deborah stiles - gold coast hospital & health service - how real-time feedback improves...

CHARMERS

Real-time feedback system

for improving

clinician performance

Presented by

Deborah Stiles

Resuscitation Coordinator

Gold Coast Hospital and Health Service Acknowledgement: Richard Oakham, Nurse Manager - eRoster

CHARMERS

Project Aim

To improve compliance

with Q-ADDS utilisation

through ongoing audit

and instant, comparative

and meaningful

feedback reports.

CHARMERS

Background

• GCHHS has 3 inpatient facilities – Carrara Health Centre – 63 bed

– Robina Hospital - 364 beds

– GCUH - 750 beds

(opened Sept 2013)

• Staffing – Nurses- 2542 FTE

– Medical- 858 FTE

(up by 17% in the last year)

CHARMERS

Background

• In preparation for the move to the new

university hospital

– Identified need to use and ensure correct use of

an early warning tool

• In July 2011, replaced 13 observation charts

with the one vital sign chart, Q-ADDS

(Queensland Health’s Adult Deterioration

System)

CHARMERS

CHARMERS

Background

• At Q-ADDS

implementation,

local auditing

was commenced

to track and

maintain quality

of charting

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The problem with auditing …

• Resource intensive for collection and analysis

• Difficult to collate & analyse

• Delayed reporting & feedback distribution

• Identified areas for improvement became irrelevant

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The Annual Queensland Bedside Audit (QBA) 2012

identified GCHHS issues in Q-ADDS charting

QBA Audit results - Nov 2012

72%

48%

40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Complete set of vital signs Scored Correctly scored

Percentages are of

total charts audited

CHARMERS

Local plan to improve quality

• Frequent ongoing audits instead of a

single bulk audit

• Real-time feedback on results to promote

local quality improvement

• Desire to use technology for the process

• Consistent, standardised audit approach

CHARMERS

Audit

Report

Review

Educate

Solution: CHARMERS Charts, Audits, Records and Medical Emergency Report/Review System

Online & fun

Blocks poor data entry

Consistent with procedure

Takes 1 minute per chart

Min 10 per week

Automatic reports generated

Different level reports

Immediate feedback

Local review identifies

low-risk issues weekly.

High risk issues are reported

daily.

Result-based

improvements

Shows rapid, visible

change.

CHARMERS

• The audit is designed to take no more than

1 minute per chart

• We aimed for 10 audits per IPU, per week

(10 minutes work!)

• Natural competitiveness between IPU’s

helps us with maintaining the number and

quality of audits!

Q-ADDS Audit

CHARMERS

CHARMERS Audit

• The questions are designed

to rapidly identify poor

practice in Q-ADDS use

– Missed deterioration and

missed escalation

– MET criteria reached but

not acted on

• These type of practices are

then specifically identified on

the reports

• The questions directly relate

to and reinforce the GCHHS

Vital Signs Procedure

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CHARMERS

CHARMERS

Report and Review

• Daily, weekly and monthly reports are

automatically sent by CHARMERS to relevant

parties

– Giving real-time feedback to NUMs and

educators, which helps to improve local practice

• Staff can give their time to acting on the

reports, instead of collating and analysing the

data

CHARMERS

Daily resuscitation coordinator report

Not shown above – time, location, UR, auditor

CHARMERS Weekly IPU tearoom report

CHARMERS Weekly – a closer look

CHARMERS Weekly – a closer look

CHARMERS Monthly IPU tea-room report

CHARMERS

Educating and improving

• Closing the quality/education loop by using

these reports effectively at IPU level

– instant feedback and capability of showcasing

local results.

• Timely reporting is critical to this process

– Events and outcomes can easily be linked

CHARMERS

August 2014

58% Perfect

(73.2% Acceptable)

HHS Results to date

CHARMERS

GCHHS QBA results Percentages are of

total charts audited

QBA Audit results - Nov 2012 & Nov 2013

(CHARMERS intervention occurred July 2013)

2012 - 72%

2012 - 48%

2012 - 40%

2013 - 82%

2013 - 73%2013 - 70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Complete set of vital signs Scored Correctly scored

CHARMERS

Summary

• CHARMERS is demonstrating the

effectiveness of frequent audits and high

quality real time reporting

• Positively impacting clinician behaviour in

regards to quality in patient safety initiative

– Improving vital sign charting and escalating

clinical concerns with use of Q-ADDS and

associated EWTs

CHARMERS

Leading through governance…

• with strong nursing leadership driving innovation,

• with establishment of norms and directing

expectations in the correct use of the vital signs

charting and escalation of clinical concerns aligning

to local procedures,

• with engaged participation at local level in auditing,

reporting and quality improvement strategies, and

• with educational and procedural developments -

locally and health service wide, to enhance overall

clinical performance and patient care and safety.

CHARMERS

Future plans

This audit and report system is being used (or in planning

for)

– Blood products (NSQHS Standard 7)

– Medication charts (NSQHS Standard 4)

– Resuscitation carts (NSQHS Standard 9)

– Code Blue/MET response (NSQHS Standard 9)

– Etc….

CHARMERS

Reference:

• Australian Commission on Safety and

Quality in Healthcare:

http://www.safetyandquality.gov.au

– Standard 9 - Recognition and Response to

Clinical Deterioration