1 Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Ann Am Thorac Soc. 2014 Mar;11(3):444-53. doi: 10.1513/AnnalsATS.201311-392AS.
The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.
质量改进项目的成功在很大程度上依赖于项目设计和用于评估变化的指标。在这个由三部分组成的美国胸科学会研讨会系列的第二部分中，我们首先描述了确定要收集哪些数据的方法、用于呈现数据的工具以及数据传播策略。正如 Avedis Donabedian 在半个世纪前详细描述的那样，确定医疗保健中的指标可能具有挑战性；算法确定最佳指标类型（结果、过程或结构）可以帮助重症监护病房（ICU）经理开始这一过程。选择适当的图形数据显示（例如，运行图）可以促进关于质量改进的讨论并促进其发展。同样，仪表盘/记分卡以吸引人的视觉方式公开或私下呈现绩效改进数据非常有用。为了有令人信服的数据展示，ICU 经理必须精心规划质量改进项目。本综述的第二部分详细介绍了四种质量改进工具——检查表、六西格玛方法、精益思维和持续改进。检查表已在许多 ICU 中变得很普遍，以提高护理质量；现在，如何最大限度地提高其效率变得至关重要。六西格玛方法、精益思维和持续改进是使用多学科团队组织对流程改进的思考、正式制定变革策略、实现计划并衡量进展的技术。这些技术都不是起源于医疗保健领域，但都已在医院环境中成功使用。为了结束本系列的这一部分，我们通过一个示例演示了如何使用这些工具来提高脓毒症患者抗生素的及时给药。
