Management Question

management writing question and need the explanation and answer to help me learn.

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Downloadedfromhttps://journals.lww.com/jhqonlinebyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3SSKucKmLu4a87LV3W4SgoIO56AHbLC8WBX+/nZ+P+RQ=on10/19/2019Downloadedfromhttps://journals.lww.com/jhqonlinebyBhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3SSKucKmLu4a87LV3W4SgoIO56AHbLC8WBX+/nZ+P+RQ=on10/19/2019JudiciousUtilizationofHealthcareResources:ReducingUnindicatedPediatricAnaerobicBloodCulturesinaPediatricHospitalIanOng,PoojaA.Jayagobi,PradeepRaut,Chia-YinChongBackgroundRecentstudieshaveshownthattheinci-denceofbloodstreaminfectionscausedbyobligateanaerobicbacteriaislowinthegeneralpediatricpopulation(Brook,2002;Grohsetal.,2007).From1974to1988,theincidenceofanaerobicbacteremiaattheMayoClinic(Rochester,MN)fellby45%(Dosheretal.,1991).Lazarovitchandcolleagues(2010),concludedthattherewasaslightdropintheincidenceofanaerobic-relatedbacteremiafrom0.84%in1998to2002to0.74%in2003to2007(p=.03).Thesereportsarecompoundedbythefindingthatyoungchildrenhavealowestriskofdevelopinganaerobicbacteremiacomparedwithadults(Goldstein,1996).Subsequently,someinvestigators(Cock-erilletal.,1997;Rosenblatt,1997)pro-posedselectiveratherthanroutineuseofanaerobicbloodcultures.Others(IwataandTakahashi,2008;Morrisetal.,1993)recommendedthatanaerobicbloodcul-turesonlybeperformedforpatientswhoareimmunocompromisedorsuspectedtobesufferingfromintra-abdominalsepsisorheadandneckinfections.Despitethesedevelopments,thepracticeoforderingpairedbloodcultures(aerobicandanaerobic)isstillprevalentinpedi-atricwards.A10-yearreview(2001–2010)ofbloodcultures(aerobicandanaerobic)frompediatricpatientsinourhospitalshowedthatonly4%ofallbloodculturesyieldedpositiveresults.Mostpositiveresultswereobtainedfromaerobiccultures,whereasanaerobicculturesonlygrewfacultativeanaerobes.Therehasbeennopositiveyieldofobligateanaerobicorganismsfrompediatricpatientsinthepast10years,despiteanincreaseinthenumberofpediatricadmissionswithasimultaneousincreaseinthenumberofbloodculturesperformed.ThisisconsistentwithresearchdonebyJamesandal-Shafi,2000,whofoundthat“significantlymoreisolateswereobtainedfromstandardaerobicbottlesthanfromstandardanaerobicbottles(p,.001).”Risinghealthcarecostshaveresultedinincreasedfinancialburdensonpatientsandhospitals.Theoverutilizationoflabo-ratorytestshascontributedtothehugehealthcarecosts(Stratton,2000).Atourhospital,afeeofUSD$29ischargedforoneBactecBottleandforprocessing.Inaddition,anestimatedUSD$21ischargedKeywordsanaerobicbloodculturesaerobicpediatricsJournalforHealthcareQualityVol.37,No.3,pp.199–205©2015NationalAssociationforHealthcareQualityAbstract:Thedeclineinanaerobicinfectionsinthepast15yearshasresultedinhealthcareprofessionalsquestioningtheneedforroutineanaerobicbloodcultures.Inthisstudy,weextractedbaselineaerobicandanaerobicbloodcultureratesoverthepast10years(2001–2010)fromourpediatricwards.Aquestionnairesurveyofdoctorswasconductedtogathertheirviewsregardinganaerobicbloodcultures.Interventionssuchasphysicianeducationwereintroducedover6monthstoreduceunindicatedanaerobicbloodcultures.Furthermore,theratesofbloodculturesweretrackedovertimeafterinterven-tion.Beforeintervention,85%ofdoctorssurveyedroutinelyorderedanaerobicbloodcultures,90%wereunawareofanyguidelinesforanaerobicbloodcultures,and100%wereunawareofthecosts.Thecombinationofphysicianeducationandrestrictiveinterventionsresultedinan80%reductioninthenumberofanaerobicbloodculturesperformedandprocessed,whichtranslatedintosavingsofUSD$2,883perweek,withprojectedsavingsofUSD$145,560annually.199Vol.37No.3May/June2015Copyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
formanpower,useoftreatmentroom,andconsumableswhenperformingbloodcultures.Therefore,thetotalcumulativecostforoneanaerobicbloodculture,tak-ingintoconsiderationthepreviouslymentionedcharges,isUSD$50.Forpaired(aerobicandanaerobic)bloodcultures,thetotalcumulativecostisUSD$101.Intheyear2010alone,atotalof8,938bloodcultureswereperformed:4,473(50.1%)aerobicand4,465(49.9%)anaerobic.Theexpenditurealoneforbloodcultureswasalmosthalfamilliondollars(USD$447,947),ofwhichUSD$224,174wereforanaerobicbloodculturesalone.Anaerobicbloodculturebottle(BactecPaed/plus)currentlyusedisvalidatedforaminimumof2–3mLofbloodasasample(Becton,DickinsonandCompany,2012).Theamounttakenfromchildrenislimitedduetodifficultiesinobtainingblood(FreedmanandRoosevelt,2004).Thislimitsthepositivedetectionofbacterialisolatesfrombloodculturesasbacteremiaratesimprovesignificantlywhenthevol-umeofbloodtestedincreases(FreedmanandRoosevelt,2004).Thisisfurthercompoundedbyvariousstudiesthathaveshownthatthemostimportantfactorforpositiveyieldineitheraerobicoranaero-bicculturebottleisthequantityofbloodinoculated(Morrisetal.,1993;Murrayetal.,1992).Despitetheestablishedguidelinesontheindicationsofanaerobicbloodcultures,thepracticeoforderingpairedbloodculturesisstillprevalentinourpediatricwardsandisincreasingyearly.Inadditiontorisingcosts,unindicatedanaerobicbloodculturesresultinincreasedworkloadforhealthcarestaff.Atourhospital,anaerobicbloodculturesconsistof2%oftheworkloadforjuniordoctorsand6%oftheworkloadformicrobiologylaboratorystaff.AimAsaresultoftheconcernspreviouslymentioned,weproposedahealthcarequalityimprovementprojecttoreducethenumberofunindicatedanaerobicbloodcultures.Thepurposeofthisstudywastoreducethemedianusageofunindicatedanaerobicbloodculturesby50%within6monthsinthepediatricwards.Ifsuccess-ful,thisstudywillresultinsavingsintermsofmoneyandresourceswhilestillmain-tainingthequalityofhealthcareservicesprovided.MethodsInclusioncriteriafortheprojectwereallpediatricpatientsyoungerthan16yearswhowereadmittedtothepediatricmedicalwards.Exclusioncriteriawerepatientswhowereimmunocompromised,hadheadandneckinfections,andpa-tientswithintra-abdominalinfections.Thesecriteriaarefurthersupportedbyrecommendationsthatanaerobicbloodculturesshouldonlybeperformedforpatientswhoareimmunocompromisedorsuspectedtobesufferingfromintra-abdominalsepsisorheadandneckin-fections(IwataandTakahashi,2008;Morrisetal.,1993).Thisstudywascon-ductedover6monthsandincluded6pediatricwards,excludingallhigh-riskwardssuchasthechildren’sintensivecareunit,surgicalwards,hematology–oncologywards,andthehighdependencyunit.Changewaseffectedthroughtherapidcyclechangemethods,involvingaseriesofPlan-Do-Study-Act(PDSA)cycles.Aquestionandanswersurveywasdissemi-natedtodoctorstounderstandthecur-rentvariationsinbloodculturepracticesinpediatricwards.Staffmemberswerethentaughtusingstrategicandopportu-nisticeducationalsessions.Variousin-terventionswereputinplaceandpilotedinasinglepediatricwardfor1week.Theseincludedlimitingthenumberofanaerobicbloodculturebottlesavailableineachward,puttingupwall-mountedreminders,bottletagsandindicationforms,andeducationallectures,andbrochureswereprovidedforstaffmem-bers.Afterasuccessfulpilotrun,thein-terventionswererolledouttotherestofthegeneralpediatricwards.Theprimaryoutcomemeasurewasthenumberofunindicatedanaerobicblood200JournalforHealthcareQualityCopyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
culturesperformedandthecountermea-sureofthenumberofreplenishedanaer-obicbloodculturebottlesatthewardlevel.Similarly,thenumberofaerobicbloodculturesperformedandthenum-berofbloodculturebottlesreplenishedatthewardlevelwerealsomonitored.Mon-itoringofoutcomemeasureswasdoneonaweeklybasis.Theseparameterswerethenplottedontoruncharts,andthemedianswerecalculated.Thistemporalviewdisplaysprocessperformanceandal-lowsustodeterminethechangesthatre-sultedinimprovement.Abefore–afterstudychartwaschosentocomparetheeffectivenessoftheinterventions.Thettestwasusedtodeterminethesignificanceofresults.ResultsDatafromthemicrobiologylaboratorysuggestedthatanaverageof75bottleseachofanaerobicandaerobicbloodcul-tureswerereceivedandprocessedweekly.Thistranslatedtoatotalof150bottlesreceivedandprocessedweekly.Thecountermeasureconfirmedthisfindingbecauseanequalnumberofbottleswerereplenishedatthewardlevelweekly.Atotalof63doctorsrespondedtothesurvey,andtheresultsshowedthat85%ofthemedicalstaffroutinelyperformedbothanaerobicandaerobicbloodcul-tures(pairedbloodcultures)aspartofthesepticworkup.Ninetypercentofthemedicalstaffsurveyedwereunawareofanyclinicalguidelinesregardinganaero-bicbloodcultures.Inaddition,100%ofthemedicalstaffsurveyedwerecompletelyunawareofthecostsinvolvedinprocess-inganaerobicbloodcultures.Thesebecamethebaselinereferencesforthenextinterventions.Withthesere-sults,thenextinterventionwasdesignedtoeducateallstaffinvolved,thatis,medi-caldoctors,nurses,andmicrobiologylab-oratorystaff.Aseriesofeducationallecturesandvisualmaterialswerede-signedanddistributed.Specialinforma-tionbrochureswerealsocirculatedthroughe-mailandplacedinstrategiclo-cationsasageneralremindertoall.Shortpresentationswereshownduringmeet-ings/handoversessionstoreminddoctorsandnursesabouttheclinicalindicationsforperforminganaerobiccultures.Inaddition,reminderpostersandbottletagsweredisplayedtohelpaidhealthpracti-tionersintheirdecision.Healthpracti-tionerswerealsoremindedabouttheinformationsourcesavailable(e.g.,hand-books,intraweb)thatstatetheclinicalin-dicationsforanaerobiccultures.Afterthefirstweekoftheproject,vari-ousinterventionalmeasureswereim-plemented:reducingthenumberofanaerobicbloodculturebottlesavailabletofiveperwardandintroducingstan-dardizedclinicalindicationformsthattheclinicianneededtocompletebeforeper-formingananaerobicbloodculture.Thisservedadualpurposeofprovidinginfor-mationandbeingpartofclinicalsurveil-lance.Byrestrictingthenumberofbottlesperward,doctorsweremorelikelytoreservethesebottlesforconditionswithclinicalindicationsrequiringanaerobicculturesaspartofallsepticworkups.Remindertagswithindicationsofanaer-obicbloodcultureswerealsoplacedonallanaerobicbloodculturebottles.Finally,therewereregularupdatesandrein-forcementfromhighermanagementincludingtheinfectiousdiseaseservice,headofthedepartmentofpediatrics,directorofnursing,andseniordoctorsandnurses.Reinforcementbythehighermanagementinvolvedtimelyremindersthathelpedtoreinforcethetrueclinicalindicationsforperforminganaerobicbloodcultures.Sincethestartoftheproject,therehasbeenasteadydeclineinthenumberofanaerobicbloodculturesprocessedandre-placed.Inthefirstweekofthisstudyalone,therewasadeclineof50%.Thiscontinuedtoreduceinsubsequentmonthsafterfur-therintervention.Themediannumberofanaerobicbloodculturesdeclinedfrom75toanadirof17.5perweek(Fig.1)byweek4oftheproject.Concomitantly,thenumberofaerobicbloodculturesshowednosignif-icantdifferencesoverthestudyweekswiththemediannumberstillmaintainingat75bottles.201Vol.37No.3May/June2015Copyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
Inparallel,wemonitoredthenumberofaerobicandanaerobicbloodculturebottlesreplenishedatthewardlevel,whichconfirmedtheobservationsastherewasalsoareductioninthenumberofanaerobicbottlesbeingreplenishedwhilethenumberforaerobicbottlesremainedstatic.Bytheendoftheproject,therewasan80%reductioninthenumberofanaero-bicbloodculturesperformedandpro-cessed.Sincetheconcurrentmedianforaerobicbloodculturesremainedthesameat75perweek,itimpliesthatthesignifi-cantreductioninanaerobicbloodcul-tureswasnotduetoanoverallreductioninbloodcultures(Fig.1).Attestshowedthattherewasasignificantreductioninanaerobicbloodcultures(ttest=27.37,p,.0001).ThissignificantreductioninanaerobicbloodculturestranslatestocostsavingsofUSD$2,883perweek,withprojectedsavingsofUSD$145,560annually.Theworkloadonthemicrobiologylaboratorystaffwasalsosig-nificantlyreduced.Wecontinuedtomoni-torthenumbersofaerobicandanaerobicbloodculturesformorethanayearaftertheprojectstarted.Resultsshowthatwithcon-stantupdatesandpositivereinforcements,thenumberofanaerobicbloodculturesbeingperformedandthenumberofanaerobicbloodculturereplenishmentsremainedlowmorethanayearafterthestudystarted(Fig.1).DiscussionFromthestartofthisproject,themostobviousreasonfortheoveruseofanaero-bicbloodcultureswasthefactthatphysi-cianssimplyforgotthetrueindicationsofanaerobicbloodcultures.Educatingstaffaboutthetrueindicationsandthecostsofanaerobicbloodcultureshelpedtoman-agethis.Persuasiveinterventionsintheformofeducation,brochures,andwall-mountedremindersinconjunctionwithrestrictivemeasuresreducedthenumberofunindicatedanaerobicbloodculturessuccessfully.Therefore,itcanbeseenthatthegeneralchangeprincipleunderlyingthissignificantimprovementinitiativere-latestochangingphysicians’behaviorthrougheducationandrestrictionoftheavailabilityoftheanaerobicbloodcultures.Wereachedouttoallhealthcarepro-fessionalsinvolvedthroughregularteach-ingsessionsindoctors’andnurses’meetings,orientationlectures,andoppor-tunisticteachingsessions,forexample,handoversessionsandincreasingtheirFigure1.Numberofbloodculturesperformedbeforeandafterinterventions.202JournalforHealthcareQualityCopyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
awarenessonthetrueindicationsofper-forminganaerobicbloodculturesinthepediatricpopulation.Inaddition,withrestrictivemeasuresandvariousremindersputinplaceinwards,theweeklynumberofanaerobicbloodculturesremainedlow.Asthenumberofanaerobicculturesbegantodecline,timelypositivereinforcementfromtheheadsofdepartmentsandtheheadofinfectiousdiseaseservicehelpedtomain-taintheongoingimprovement.Thenumberofunindicatedanaerobicbloodcultureswassharplyreducedsuc-cessfullyover4weekstoanadirof17.5perweek,whichwasan80%reduction.Aftercompletionofthe6-monthprojectinDecember2011,thenumberofanaerobicculturesperformedremainedlowandtheeffectwassustainedforatleast1yearthereafter.ThistranslatestocostsavingsofUSD$145,560perannum.Infectiousdiseasereferralswereusuallymadeifthepatientswerenotrespondingtostandardfirst-linetherapyoriftheyweresufferingfromaprolongedfever.InfectiousdiseasereferralstotheInfectiousDiseaseteamduringthisstudywereobserved,andaccordingtotheInfectiousDiseaseteam’selectronicdatarecords,therewerenocasesofmissedinfectionsattributedtoanaerobicorganisms.Thefindingsfromthisstudyhavesignificantimplicationsforimprovingworkflow,resourceutilization,andreduc-inghealthcarecosts.ConclusionThisprojecthashelpedtoidentifytheshortcomingsofroutineanaerobicbloodculturesforsepticworkupsinthepediatricpopulationandimplementmeasurestorectifythesituation.Withcontinuedcompliancemonitoringfromthelabora-toryandtimelypositivefeedbacktosup-portcollation,thesenumbersremainlow.Assuch,whatthisqualityimprovementprojecttranslatestoisimprovedclinicalpracticewithincreasedawarenessamongststaffmembers,reductioninun-indicatedbloodcultures,reductioninworkloadofmicrobiologylaboratorystaff,andsignificantprojectedcostsavingsforbothpatientsandthehospital.Positivereinforcementfromhighermanagementandseniorstaffhasledtoasustainedimprovement.Fromthepositiveresults,westronglyrecommendtheincorporationofindicationsforanaerobicbloodcul-turesintoorientationlectures,guidelines,medicalhandbooks,andlocalhealthcareWebsitestomaintainawarenessamongsthospitalstaff.ReferencesBecton,DickinsonandCompany.BDBactecIn-strumentedBloodCultureSystem.Availableat:www.bd.com/ds/productCenter/BC-Bactec.asp.AccessedAugust21,2012.Brook,I.Clinicalreview:bactermiacausedbyanaerobicbacteriainchildren.CritCare2002;6:205–211.Cockerill,F.,III,Hughes,J.G.,&Vetter,E.A.,etal.Analysisof281,797consecutivebloodculturesperformedoveraneight-yearperiod:trendsinmicroorganismsisolatedandthevalueofanaerobiccultureofblood.ClinInfectDis1997;24:403–418.Dorsher,C.W.,Rosenblatt,J.E.,Wilson,W.R.,&Ilstrup,D.M.Anaerobicbacteremia:decreas-ingrateovera15yearperiod.RevInfectDis1991;13:663–666.Freedman,S.,&Roosevelt,G.E.Utilityofanaerobicbloodculturesinapediatricemergencydepartment.PediatrEmergCare2004;20:433–436.Goldstein,E.J.AnaerobicBacteremia.ClinInfectDis23Spool1:S97–101.Grohs,P.,Mainardi,J.L.,&Podglajen,I.,etal.Relevanceofroutineuseoftheanaerobicbloodculturebottle.JClinMicrobiol2007;45:2711–2715.Iwata,K.,&Takahashi,M.Isanaerobicbloodculturenecessary?Ifso,whoneedsit?AmJMedSci2008;336:58–63.James,P.A.,&al-Shafi,K.M.Clinicalvalueofanaerobicbloodculture:aretrospectiveanalysisofpositivepatientepisodes.JClinPathol2000;53:231–233.Lazarovitch,T.,Freimann,S.,Shapira,G.,&Blank,H.Decreaseinanaerobe-relatedbac-teremiasandincreaseinBacteroidesspeciesisolationratefrom1998to2007:aretrospec-tivestudy.Anaerobe2010;16:201–205.Morris,A.,Wilson,M.L.,Mirrett,S.,&Reller,L.B.Rationaleforselectiveuseofanaerobicbloodcultures.JClinMicrobiol1993;31:2110–2113.Murray,P.,Traynor,P.,&Hopson,D.Criticalassessmentofbloodculturetechniques:analysisofrecoveryofobligateandfaculativeanaerobes,strictanaerobicbacteriaandfungiinaerobicandanaerobicbloodcul-turebottles.JClinMicrobiol1992;30:1462–1468.203Vol.37No.3May/June2015Copyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
Rosenblatt,J.Canweaffordtodoanaerobicculturesandidentification?Apositivepointofview.ClinInfectDis25Suppl2;1997:S127–131.Stratton,C.UtilizationofBloodCulturesinthe21stCentury.AntimicrobicsandInfectiousDis-easesNewsletter,2000:9–13.Authors’BiographiesDr.IanOng,MBBS,MRCPCHisanAssociateConsultantattheChildren’sEmergencyDepartmentinKandangKerbauWomen’sandChildren’sHos-pital(KKH)inSingapore.AdjunctAssociateProfessorChia-YinChong,MBBS,MMed,MRCP,FAMS,FRCPCHistheHeadandSeniorConsultantwiththeDepartmentofPaediatricMedicine,andInfectiousDiseaseServicesatKKWomen’s&Children’sHospitalinSingapore.SheisalsotheChairmanofHospitalInfectionControl,AdjunctAssociateProfessoratYongLooLinSchoolofMedicine,NationalUniversityofSingapore(NUS),andanAdjunctAssociateProfessoratDuke-NUSGraduateSchoolofMedicine.Dr.PoojaA.Jayagobi,MBBS,DCH,DNB(Paed),MMED(Paed),MRCPCHisanAssociateConsul-tantwiththeDepartmentofNeonatologyatKKWomen’sandChildren’sHospitalinSingapore.Dr.PradeepRaut,MBBS,MMED(Paed),MRCPCHisanAssociateConsultantwiththeDepartmentofNeonatology,KKWomen’s&Child-ren’sHospitalinSingapore.HeisalsoaClinicalTutoratYongLooLinSchoolofMedicine,NationalUniversityofSingapore(NUS).Formoreinformationonthisarticle,contactChia-YinChong,atChong.Chia.Yin@kkh.com.sg.Theauthorsdeclarenoconflictsofinterest.JournalforHealthcareQualityispleasedtooffertheopportunitytoearncon-tinuingeducation(CE)credittothosewhoreadthisarticleandtaketheon-lineposttestathttp://www.nahq.org/education/content/jhq-ce.html.Thiscontinuingeducationoffering,JHQ253,willprovide1contacthourtothosewhocompleteitappropriately.CoreCPHQExaminationContentAreaIII.PerformanceImprovementAnaerobicbloodcultures.LearningObjectives1.Describetheindicationsofanaerobicbloodcultureinpediatricpopulation.2.Understandtheimportanceofvari-ousstepsoftheimprovementprocesssuchasabaselinesurveyandplan-ninginterventionsbasedonresults.3.Designeffectiveinterventionstocreatethemaximumchangeandimprovements.Questions1.Describetheindicationsfordoinganaerobicbloodculturea.Communityacquiredpneumonia,urinarytractinfection,septicarthritisb.Suspectedintraabdominalsepsis,head-neckinfectionandfeverinimmunocompromisedpatientsc.Feverinneonatesandinfantswithoutsource,pyrexiaofunknownorigind.Woundinfectionforclean-contaminatedsurgicalwounds.2.Whatisthemainobjectiveofdoingastructuredsurveybeforeaqualityimprovementproject?a.Toaskpatientsand/orstaffabouttheneedforqualityimprovementinitiativeb.Toinformstaffsoastoimproveparticipationandcooperation.c.Toassessthebaselineunderstand-ing,identifyareasofimprovementandplaninterventionsd.Todeterminethetimelineandtrackingmechanismforinterventions3.Whatdidtheinitialsurveyresultsrevealinthisprojecta.Highcostofanaerobicbloodculturesandtheprocessofbloodcultureinlaboratoryb.Knowledgegapsinhealthcareworkersregardingtheindicationsforanaerobicbloodculturesc.Workloadofhealthcareworkersandlaboratorystafffromanaer-obicbloodculturesd.Coststopatientsfromanaerobicbloodcultures204JournalforHealthcareQualityCopyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.
4.Themostcommonreasonforper-forminganaerobicbloodculturesinpediatricwardsinthisstudywasa.Healthcarestaffwereunawareofguidelinesforanaerobicbloodcultureb.Highincidenceofculture-positiveanaerobicinfectionsinpediatricpatientsc.Anaerobicbloodculturesimprovetheyieldofbacterialgrowthascomparedtoaerobicbloodcultured.Easyaccesstobloodforanaerobicbloodcultures5.Whichofthefollowingvariablesreflectedtheimprovementinuti-lizationofanaerobicbloodcultures?a.Workloadreportingbypartici-patinghealthcareworkers(doc-tors,nurses,laboratorystaff)b.Numberofanaerobicbloodcul-turebottlesprocessedperweekinthelaboratoryandnumberofbottlesreplenishedinwardc.Numberofsepticworkupperweekperwardandtotalnumberofadmissionsd.Positiveisolationratesfromanaerobicbloodcultures6.Whichoneoffollowingisthemostsuitablemethodtorepresentthedatashowingthechangesinthistypeofqualityimprovementprojects?a.Runchartswithgridlinesb.Datatableforstudyperiodc.Differentialbargraphofeachweekd.Piechartwithproportionlabels7.Ingraphicalrepresentationofdatainqualityimprovementprojects,thetrendtowardsthepre-determinedbenchmarkrepresentsa.Changeisduetointerventionanditisaworseningofprocessb.Thereisnaturalprogressionandhencethechangeisnotbecauseofinterventionc.Changeisduetointerventionanditisanimprovementd.Changeisnotsignificantandmoredataneeded8.Basedonfindingsfromtheinitialsurvey,whichoneofthefollowingwouldhavemademaximumimpactinthisqualityimprovementprojecta.Educationofhealthcareworkers(Doctorsandnurses)b.Reducingsupplyofanaerobicbloodculturebottlesc.Remindersinformoftags,post-ers,emails,reinforcementsd.Monitoringandfeedback9.Whatistheimportanceoflong-termsurveillanceinaqualityimprovementprojectthatinvolvesashortduration?a.Tohighlighttheimportanceofqualityimprovementprojectamongstthestaffsothatmoreprojectscanbedoneb.Tomaintainthekeyperformanceindicatorforthedepartment.c.Tomonitorandestablishthattheimprovementchangesarelong-lastingorpermanentd.Toensurethathealthcarecostsdonotescalatebeyondwhatthehealthinsuranceallowinclaims10.Whatistheimportanceofmonitor-ingmultiplevariables/paramenters(countermeasures)inqualityimprovementproject?a.Tojustifytheneedforqualityimprovementprojectsb.Toconfirmthechangeisduetointerventionanditisanimprovementc.Fordatamonitoringandpatientsafetyd.Toimprovesignificanceandpre-cisionofresultsandaddmoredatapointstographs205Vol.37No.3May/June2015Copyright2015NationalAssociationforHealthcareQuality.Unauthorizedreproductionofthisarticleisprohibited.

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