Please see attachments for questions
Knowledge Activity: Quality Improvement with the EHR (Associate)
Student instructions
1. If you have questions about this activity, please contact your instructor for assistance.
2. You will review the chart of
William Petrov to complete this activity. Your instructor has provided you with a link to the
Quality Improvement with the EHR (AS) activity. Click on
2: Launch EHR to review the patient chart and begin this activity.
3. Refer to the patient chart and any suggested resources to complete this activity.
4. Document your answers directly on this activity document as you complete the activity. When you are finished, you will save this activity document to your device and upload this activity document with your answers to your Learning Management System (LMS).
Glossary
Quality Improvement (QI): Systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups (Rider & Schertzer, 2023).
Continuous Quality Improvement (CQI): is a continual process focused on making gradual and incremental improvements in processes, safety, and patient care. It involves a quality management approach that prompts healthcare team members to consistently question and assess performance, encouraging the pursuit of better practices. To address these inquiries effectively, structured clinical and administrative data are essential components of the practice. (O’Donnell & Gupta, 2023).
Rapid-Cycle Quality Improvement: Is a method for enhancing quality that involves identifying, implementing, and measuring changes to improve a process or system. In this approach, changes are made and tested within short periods, typically three to six months, as opposed to the usual eight to twelve months. It reduces wasted activity and efforts for a quick turnaround on QI projects. (Office of the National Coordinator for Health Information Technology, 2019).
PDSA/PDCA: Plan, Do, Study/Check, Act. A commonly used QI strategy that is a four-step rapid-cycle quality improvement strategy. (Office of the National Coordinator for Health Information Technology, 2019).
Plan: Identify an opportunity to improve and plan a change.
Do: Implement the planned changes on a limited scale, involving a small number of patients.
Study/Check: Evaluate the outcomes of the changes. Did you successfully meet your objectives?
Act: Utilize the obtained results to make informed decisions, integrate the changes into your workflow.
The activity
The General Hospital has asked for your help to initiate continuous quality improvement (CQI) regarding re-admission rates.
A re-admission is considered two or more hospital admissions within a 30-day window, for any reason. The CMS Readmissions Reduction Program (HRRP) through the Affordable Care Act enforces financial incentives to hospitals who can lower their re-admission rates. (CMS, 2023). The Hospital’s Quality Improvement committee would like to look at the re-admission rates for four diagnoses with high re-admission rates nationally: renal failure, congestive heart failure, sickle cell anemia, and diabetic gangrene.
Access the
General Hospital Readmission Report with Pivot Table (an Excel spreadsheet included with this activity under
1: Overview and Resources). This pivot table was created from a data report extracted from the EHR. For this pivot table, “Readmitted <30 days” means readmitted within the one-month window of discharge. “Not readmitted <30 days” means not readmitted within the one-month window of discharge. Review the table and answer the following questions.
Questions
Examine the pivot table for the readmission report data from the last quarter’s admissions to the General Hospital. Use the data presented in the pivot table to calculate rates of readmissions to answer the questions below.
Important: a readmission is defined as two or more hospital admissions within a 30-day window, for any reason. On the pivot table, “Readmitted <30 days” means readmitted within the one-month window of discharge. “Not readmitted <30 days” means not readmitted within the one-month window of discharge. Answer the following questions.
1. What was the overall rate of readmission for all diagnoses last quarter? Round to the nearest percent.
2. What is the rate of readmission for unnamed diagnoses or all other admissions? Round to the nearest percent.
List the rates of readmission for each diagnosis listed below. Round to the nearest percent:
3. Gangrene:
4. Congestive heart failure:
5. Renal Failure:
6. Sickle Cell Anemia:
7. What diagnosis has the highest rate of readmission?
Complete the following sentence:
8. ______%
9. ______%
Compare the General Hospital readmission rates to the national averages cited in the Healthcare Cost and Utilization Project (HCUP) flier 30-Day Readmission Rates to U.S. Hospitals. (Healthcare Cost and Utilization Project (HCUP), 2010). This resource is included under 1: Overview & Resources along with this activity document.
10. For which diagnosis(es) does the General Hospital have a lower readmission rate than the national average?
11. For which diagnosis(es) does the General Hospital have a higher readmission rate than the national average?
Critical Thinking Questions
12. The General Hospital’s Quality Improvement committee wants to know how their hospital’s readmission rates compare to national averages based on your review of the readmission data. What will you tell them? Select the correct answer.
a. The General Hospital’s readmission rates are below the national rates.
b. The General Hospital’s readmission rates are above the national rates.
c. The General Hospital’s readmission rates are below the national rates for all diagnoses, except for congestive heart failure.
d. The General Hospital’s readmission rates are above the national rates for congestive heart failure and renal failure.
Based on your report, the General Hospital’s Quality Improvement committee has implemented a pilot test called
heart failure (HF) re-admission CQI. Review the Clinical Reminder found on the Alerts Tab of the William Petrov EHR and answer the following questions.
13. What is the subject of the Clinical Reminder in William Petrov’s EHR?
14. What is the description/rationale for this Clinical Reminder?
15. What action will be taken for this Clinical Reminder?
16. What is the frequency for the Clinical Reminder action?
The General Hospital’s Quality Improvement committee has used the Plan, Do, Study/Check, Act method for developing the CQI intervention.
17. Three months after the implementation of the
heart failure (HF) re-admission CQI Clinical Reminder, a new re-admission report is run for evaluation of the pilot. The patients who were part of the
heart failure (HF) re-admission CQI Clinical Reminder pilot were now found to have a re-admission rate of 24%. What does this data mean?
Submit your work
Document your answers directly on this activity document as you complete the activity. When you are finished, save this activity document to your device and upload this activity document with your answers to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.
Learning objectives
1. Evaluate policies and strategies to achieve data integrity (5)
2. Leverage data-driven performance improvement techniques for decision making (5)
References
CMS. (2023, September 06). Hospital Readmissions Reduction Program (HRRP). Retrieved from
Office of the National Coordinator for Health Information Technology (ONC). (2019, April 15). How do I use a rapid-cycle improvement strategy?. HealthIT.gov.
O’Donnell, B., & Gupta V. (2023). Continuous Quality Improvement.
Rider, A., & Schertzer, K. (2023). Quality Improvement in medical simulation.
EHR Go Knowledge Activity: Quality Improvement with the EHR (Associate) HAK1021.5
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