Continuous Quality Improvement in Orthopaedic Surgery: Improving Patient Experience, Safety and Outcomes
Main Article Content
Abstract
As the demand for accountability and transparency surrounding the supply of increasingly expensive medical services grows, health- care providers have put continuous quality improvement (CQI) programs in place to optimize care and improve efficiencies. CQI pro- grams that rigorously evaluate healthcare services can lead to informed decisions about the direction of planned improvements through evolving knowledge translation. Successful end products may include better patient satisfaction, improved patient-reported outcomes, highly-efficient care pathways, and overall cost-savings. There are numerous steps involved in implementing CQI programs that require collaboration and cooperation from physicians, allied health care workers, support staff and hospital management in order to achieve desirable goals. The Division of Orthopaedic Surgery at The Ottawa Hospital (TOH) has initiated a CQI program which is designed as a classic Donabedian Construct with a triple aim framework of: 1. improving care, 2. improving patient experience, and 3. lowering cost. The development of our electronic CQI database will be a key component in the 5-year (2015-2020) Strategic Plan for the Division, and is in keeping with the goal of TOH becoming a top 10% performer in quality and safety of patient care in North America. The aim of this paper is to outline our compliance with the ongoing activities required to meet clearly delineated quality metrics, and the development of the many facets of our CQI program.
RÉSUMÉ
En réponse à la demande croissante de transparence et de responsabilité concernant les services de santé dispendieux, les fournis- seurs de soins de santé ont mis sur pied des programmes d’amélioration continue de la qualité (ACQ) pour optimiser les soins et l’efficience. Les programmes d’ACQ qui évaluent rigoureusement les services de santé permettent des décisions plus éclairées quant aux améliorations à apporter, grâce au transfert de connaissances. Parmi les résultats positifs de ces programmes, on peut compter une plus grande satisfaction et une amélioration des résultats rapportés par les patients, des plans d’intervention particulièrement efficients, et une réduction des coûts. De nombreuses étapes dans la mise en place des programmes d’ACQ nécessitent une collabora- tion entre les médecins, le personnel de soutien, les gestionnaires de l’hôpital et les autres professionnels de la santé afin d’atteindre les objectifs désirés. La Division de chirurgie orthopédique de l’Hôpital d’Ottawa a lancé un programme d’ACQ conçu selon le modèle classique Donabedian, qui poursuit un triple objectif : 1. améliorer les soins, 2. améliorer l’expérience des patients, et 3. minimiser les coûts. La création d’une base de données électronique pour l’ACQ sera une composante clé du plan stratégique de 5 ans (2015-2020) de la Division, et se conforme à l’objectif de l’Hôpital d’Ottawa de devenir l’un des plus performants en Amérique du Nord, sur le plan de la qualité et de la sécurité des soins aux patients. Le but de cet article est de décrire brièvement le développement de nombreuses facettes de notre programme d’ACQ, et notre conformité aux normes de la qualité.
Article Details
- Authors publishing in the UOJM retain copyright of their articles, including all the drafts and the final published version in the journal.
- While UOJM does not retain any rights to the articles submitted, by agreeing to publish in UOJM, authors are granting the journal right of first publication and distribution rights of their articles.
- Authors are free to submit their works to other publications, including journals, institutional repositories or books, with an acknowledgment of its initial publication in UOJM.
- Copies of UOJM are distributed both in print and online, and all materials will be publicly available online. The journal holds no legal responsibility as to how these materials will be used by the public.
- Please ensure that all authors, co-authors and investigators have read and agree to these terms.
- Works are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
2. Goldstone J. The role of quality assurance versus continuous quality im- provement. J Vascular Surgery. 1998;28(2):378-80.
3. Health Information Technology Research Center (HITRC). Continuous Quality Improvement (CQI) Strategies to Optimize your Practice [Internet]; 2013 [cited 14 April 2017]. Available from: https://www.healthit.gov/sites/default/files/tools/nlc_continuousqualityimprovementprimer.pdf.
4. Frank C, Marshall D, Faris P, Smith C; Alberta Bone and Joint Health Institute. Essay for the CIHR/CMAJ award: improving access to hip and knee replacement and its quality by adopting a new model of care in Alberta. CMAJ. 2011;183(6):E347-50.
5. Marshall DA, Christiansen T, Smith C, et al. Continuous quality improvement program for hip and knee replacement. Am J Med Qual. 2015;30(5):425-31.
6. Health Quality Ontario. Quality Improvement Planning [Internet]. 2016 [cited 14 April 2017]. Available from: http://www.hqontario.ca/Quality- Improvement/Quality-Improvement-Plans/Quality-Improvement-Plan-Guidance.
7. Kahan B, Goodstadt M. Continuous quality improvement and health promotion: can CQI lead to better outcomes? Health Promot Int. 1999;14(1):83-91.
8. Health Quality Ontario. Quality Improvement Guide [Internet]. 2012 [cited 14 April 2017]. Available from: http://www.hqontario.ca/portals/0/documents/qi/qi-quality-improve-guide-2012-en.pdf.
9. Baker A. Crossing the quality chasm: A new health system for the 21st century. BMJ. 2001;323(7322):1192.
10. Saleh KJ, Bozic KJ, Graham DB, et al. Quality in orthopaedic surgery- an international perspective: AOA critical issues. J Bone Joint Surg Am. 2013;95(1):e3.
11. Pinney SJ, Page AE, Jevsevar DS, Bozic KJ. Current concept review: quality and process improvement in orthopedics. Orthop Res Rev. 2015;2016(8):1-11
12. Wick EC, Hobson DB, Bennett JL, et al. Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections. J Am Coll Surg. 2012;215(2):193-200.
13. Chen BP, Garland K, Roffey DM, et al. Can Surgeons Adequately Capture Adverse Events Using the Spinal Adverse Events Severity System (SAVES) and OrthoSAVES? Clin Orthop Relat Res. 2016;475(1):253-60.
14. Sink EL, Leunig M, Zaltz I, et al. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res. 2012;470(8):2220-6.
15. Sink EL, Beaulé PE, Sucato D, et al. Multicenter study of complications following surgical dislocation of the hip. J Bone Joint Surg Am. 2011;93(12):1132-6.
16. Beaule PE, Roffey DM, Poitras S. Continuous quality improvement in orthopedic surgery: changes and implications with health system funding reform. Can J Surg. 2016;59(3):149-50.
17. Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005;83(4):691-729.
18. International Consortium for Health Outcomes Measurement (ICHOM). Standard Set for Hip & Knee Osteoarthritis [Internet]. 2016 [cited 14 April 2017]. Available from: http://www.ichom.org/medical-conditions/hip-knee-osteoarthritis/.
19. Hailer NP. Orthopedic registry research - limitations and future perspectives. Acta Orthop. 2015;86(1):1-2.
20. Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care. 2004;13(Suppl 1):85-90.
21. Woolf SH, Kuzel AJ, Dovey SM, Phillips RL Jr. A string of mistakes: the impor- tance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med. 2004;2(4):317-26.
22. Colvin MO, Eisen LA, Gong MN. Improving the Patient Handoff Process in the Intensive Care Unit: Keys to Reducing Errors and Improving Outcomes. Semin Respir Crit Care Med. 2016;37(1):96-106.
23. CMPA. Who is the most responsible physician? Check your knowledge [Internet]. 2016 [cited 14 April 2017]. Available from: https://www.cmpa- acpm.ca/-/who-is-the-most-responsible-physician-check-your-knowledge.