Timothy Dickinson, MS
Purpose: Continuous quality improvement (CQI) is simply a set of concepts and methods used to improve processes. Shann et al [1] mention that unintended variations in processes are associated with unwanted variation in outcomes (i.e. increased costs, length of stay, neurologic injury and mortality). Therefore, CQI is widely recognized as appropriate management tool in order to reduce or eliminate unwanted variation. The purpose of this talk is to illustrate one method, the DMAIC process, which may be used in process improvement. DMAIC is an acronym for five interconnected phases. Define the project purpose, Measure the process, Analyze and determine the root cause(s), Improve the processes, and Control future process performance.
Method: The DMAIC process was implemented by an open-heart team with the purpose of reducing variation in intraoperative blood glucose levels. The Quality Indicator Program from Fresenius Medical Extracorporeal Alliance was used to collect and report intraoperative blood glucose values. The open-heart team, comprised of key stakeholders (physicians, nurses and technicians) held regular meetings to determine some root causes for variable in glucose levels, implement solutions to the root causes, evaluate the solutions and maintain improvement by standardizing certain processes.
Results: The results, from three implemented solutions, showed that compliance to targeted intraoperative blood glucose levels increased over 250% from 33% to 83%
Conclusions: Use of the DMAIC process helped to ensure a structured and disciplined approach to problem solving. The open-heart team was able to demonstrate process improvement in intraoperative blood glucose levels. Employing a multidisciplinary approach to tighter intraoperative glucose control by engaging all key stakeholders help to ensure a successful process improvement result.
