How to Use the Resource Room

Preface: Recognizing and defining the general quality problem

Congratulations on your commitment to improve the care of your patients. Quality improvement (QI) projects should always develop from recognition of a gap between the level of care that is optimal and best supported by the evidence contrasted to the care that is actually being delivered.

Hospitals are complex systems. Over time each hospital accumulates its own set of care processes - some coordinated, some autonomous - which directly affect inpatient outcomes. As systems, hospitals are perfectly designed to achieve exactly what they do, so improving the output of a hospital requires change. Not all change results in improvement, however, and the same skills most critical for driving actual improvement in the hospital – designing, managing, and leading change successfully over time – are also commonly missing from clinician skill sets.

This resource room is designed to help you acquire and apply that skill set. It is built on well-proven principles of quality improvement, personal experiences, and evidence-based medicine.

The goal of the resource room is to enhance the efficiency and reliability of your quality improvement efforts to close the gap between best practice and what we actually do to prevent one of the most common causes of hospital deaths, hospital-acquired venous thromboembolism (VTE). In order to implement effective protocols and other QI strategies to minimize hospital-VTE in your institution - while at the same time minimizing adverse outcomes - redesign is needed in care delivery and performance tracking.

Ideas for what to change, how, and how to manage change successfully over time should come from a local improvement team, ideally a selection of established or emerging leaders with experience as frontline caregivers or complimentary insights. Members of this multidisciplinary team should have knowledge of the evidence base, local influence or insight into care delivery, or a framework for leading quality improvement. In a growing number of hospital systems, hospitalists are prime candidates to lead such teams.

Essential elements to reach breakthrough levels of improvement in care include:

1. Institutional support and prioritization for the initiative, expressed in terms of a meaningful investment in time, equipment, personnel, and informatics, and a sharing of institutional improvement experience and resources to support any project needs.
2. A multidisciplinary team or steering committee focused on reaching VTE prophylaxis targets and reporting to key medical staff committees.
3. Reliable data collection and performance tracking
4. Specific goals, or aims, which are ambitious, time-defined, and measurable
5. A proven QI framework to coordinate steps towards breakthrough improvement
6. Protocols that standardize VTE risk assessment and prophylaxis
7. Institutional infrastructure, policies, practices, or educational programs promoting the use of the protocol. The protocol that standardizes VTE risk assessment is so fundamental that is must not merely exist. It must be embedded in patient care. High reliability design should be used to enhance effective implementation.

How to Use the Resource Room

In its progress, quality improvement is not particularly linear. But in this resource room we’ve tried to present a little ‘polarity’ to help create a sense of direction. The resource room is divided into sections. The sections try to present the steps of a QI project in a logical progression. Because many of the steps in a QI project occur simultaneously while also depending on one another, we present a novel diagram that tries to convey the sequence and relationship of steps (Diagram 1).

Since our primary goal is to help you advance your QI project, we’ve also created companions to this resource room, the “VTE Implementation Guide” the “VTE Prevention Snapshot.” The Implementation Guide is the paper-based version of the main steps of a quality improvement project as outlined in the room, and the Snapshot is a much smaller document. It is intended to be a practical checklist of vital activities for the QI project. Each item in the Snapshot refers back to a specific section of the guide. By filling out the Snapshot as you go, you’ll maintain a very helpful record of the most critical steps of the project. The Snapshot is also intended to help you organize the product of your QI work for presentations, discussions, or write-ups.