Needs/Resource Assessment

Survey previous or ongoing efforts and resources

In many ways a multidisciplinary QI team is building, flying, and navigating an aircraft that is already airborne. Therefore it pays to know exactly what resources or circumstances are already available. Experience, precedents, or skilled individuals can significantly lift an effort. Conversely, working at odds with infrastructure or strategic goals can sabotage everything.

Each of the items below could affect the approach to this improvement effort. These items can influence interventions and the performance tracking system. The QI team should find the answers to these questions. 

1. What is the existing quality improvement infrastructure? What support or services are available for this project?
2. Are there any ongoing quality improvement initiatives to learn from or leverage?
3. Are there any initiatives that could influence support for a VTE prevention effort: e.g. pursuit of Magnet Recognition, Ventilator Associated Pneumonia bundle, Surgical Care Improvement Project (SCIP), interest in TJC/NQF proposed core measures
4. What performance data on VTE prevention or VTE events already exist?
5. Are there any major lessons from previous or ongoing interventions to prevent VTE?
6. How successful were previous VTE risk assessments and why? Were they integrated into order sets?
7. Are there ongoing VTE educational or awareness activities for medical staff?
8. Are hospital policies capable of enforcing provider performance of anything, e.g. medication reconciliation, vaccinations, VTE prophylaxis, etc?
9. How fragmented is care in the hospital? Are ICUs open or closed? Are patients geographically cohorted by service/specialty?
10. What are the existing practices for standardizing care transitions between settings, e.g. ER-to-floor, ICU-to-floor, OR-to-floor, direct admissions?
11. Can precedents be leveraged that have engaged patients in promoting medical staff accountability for any specific care goals?
12. In what areas of the hospital are nurses engaged in promoting medical staff accountability for any specific care goals, e.g. daily goals worksheet, participation in multidisciplinary rounds?
13. In what precedent-setting ways do clinical pharmacists already participate in care delivery, e.g. participation in multidisciplinary rounds, pharmacokinetics consults, pages to providers to adjust medication dosages for estimated GFR, etc?
14. Could the electronic health information or paging system relay clinical information to members of the care team: e.g. alerts by email, text page, fax, or CPOE?
15. Is there a precedent anywhere in the institution for feeding back individual (or service line) performance to providers?
16. Does the medical center have an electronic medical record? CPOE? Digital radiology?