Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and...

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Autores principales: Goulding, Lucy, Parke, Hannah, Maharaj, Ritesh, Loveridge, Robert, McLoone, Anne, Hadfield, Sophie, Helme, Eloise, Hopkins, Philip, Sandall, Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645923/
https://www.ncbi.nlm.nih.gov/pubmed/26734368
http://dx.doi.org/10.1136/bmjquality.u203938.w3268
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author Goulding, Lucy
Parke, Hannah
Maharaj, Ritesh
Loveridge, Robert
McLoone, Anne
Hadfield, Sophie
Helme, Eloise
Hopkins, Philip
Sandall, Jane
author_facet Goulding, Lucy
Parke, Hannah
Maharaj, Ritesh
Loveridge, Robert
McLoone, Anne
Hadfield, Sophie
Helme, Eloise
Hopkins, Philip
Sandall, Jane
author_sort Goulding, Lucy
collection PubMed
description Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-load, with new cohorts of staff regularly passing through critical care. In addition to presenting the results of this quality improvement project, we also reflect on the lessons learned and make suggestions for future projects.
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spelling pubmed-46459232016-01-05 Improving critical care discharge summaries: a collaborative quality improvement project using PDSA Goulding, Lucy Parke, Hannah Maharaj, Ritesh Loveridge, Robert McLoone, Anne Hadfield, Sophie Helme, Eloise Hopkins, Philip Sandall, Jane BMJ Qual Improv Rep BMJ Quality Improvement Programme Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work-load, with new cohorts of staff regularly passing through critical care. In addition to presenting the results of this quality improvement project, we also reflect on the lessons learned and make suggestions for future projects. British Publishing Group 2015-04-30 /pmc/articles/PMC4645923/ /pubmed/26734368 http://dx.doi.org/10.1136/bmjquality.u203938.w3268 Text en © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/http://creativecommons.org/licenses/by-nc/2.0/legalcode
spellingShingle BMJ Quality Improvement Programme
Goulding, Lucy
Parke, Hannah
Maharaj, Ritesh
Loveridge, Robert
McLoone, Anne
Hadfield, Sophie
Helme, Eloise
Hopkins, Philip
Sandall, Jane
Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title_full Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title_fullStr Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title_full_unstemmed Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title_short Improving critical care discharge summaries: a collaborative quality improvement project using PDSA
title_sort improving critical care discharge summaries: a collaborative quality improvement project using pdsa
topic BMJ Quality Improvement Programme
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4645923/
https://www.ncbi.nlm.nih.gov/pubmed/26734368
http://dx.doi.org/10.1136/bmjquality.u203938.w3268
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