QI Story St Joseph Ann Arbor, Chelsea, Livingston 7.20.2018

St. Joseph Mercy Hospitals

Quality Initiative Project

PONV 01

Presented By: Traci Coffman and Jerri Heiter

Date: 07/20/2018

The Sites We Serve

• St. Joseph Mercy Ann Arbor

• St. Joseph Mercy Chelsea

• St. Joseph Mercy Livingston

• St. Joseph Mercy Brighton

• 206 anesthesia providers

What is Quality Improvement?

Quality improvement in regards to our anesthesia

practice is a systematic approach for

improving performance so as to reach the

desired clinical outcome. Our goal then was to

maximize compliance with the PONV guidelines

our Quality Committee endorsed which

corresponded with the ASPIRE PONV 01

measure. As a result of using this guideline we

believe our patients will have less PONV.

Our hypothesis

If we could develop a central electronic site

of access for all of our anesthesia providers

which housed the relevant information

regarding our ASPIRE PONV 01 measure

and our algorithm for PONV management,

we would have better compliance with

following the algorithm and, therefore, meet

our ASPIRE measure with resultant

improvement in our performance. Our goal

being >90% compliance with the PONV 01

measure.

Systematic Approach

Part 1

1. Many anesthesia practitioners rely heavily on

the internet for access to information including

medical information.

2. Almost all of them have smart phones.

3. Access to an internet app that allows our

organization to find protocols, guidelines and

ASPIRE measures specific to our practice in a

single location would be clinically helpful.

4. The portable nature of this information allows

practitioners access to it in all the locations

where they practice.

5. Information can be added and/or changed

easily.

6. Paper is no longer relevant when electronic

means of information is a available.

Along comes Trello…

 A smart phone app that is FREE

 Works like a substitution for a bulletin board

 Cards, checklists, file attachments can all be created

as reference materials

 Single location for comprehensive clinical information

 Designed specifically for our needs (ASPIRE focus

measures, PSH checklists, PONV algorithm)

So we are moving from this…

To this… Trello

Access to the One Pager

Access to PONV algorithm

Systematic Approach

Part 2

1. Follow the leader. Our ERP for colorectal surgical

patients used this tool for resident education and

found it successful for clinical communication

2. Hire a low-cost tech-savvy administrative person

(like my daughter Catie) to fill your Trello board with

relevant information.

3. Educate your providers on the app

4. Send out the email invitation to join Trello for your

providers. This is how they have access to your

specific board

5. Follow up to see that people have actually signed up

Performance Improvement

1. Trello board created in the beginning of May 2018

2. Presentation to anesthesia department on May 14, 2018

3. Email invitation to join Trello sent on 5/31/2018

4. Email communication to physicians sent on 5/31/2018

5. Email CRNA communication sent on 6/1/2018

Sample Section

Breaker Title

(only use if necessary)

Performance Improvement

48/158 Have accepted their invitation to Trello

That is only 30%

: (

Not quite there yet!!!

Performance Improvement

What can A4 do?

1. Encourage our physicians to discuss PONV risk

assessment with our CRNA colleagues on every

case and create a plan.

2. Ongoing education regarding the algorithm and the

ASPIRE measure.

3. Re-invite those that have not signed up to Trello.

Provide a resource for help if needed to access the

information.

4. Create an intra-op electronic reminder that is linked

to the patient’s risk assessment to ensure the

proper anti-emetics are given.

Desired Clinical Outcome

What can ASPIRE do next?

1. Extract our PACU data to see who has gotten rescue

treatment for PONV. Who still has PONV after the

recommended treatment was given?

2. Extract our pre-op data to see who has gotten an anti-emetic

prior to the OR (this would include floor medications that

were received pre-op as well as the the pre-op OR area).

This would be a comprehensive list of pre-op anti-emetic

treatment.

3. Assess patient populations and anti-emetics given and

provide recommendations for specific subsets of populations.

Ultimate Desired Clinical Outcome

Patient Satisfaction

Thank you!

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