Quality Improvement Plan (QIP) Topic Suggestions

bbogda@morrishospital.org

Our CDI team is being asked to pick a topic for a QIP project.  One suggestion was something like increasing the numbers of clarifications but I see that as not a good measure of success for our program.  I also don't think CMI is a great measure for us either, we are a small facility and our volumes vary with vacations etc and our CMI seems to fluctuate without regard to what we are doing.  We don't have the software to measure SOI.  I was wondering if anyone has any suggestions on something which they have been successful.

evanspx@sutterhealth.org

Some suggestions, if tracked by your site, would be following the Observed/Expected Mortality ratio, which can be impacted by the coding of all risk factors and significant conditions or the Survival Rates of Severe Sepsis as this is impacted by documentation and coding of sepsis.  Also consider monitoring of the factors linked to VPB that may need attention, such as the rate of postoperative respiratory failure,  the % of CAUTIs reported, the % pneumothoraces reported as complications.  

cynthia.mead@nahealth.com

I agree with you on using query rate as a metric! But you could look at response rate to queries as an indicator of physician engagement? I've noticed that well written appropriate queries get answered.

I like O/E ratio as a quality indicator as CDI can have a positive impact.

Do you review PSI's and HAC's? You could measure the impact of CDI review/queries on reducing PSI's and HAC's.

Cynthia

lprescott1

You could pick a query subject that has a high rate- for example lets say you have a high query rate related to pressure ulcers (POA, diagnosis, etc.). Then role out educational efforts to providers and nursing staff related to the importance of capture of PU present on admission. perhaps review the policy as to how nurses complete such assessments and required documentation and communicaiton with porviders. Then you can compare pre- CDI educational effort to post CDI effort as related to the number of queries related to Pressure ulcers and the required documentation, you could track the incidence of codes with a POA- N and POA of Y etc. You could do a project like this on any number of condition types, with your goal being accurate capture of the patient condition but also decreased query need. 

bbogda@morrishospital.org

Thanks everyone for suggestions.  Laurie - I like your suggestion as it will easily be measureable for us.

lprescott1

great- I liked to keep such projects simple- often that is where you can demonstrate the most impact- also counts as a multiple department quality effort- which always looks good.