Assessing Processes of ACS Care

As you implement new order sets, algorithms, and guidelines, your team will need to assess if your efforts are leading to the desired changes in practice. When you find that the outcomes you are most interested in, whether process measures or clinical measures, are suboptimal, it is critical to find out why. If you have developed tools to help guide clinical care, such as order sets, forms, or reminders, you may need to monitor their use.

A. Use of ACS improvement tools

You may have developed a number of tools to improve ACS care, and monitoring how those tools are being used is very important to understanding the impact of your intervention and possible revisions to them.

If you find the tools are not being used from the start, you need to explore why that is the case. Are they not usable or available? Are they too distant from current work flow? Do the end users not have adequate buy-in with the tools? These are key questions to find answers to in order to improve ACS care. Once you have determined that the tools are being used, it is important to consider ongoing monitoring of their use. When you uncover a change in tool use, it is important to investigate its root causes. Perhaps the definitions have changed, or staff members previously assigned to this area have been reassigned, or the tool itself needs revision.

B. Other data collection strategies

Although ideally, you would like to systematically collect data over time, sometimes it can be very overwhelming for individuals primarily involved in patient care to imagine developing a sustainable system of data collection. To this end, it is important to be mindful of resource constraints and consider using strategies such as intermittent sampling to help identify a gap and monitor it over time. This approach has limitations but is a way to help teams less familiar with data collection get started. It is better to monitor at a low level than to not monitor at all.

C. Additional Considerations

No matter what you are monitoring, it is important to look at the data in ways that allow you to make sense of it. So, consider using summary graphs and/or run charts rather than raw data as you look at whatever step in your improvement process you are interested in. Also, remember that although average time and average rate of compliance may be key numbers for reporting and reviewing performance, understanding the variation around these averages can be even more helpful in understanding why performance is not meeting your targets.