Improving quality: assessment of risk, interventions and measuring improvement in critical care

Richardson, Annette (2018) Improving quality: assessment of risk, interventions and measuring improvement in critical care. Doctoral thesis, Northumbria University.

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Abstract

Introduction
My ten published papers focus on two domains of the quality agenda, patient safety and patient experience, concentrating on how quality improvement can reduce the occurrence of serious consequences of patient harm and poor patient experience.

Aims
My goal was to design, test and discover how to make improvements in clinical practice in four areas: sleep deprivation, infection prevention, falls prevention and pressure ulcer prevention.

Literature Review
There was limited evidence of successful strategies for change to improve quality. Common quality improvement challenges were within the complex critical care environment and an urgency to act without the focus on well-designed methods.

Design and Methodology
A broad range of research methods was applied to evaluate the implementation of improvement interventions in critical care. These included: observational designs to uncover understanding on patient experience, activities and processes; before and after design; stepped cluster design and longitudinal time series design, utilised to increase confidence with attributable effect from the interventions.

Results
My appraisal of my ten publications showed quality varied. Process and outcome measures were used to determine the success, and I received national and local recognition for some of my work.

Discussion
My three main knowledge contributions were:
 practical ways to help nurses assess and improve patients’ sleep
 risk assessment approaches
 translation and implementation of improvement methodology in critical care.
I discovered four cross-cutting themes which add to quality improvement knowledge and I developed an enhanced model for improvement. The four themes are:
 clinical leadership at a programme and local level
 using a bundle of technical and non-technical interventions
 undertaking patient risk assessment to guide interventions
 the value of data measurement and feedback

Conclusions & Recommendations
My work has improved patient experience and patient safety knowledge. With further testing this
knowledge could greatly benefit other areas of healthcare.

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