Posted: January 2nd, 2024

Quality Improvement Scenario Assignment

Quality Improvement Scenario Assignment
Number of sources: 2
Paper instructions:
After re-reading Chapter 21 and applying what you learned, please read the following scenario and respond to the questions with rationale from the textbook and other readings. This Discussion Board assignment is a writing assignment. The response to each question should be a paragraph, in APA format with citations and references (at least 2 articles published within the last 5 years).

Quality Scenario

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Carmen Gonzales, RN, has worked as a charge nurse in the cardiac surgery unit at a large urban hospital for the past 3 years. Carmen has become concerned about what seems to be an increase in infection rates of post coronary artery bypass graft (CABG) patients' surgical incisions. Through the hospital's electronic health record system, Carmen is able to do a quick review of discharge summaries for cases done in the previous month and learns that during this time, three patients had incisional infections that required intravenous antibiotics and extended hospital stays. Carmen considers the seriousness of these infections in light of their effect on a patient's overall health, as well as their financial effect on both the patient and the hospital. Carmen knows that in almost all cases, post-surgical incisional infections are preventable and decides to take action to reduce the rate of these infections in her unit.

Questions

1) What is the financial effect on the hospital of post-surgical infections?

2) What financial effect will a post-surgical infection have on the patient and his or her family?

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3) Carmen would like to use the quality improvement model presented in this chapter to reduce or eliminate post-surgical infection among CABG patients. How will she go about initiating this project and answer the first three questions of the quality improvement model? What will be Carmen's first step in initiating the plan-do-check-act (PDCA) cycle?

4) What quality improvement tool or tools would be most useful to help analyze and monitor the problem and why (e.g., run chart, flowchart, Pareto chart)?

5) Where can Carmen get the best information about best practices or recommended guidelines related to post-CABG wound care?

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6) How can Carmen share her experience in reducing the rate of post surgical infection in her unit to help other units in the hospital? In the region, state, or nation?

The financial effect of post-surgical infections on the hospital can be significant. According to the Centers for Disease Control and Prevention (CDC), hospital-acquired infections (HAIs) add $28 billion to $45 billion in excess medical costs each year in the U.S. alone (CDC, 2020). Post-surgical site infections (SSIs) are one of the most common and costly HAIs. A study in the American Journal of Infection Control found the average additional cost per SSI was $20,785, with costs ranging from $10,730 for a superficial SSI to $40,145 for an organ/space SSI (Anderson et al., 2014). Reducing SSIs can help lower unnecessary healthcare costs.
Patients who develop post-surgical infections also face increased financial burdens. They face longer hospital stays, additional medical and surgical treatments, and prolonged recovery times (CDC, 2020). A study in Medical Care found the average additional cost to a private payer (insurance company or patient) of a SSI was $25,546, with 25% of those costs paid by patients in the form of higher deductibles, copays or lost wages (Pastor et al., 2010). Preventing infections can help reduce the financial toxicity of illness for patients.
To initiate a quality improvement project using the PDCA model, Carmen's first step would be to define the problem clearly, as outlined in the first question of the model. Based on her review of discharge summaries, it seems post-CABG surgical site infections may be increasing on her unit. Her next steps would be to collect and analyze data to determine the current rate of these infections. This will help establish measures to track improvement. Some potential tools could include a run chart to monitor infections over time or a fishbone diagram to identify potential causes.
A run chart would be a very useful tool for Carmen to analyze and monitor the SSI problem over time, as it allows visualization of data trends and the impact of changes. Run charts are straightforward but powerful for displaying variation in outcomes (Nelson, Batalden, & Godfrey, 2007). This would help Carmen determine if the rate of infections is random or non-random variation in need of intervention.
The CDC has evidence-based guidelines and toolkits on recommended practices for preventing SSIs that would provide Carmen the best information (CDC, 2021). Professional nursing organizations like AACN may also have consensus statements on best practices. A literature review in CINAHL or PubMed could identify additional high-quality studies on effective SSI prevention strategies.
Carmen could share her quality improvement project and results through a poster or podium presentation at a national nursing conference to disseminate her work. She could also submit an article to a peer-reviewed journal like the American Journal of Infection Control or AORN Journal to educate other healthcare professionals. Publishing her experience could help spread best practices to reduce SSIs in other facilities.