Inpatient and outpatient settings — though riddled with staff shortages and workflow challenges — hold key opportunities for quality improvement. To realize potential here, hospitals and health systems must consider support that will drive not only advancements but also innovation across the organization.
During an August Becker's Hospital Review virtual roundtable sponsored by Edwards Lifesciences, a panel of clinical quality and safety leaders discussed common challenges in their operating rooms and intensive care units and how they approach related investments in technology.
Here are the four key takeaways from their discussion:
1. Workforce-related issues dominate quality improvement challenges in the OR and ICU. When asked to share their biggest challenges in the OR and ICU, roundtable participants repeatedly highlighted staffing shortages. The shortages are exacerbated by the different needs and expectations of new, younger staff members, which include both a need for further training and a desire for fast-tracked promotion.
"It takes two to three years to get a nurse up and running to be proficient," said the director of quality management at a nonprofit hospital chain in the Southwest. "Not that they can't do the job, but it's that proficiency that we look for when we're trying to remain a high-reliability organization."
Other challenges include a need for standardization of practices, interventions and transitions of care, as well as a breakdown in standard workflows — in part due to an influx of newly recruited staff. "We've seen a temporal association between the arrival of new staff members en masse and increased central line-associated bloodstream infection rates," said the chief quality, safety and data analytics officer of an academic medical center in the mid-Atlantic region.
2. Investments in the inpatient setting can drive strategic innovation in outpatient settings. Advanced analytics and robotics that can perform the functions of hard-to-find and hard-to-retain surgical technicians are a prime example of innovation that can start within and expand beyond the OR or ICU. By conducting analytics-driven cleanliness checks, robots can help reduce surgical site infections and infections related to surgical equipment — a problem for hospitals that ambulatory surgical centers and outpatient clinics share.
"Understanding how artificial intelligence can help providers improve their practices will reduce malpractice, reduce errors and improve community confidence," said the director of quality management and performance improvement at a health system in the Southwest.
3. Quality improvement initiatives in the OR and ICU can drive larger strategic innovation. Selecting technologies or programs that are not one-off solutions is the key to ensuring quality improvement initiatives in surgical or high-acuity care settings see return on investment.
"It's important to ensure the investments you're making are going to be functional in more than one area or have the capability to be flexible so you can build a solution within that tool for other areas," said the director of clinical quality analytics at a major hospital in the South.
Beyond investing in versatile technology, hospitals and health systems can propel quality improvement initiatives by promoting a culture of collaboration. Collaboration in the OR and ICU are paramount; success in these environments depends largely on intense, well-oiled collaboration among team members.
"We have to understand where each of us is coming from and how we can best take our strengths and our knowledge and work together for that common cause of safe patient care," said a patient safety consultant and director of clinical services.
4. Edwards Lifesciences supports quality improvement in key service lines. The company's Outcomes Advisors Program, which gives health systems access to four-month clinical pilots to optimize hemodynamic care, aims to help organizations reduce high-cost complications, improve length of stay, decrease cost per case and standardize clinician practice.
The program is staffed by experienced nurses in administrative positions, clinical data analysis and Lean Six Sigma project managers — and offers support through:
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- Hemodynamic management in cardiac, bariatric, obstetric, ICU and critical care
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- Enhanced surgical recovery
- Sepsis management
- Clinical and cost data analytics
- Post-pilot metrics management
Edwards Lifesciences piloted the program on 60 patients in the orthopedic service line of a large integrated delivery network and observed a 47 percent reduction in complication rates and a 20 percent reduction in average length of stay.
"With this program, we want to establish ourselves as a partner instead of a regular vendor that just sells you a disposable or a capital platform," said Lucerna Sung, marketing director at Edwards Lifesciences.