Essential First Steps in Quality Improvement

Garnering Institutional Support, Assembling a Team and Team Rules, and Understanding the Framework for Improvement

Essential elements for improving the discharge transition include:

1. Institutional support for and prioritization of this initiative, expressed as a meaningful investment in time, equipment, informatics, and personnel in the effort.
2. A multidisciplinary team or steering committee that is focused on improving the quality of care transitions in your institution.
3. Engagement of patients and families and recognition of the central role they play in executing the post–hospital care plan.
4. Data collection and reliable metrics that, at a minimum, reflect any relevant CMS core measures and the relevant PQRI measures. These data should be transformed into reports that inform the team and frontline workers of progress and problem areas to address.
5. Specific aims, or goals, that are time defined, measurable, and achievable.
6. Standardized discharge pathways that highlight key medications and any medication changes, important follow-up and self-management instructions, and any pending tests.
7. Policies and Procedures that are institution specific and that support the order sets and promote their safest and most effective use. These documents must be widely disseminated and used and when possible embedded in the order set. A high-reliability design should be used to enhance effective implementation. These policies and procedures should outline and guide the care team in:
   • Team communication
   • Content of the discharge summary
   • Patient education
   • Medication safety and polypharmacy
   • Symptom management
   • Discharge and follow-up care
8. Comprehensive education programs for health care providers and patients, re¬in¬forcing both general and institution-specific information about the discharge process and use of specific tools.

Prior to this section, consider reviewing the slide presentation on Quality Improvement Theory in the QI Basics section of the room.