Quality Improvement
“Count what is countable, measure what is measurable, and what is not measurable, make measurable” is frequently attributed to Galileo. Whether that is true or not, the concept of improving outcomes or processes of care is tied to the ability to measure them. At the Interdepartmental Division of Critical Care Medicine, an interprofessional group of clinicians devoted to Quality Improvement and Patient Safety has been doing just that. Using the iCORE registry, our team has created a dashboard of evidence-based processes of care, such as sedation minimization, delirium screening, lung protective ventilation, spontaneous breathing trials, DVT prophylaxis, hyperoxia, use of physical restraints, and early mobility. This set of metrics is collected daily in mechanically ventilated patients across ICUs from the teaching hospitals and reported on a monthly basis to all stakeholders. The reliability, clinical relevance and potential for change of these indicators makes them highly valuable for clinicians to identify quality gaps and monitor the success of quality improvement projects.
The division currently provides different opportunities for education on quality improvement and patient safety. It is part of academic half-day curriculum, including topics on quality improvement and communication for all residents and fellows, and, in conjunction with the Department of Medicine, we also offer an optional Co-Learning in Quality Improvement Workshop, consisting of 2 workshops where fellows and interprofessional members of our department have an opportunity to learn the basics of Quality Improvement, while working together in a project. Over the past few years many of these projects were presented at national and international conferences:
Timothy Chimunda, Kate Tatham, Bharat Kumar, Irene Telias, Mika Hamilton, Andrew Kuhl and Jonathan Marhong working on improving consent for common ICU procedures at Sunnybrook Health Sciences Centre, awarded the Garner King award at the Canadian Critical Care Forum, 2016:
Michelle Baczynski, Catherine, Eta-Ndu, Joseph Gajasan, Aditi Jain, Maureen Keelty, Raid Shaarbaf, Marlene Traille and Christie Lee working on improving the rates of spontaneous breathing trials at Mount Sinai Hospital:
Tom Bodley, Beth Linseman and Julie Nardi demonstrating a successful project to decrease hyperoxia rates at Sunnybrook Health Sciences Centre (winner of the best QI poster at the 2019 University of Toronto DOM QI Day):
Bruno Ferreyro, Julien Viau Lapointe, Anna Geagea, Abdulramman Al-Fares, Aziz Alali, Ricardo Mellado and Mohammed Hamidi working to decrease blood work at Mount Sinai Hospital:
For videos: https://youtu.be/7HOUu2NLsPA
Thank you,
Dr. Andre Amaral
Associate Professor
Interdepartmental Division of Critical Care Medicine
University of Toronto in Toronto
&
Dr. Eddy Fan
Associate Professor
Interdepartmental Division of Critical Care Medicine
University of Toronto in Toronto