Improving Knowledge of Active Safety and QI Projects Amongst Practitioners in a Pediatric ICU

Abstract

Introduction: The success of quality improvement (QI) projects depends on many factors, with communication and knowledge of project-specific practice change being fundamental. This project aimed to improve the knowledge of active safety and QI projects.

Methods: Two interventions were trialed to improve knowledge: paired email and meeting announcements followed by a daily huddle to review ongoing projects. Knowledge, measured as the ability to recall a project and its practice change, was the primary outcome. The frequency and duration of the Huddle were process and balancing measures, respectively.

Results: Seven days after a meeting/email announcement, 3 of 13 (23%) faculty and fellows recalled the announced practice change. Investigators then tested the effects of the Huddle by assessing practitioners' knowledge of safety and QI project-related practice changes on the first and last day of a service week. The average percentage of items recalled increased from the beginning to end of a service week by 33% [46% to 79%, 95% confidence interval (CI) 12-53] for faculty and 27% (51% to 77%, 95% CI 13-40) for fellows. The Huddle occurred in four of seven (interquartile range 2-5) days/wk with a mean duration of 4.5 (SD 2) minutes. Follow-up assessment 2 years after Huddle implementation demonstrate sustained increase in item recall [faculty +36% (95% CI +13% to 40%); fellows +35% (95% CI +23% to 47%)].

Conclusions: A daily huddle to discuss safety and QI project-related practice change is an effective and time-efficient communication method to increase knowledge of active projects.

Fig. 1.

Summary of baseline analysis. A, Cause-and-effect diagram showing potential causes of low knowledge of projects. B, Key driver diagram showing project goal, driver of change, and potential interventions. * = intervention used in the project.

Fig. 2.

The Huddle Sheet is an 8.5 × 11 inch sheet of green, laminated paper attached to the mobile computer used by faculty and fellows for rounds.

Fig. 3.

The p-chart includes data for 20 months from a project to reduce the proportion of code events missing documentation in the electronic health record. Months 2, 3, and 4 had no codes. The project was added to the Huddle after week 12, decreasing missing documentation is noted in weeks 13–20.