Following an annual review, a local hospital determines that the number of emergency response codes called on the general pediatric unit exceeds the average number for other similar-sized hospitals nationwide. Hospital leadership decides to use a clinical microsystems approach to improve this outcome measure. Which of the following interventions would be most consistent with this approach?

Question

Following an annual review, a local hospital determines that the number of emergency response codes called on the general pediatric unit exceeds the average number for other similar-sized hospitals nationwide.  Hospital leadership decides to use a clinical microsystems approach to improve this outcome measure.  Which of the following interventions would be most consistent with this approach?

Quizplus · Accepted Answer

Explanation: Clinical microsystems are frontline health care settings where patients, families and health care teams interface. These microsystems may also include support staff, equipment, information technology, billing, and processes specific to that setting. Examples of clinical microsystems include an outpatient primary care clinic, a cancer center, a hospital emergency department, a hospital intensive care unit, or a nursing home. Patients often depend on the coordination of different microsystems to receive comprehensive care. For this reason, seamless functioning, high efficiency, and high-quality care provided by the individual microsystems that compose a health care system are essential. Analyzing the components of the clinical microsystem to create system-based improvements can lead to better patient outcomes and safety. In this case, the microsystem is the pediatric inpatient unit, which performs below standard in comparison to similar hospitals. Quality improvement would involve instituting procedures that improve the ability of the interdisciplinary health care team to anticipate and address life-threatening conditions prior to requiring an emergency code. Of the available options, implementing a bedside scoring system to be used by all clinical staff members would best address this issue. This intervention would ensure that all staff members are aware of the most unstable patients, allowing them to take proactive measures that may prevent an emergency response code. (Choice A) Although a staff retreat can be helpful when poor staff communication and conflict are causing negative outcomes within a microsystem, there is no evidence that this is the case. (Choice C) Hiring more nursing staff addresses this issue on a personnel level rather than a systems level. (Choice D) Increasing payment incentives for the rapid response team would not effectively decrease the number of emergency response codes. (Choice E) Family members should not be discouraged from calling for a rapid response if they observe that their child is worsening clinically. Requiring that they consult first with medical providers may create unnecessary delays and worsen outcomes. Quality improvement measures should focus on proactively recruiting family members to work with the health care team to share important observations early on that might prevent the need for an emergency response code. Educational objective: Clinical microsystems are frontline health care settings where patients, families, and health care teams interface. They are the building blocks of the larger health care system. Quality improvement measures targeting microsystem components can enhance delivery of high-quality care and improve overall patient outcomes in the system as a whole. References: Patient safety can be ensured in clinical microsystems. (http://www.ncbi.nlm.nih.gov/pubmed/23137384) Stakeholder perspectives on handovers between hospital staff and general practitioners: an evaluation through the microsystems lens. (http://www.ncbi.nlm.nih.gov/pubmed/23118408)

Following an Annual Review, a Local Hospital Determines That the Number