerously close calls. The readmission of patients to hospitals is a significant issue in the United States and may result from ineffective communication, restricted access to medical professionals, or pharmaceutical issues. The use of the Model for Improvement has the potential to contribute to the improvement and expansion of quality outcomes. There may be fewer cases of patients being readmitted to the hospital owing to medication errors if telehealth and other similar technologies allow for constant, real-time communication between medical staff and patients.

References

Agency for Healthcare Research and Quality. (2022, January). Section 4: Ways to approach the quality improvement process. AHRQ. Retrieved December 6, 2022, from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-approach-qi-process/index.html

Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information technology to improve care and outcomes for older adults. Research in gerontological nursing, 8(1), 5-10.

Da Silva, B. A., & Krishnamurthy, M. (2016). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of community hospital internal medicine perspectives, 6(4), 31758.

El Morabet, N., Uitvlugt, E. B., van den Bemt, B. J., van den Bemt, P. M., Janssen, M. J., & Karapinar‐Çarkit, F. (2018). Prevalence and preventability of drug‐related hospital readmissions: a systematic review. Journal of the American Geriatrics Society, 66(3), 602-608.

Gupta, K. S., & Rokade, V. (2016). Importance of quality in health care sector: A review. Journal of Health Management, 18(1), 84-94.

Hesselink, G., Zegers, M., Vernooij-Dassen, M., Barach, P., Kalkman, C., Flink, M., … & Wollersheim, H. (2014). Improving patient discharge and reducing hospital readmissions by using Intervention Mapping. BMC health services research, 14(1), 1-11.

Petigara, S., Krishnamurthy, M., & Livert, D. (2017). Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities. Journal of Community Hospital Internal Medicine Perspectives, 7(2), 66-69.