Health: Quality and Patient Safety

Value does not always involve money; it reflects maximum utilization of available resources with improving quality. High value in health care is neither a lower-cost treatment that might have uncertain outcome nor a great outcome that is not affordable to the community. A great outcome that is available to the patient at the lowest possible cost is what is meant by “high value”. 

The Heart Hospital Office for Performance Improvement has been working with the Institute for Healthcare Improvement (IHI) piloting a new approach to quality improvement known as “Value Management”. This approach uses improvement science and three new concepts, a “box score” of measures, a “visual management board”, and weekly staff huddles to drive very rapid cycle improvement. 

The value management project was piloted in one of the High Dependency Units in Heart Hospital. After getting promising results, the project was also implemented to the Cardiac Intensive Care Unit and the Noninvasive Cardiology Department.

Departments operating above their capacity negatively impact the quality of care being provided. A variety of patient flow strategies were implemented to reduce crowding in the Emergency Department (ED) and to facilitate critical care patient flow. The purpose of this project was to understand the current process, barriers in patient flow and to overcome those barriers with available resources without creating an extra burden on the system. A multidisciplinary team (MDT) was formed with delegates from the Corporate Critical Care Center, Leaders of Critical Care Areas HGH, Bed & Case Managers, Nurses, Physicians, and Social Workers. A 24/7 support structure for reporting, led by the leaders, facilitated the implementation of the strategies. The project started in March 2017 when 85% of critical care patients were waiting in ED for more than 4 hours after being accepted by the critical care team. With MDT efforts and efficient strategies, we have surpassed the initial expected goal with less than 26% of patients waiting for more than 4 hours.

To decrease the percentage of patients waiting in the Emergency Department (ED) for a Medical Intensive Care Unit (MICU) bed after getting accepted by the critical care team  for more than 4 hours from 80% to 50% from March 2017 to December 2017 and to 30% by the end of July 2018. 

The aim of this project is to reduce blood wastage in post cardiac patients admitted to CTICU from 100% to 50% by the end of October 2017 and to zero percentage by end of February 2018, hereby reducing the additional risk of anemia. 

Currently in Heart Hospital-CTICU, we observed that an open system is used in all patients to obtain blood samples and 10 ml of a patient’s blood is discarded from the sample taken. This practice puts a greater burden on post cardiac surgery patients as they have already loss their RBC’s from mediastinal bleeding. 

As a result of this problem, we have responded by initiating this project of laboratory blood sampling by applying a closed blood sampling system instead of the current open blood sampling which will reduce blood waste or “discard blood volume” during diagnostic phlebotomy.

The expected improvement in the quality system in Heart Hospital-CTICU is 100 % usage of the closed blood sampling by the nurses and thereby promoting patient safety as shown in the 0% blood waste reduction in post cardiac surgery patients.