INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM
METHODS FOR QUALITY IMPROVEMENT IN
RESPIRATORY CARE
• quality improvement must be everyone’s job,
starting from executive management to the front-line
worker.
Plan-Do-Study-Act Cycle
PLAN PHASE
• In the Plan phase, clear goals are set for the
quality improvement process. Goals should be
SMART: Specific, Measurable, Achievable, Realistic,
and Time-bound.
• A SMART goal might be “a 20% increase in
referrals to pulmonary rehabilitation on discharge for
patients with chronic obstructive pulmonary disease
(COPD).”
• The planned intervention should be stated clearly.
For instance, “respiratory therapist stationed on the
nursing floor will distribute pulmonary rehabilitation
program pamphlets to clinical team and remind
clinicians to place the order for patients with COPD.”
• A time limit should be specified, for example, “a
20% increase in referrals to pulmonary rehabilitation
on discharge over the next 3 months.”
• During the planning phase, it is also helpful to
create a diagram or a flow chart of the process that
needs to be improved. The project team may choose
to use tools such as the fishbone (or Ishikawa)
diagram to systematically evaluate the different
factors that affect the process and contribute to the
problem, that is, people, technology, environment,
materials, equipment, and methods.
DO PHASE
• In the Do phase, the intervention is begun and
observations are recorded. Sometimes,
observations may need to be made on a limited
sample that is hopefully representative of the entire
process.
• The size of that sample should be determined by
statistical methods that may require the help of a
quality improvement professional or biostatistician.
The observations are plotted on a statistical process
chart or its simpler version, a so-called run chart, for
analysis.
STUDY PHASE
• In the Study phase, the observations are analyzed,
usually by examination of the process charts. The
barriers to achieving the set goals are considered
and discussed.
ACT PHASE
• In the Act phase, based on the analysis performed
in the Study phase, modifications to the intervention
are made.
RULE OF THUMB
• The crucial components of a quality improvement
project are summarized in the PDSA cycle:
• Plan: Determine the specific aim, duration, data
collection strategy, and team that will run the quality
improvement project.
• Do: Collect data and record the observations.
• Study: Analyze results and derive conclusions.
• Act: Change the process for improvement, plan the
next cycle
Disease Management
• refers to an organized strategy of delivering care to
a large group of individuals with chronic disease to
improve outcomes and reduce cost. Disease
management has been defined as a systematic
population-based approach to identify persons at
risk, intervene with specific programs of care, and
measure clinical and other outcomes.
Disease management programs include four
essential components:
• (1) an integrated healthcare system that can
provide coordinated care across the full range of
patient needs.
• (2) a comprehensive knowledge base regarding
the prevention, diagnosis, and treatment of disease
that guides the plan of care.
• (3) sophisticated clinical and administrative
information systems that can help assess patterns of
clinical practice.
• (4) a commitment to continuous quality
improvement.
Nine Steps for Quality Assurance Plan
1. Identify problem
2. Determine cause of problem
3. Rank problem
4. Develop strategy for resolving problem
5. Develop appropriate measurement techniques
6. Implement problem-resolution strategy
7. Analyze and compile results of intervention
8. Report results to appropriate personnel
9. Evaluate intervention outcome
 INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM

Monitoring Quality Plans Quality Monitoring Benchmarks

Specific methods to monitor the quality of respiratory • Monitoring the correctness of respiratory care
care protocol programs include: plans.
• conducting care plan audits in real time, ensuring • Monitoring the consistency of formulating
practitioner training by using case study exercises, respiratory care plans among therapist evaluators.
and using simulation exercises to enhance and to • Evaluating the efficacy of algorithms or protocols.
measure the performance of RTs. • Evaluating the overall effectiveness of the protocol
• Monitoring correctness of respiratory care plans program.
can be accomplished by using a care plan audit
system.
• Care plan auditors must be therapists who are
experienced in providing respiratory care and patient
assessment. The auditors must also have
experience with using the institution’s protocol
system and in writing care plans. With an auditing
system, the auditor writes a care plan for a patient
and compares it with the care plan written by the
therapist evaluator to determine correctness. A
specified number of audits should be performed
monthly, with results tabulated and reported monthly
or quarterly, depending on the size of the hospital.
• Feedback must be provided to the evaluators
whose care plans are being audited to show their
proficiency or to indicate areas that require
improvement. Another monitoring method found
useful for respiratory therapy consult services is the
case study exercise (or simulated patient scenario
exercise).
• Simulated patient exercises can help determine the
consistency of respiratory care plans among
therapist evaluators.
• The scores of individual RTs may be tracked over
time to identify problems and assess improvement.
• Simulated patient exercises may consist of a set of
three or four patient scenarios.
• All RTs working under the protocol system, whether
or not they are evaluators, complete an assessment
sheet and, following the associated algorithms, write
a care plan for each scenario.
• The assessment sheets and the care plans are
compared with the gold standard, or correct
assessments and care plans, as determined by the
consensus of the education coordinator and the
supervisors.
• Scores are tabulated for the individual RTs, and the
number of errors for each therapy is examined.
• If a particular therapy consistently has a large
number of associated errors, the algorithm is
reviewed for errors or vagueness. In some settings a
computer-based system that scores the
assessments and care plans and provides feedback
to the RT has been used.
• Performance data of individual RTs are maintained
in a database to calculate and track aggregate
performance statistics.