8-Making it Work Big and Small: Digestible Stories of Success

MODULE 10 | Section 8 of 11

Making it Work Big and Small: Digestible Stories of Success

TWO EXAMPLES OF HIGH-VALUE IMPROVEMENTS IN MEDICAL SYSTEMS

A RESIDENT LED IMPROVEMENT PROJECT: THINK TWICE STICK ONCE

This research letter describes a project that aimed to decrease the number of times a patient is stuck with a needle to draw blood for labs in an inpatient setting. This project used the COST framework to structure the intervention which included:

      • Culture: raising awareness of the program through posters, buttons, and pens with the slogan, “Think Twice, Stick Once” (Culture).
      • Oversight: Team-specific phlebotomy data were reported twice monthly to members of the housestaff
      • Systems change: The Division of Hospital Medicine adopted phlebotomy reduction as a performance metric
      • Training: Resident champions introduced the program at monthly orientations and didactic sessions, emphasizing the patient experience related to phlebotomy.

Interrupted Time-Series Analysis Showing Average Number of Phlebotomies per Patient on the Internal Medicine Service
Average number of phlebotomies per patient per day with introduction in July 2014 of the “Think Twice, Stick Once” program to reduce the number of phlebotomies per day.

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Source: Wheeler D, Marcus P, Nguyen J. Evaluation of a resident-lef project to decrease phlebotomy rates in the hospital: think twice, stick once. JAMA Intern Med, 2016;176(5):708-710

UCSF CARING WISELY

The UCSF Caring Wisely Program is an ongoing program at UCSF that aims to improve the quality of health care and reduce costs to the health care system. The program is designed to engage clinicians on the frontlines of care in the development of project based solutions to local areas in need of improvement.

 

The program supports three to four projects each year selected with a combination of crowdsourcing, selection criteria including improving quality without passing costs to others, and alignment with medical center improvement priorities.

 

Projects are supported by an expert implementation team, which includes coaching of implementation development.

REFERENCES

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