Deborah Stiles - Gold Coast Hospital & Health Service - How Real-Time Feedback Improves Clinicians...
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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
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CHARMERS
Project Aim
To improve compliance
with Q-ADDS utilisation
through ongoing audit
and instant, comparative
and meaningful
feedback reports.
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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)
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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)
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CHARMERS
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CHARMERS
Background
• At Q-ADDS
implementation,
local auditing
was commenced
to track and
maintain quality
of charting
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CHARMERS
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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CHARMERS
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
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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
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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.
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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
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CHARMERS
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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
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CHARMERS
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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
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CHARMERS
Daily resuscitation coordinator report
Not shown above – time, location, UR, auditor
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CHARMERS Weekly IPU tearoom report
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CHARMERS Weekly – a closer look
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CHARMERS Weekly – a closer look
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CHARMERS Monthly IPU tea-room report
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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
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CHARMERS
August 2014
58% Perfect
(73.2% Acceptable)
HHS Results to date
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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
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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
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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.
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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….
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CHARMERS
Reference:
• Australian Commission on Safety and
Quality in Healthcare:
http://www.safetyandquality.gov.au
– Standard 9 - Recognition and Response to
Clinical Deterioration