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Selecting an appropriate quality improvement method to identify, assess and treat a practice gap in the Neuro-IR is an arbitrary choice that should incorporate the input of stakeholders. One practice team or discipline should not be responsible for all aspects of quality improvement project that effects the of patients in that designated area. Two methods used to address quality improvement practice gaps associated with first case start times are the lean and TCAB project methods. The TCAB methods, also known as “transforming care at the bedside,” is a nurse driven initiative that focuses on workflows to ensure nurses optimize their time at the bedside. When applied to the Neuro-IR, a potential TCAB project would start by evaluating how much time nurses spend performing perioperative assessments and how that time influences potential delays on cases starting the in the procedural area. Application of an assessment script to the nurses would be the testing agent. Pre and post intervention evaluations of time would be distributed to care teams. The use of rapid-cycle testing, as presented by Hassmiller & Bolton (2009) allows members of the quality improvement team to actively, rather than passively, assess the success of the intervention while it is in use. In this case, questions in the perioperative assessment would be tailored to shorten the time spent completing the assessment. White (2018) discusses the use of checklists in the perioperative setting that direct care to minimize care delays Use of the TCAB method to address the quality improvement gap associated with first case start times is nurse driven primarily however input from other care services of the Neuro-IR suite, such as physician assistants and anesthesiologists, is imperative for system improvements. TCAB quality improvement projects accentuate the areas in care where gaps exist and identifies areas where waste, either literal or figurative such as time, can be better managed (Hassmiller & Bolton 2009).
The second tool that can be applied to facilitating efficiency in first case start times is the “lean” model of quality improvement. This model also addresses inefficiency in practice by assessing wasteful processes through a team approach (Isaacson et al., 2014). The lean model is data driven and uses communication tools, such as signs, emails and check sheets, to mitigate time consuming activities that impede first case start times. Lean uses the processes of define, measure, analyze, improve and control to initiate, test and maintained quality improvement strategies that translate into practice changes (Dowell et al., 2017). This is a less nursing focused venture but still uses data to drive improvements in outcomes.
Reference
Agency for Healthcare Research and Quality. (2018). Key driver two: implement a data driven quality improvement process to integrate evidence into practice procedures. Retrieved from: https://www.ahrq.gov/evidencenow/tools/keydrivers/implement-qi.html.
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