Practical Skills Building Session: Control Charts Worksheets
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1 2018 frican Forum on Quality and Safety in Healthcare Practical Skills Building Session: Control Charts Worksheets Faculty Robert Lloyd, PhD, Vice President Institute for Healthcare Improvement 20 February 2018
2 Rules for Detecting Special Causes single point outside the control limits Six consecutive points increasing (trend up) or decreasing (trend down) Two our of three consecutive points near a control limit (outer one-third) Eight or more consecutive points above or below the centerline Fifteen consecutive points close to the centerline (inner one-third) 2 Copyright 2016 IHI/R. Lloyd
3 Is there a Special Cause on this chart? Month ED/100 Returns M M Unplanned Returns to Ed w/in 72 Hours S O N D u chart F M M S UCL = 0.88 Rate per 100 ED Patients Mean = LCL = Copyright 2013 Institute for Healthcare Improvement/R. Lloyd
4 PERCENT PTIENTS C/O CHEST PIN SEEN BY CRDIOLOGIST WITHIN 10 MINUTES OF RRIVL TO ED EXMPLE CHRT 120% re there special causes on this chart? Percent Patients Seen 10 Minutes 110% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% XYZ Medical Center Performance Improvement Report March 25, 2004 Fictitious data for educational purposes 4 Target Goal / Desired Direction: INCRESE in the PERCENT of patients c/o chest pain seen by cardiologist within 10 minutes of arrival to Emergency Department. Interpretation: Current performance shows (desirable) upward trend Weeks: October March % Copyright 2013 Institute for Healthcare Improvement/R. Lloyd P UCL verage LCL p-chart, possible range 0-100%
5 Number of Patient Complaints by Month (XmR chart) re there any special causes present? If so, what are they? UCL= Number of Complaints B C CL= C B LCL= an01 Mar01 May01 uly01 Sept01 Nov01 an02 Mar02 May02 uly02 Sept02 Nov02 5 Month Copyright 2013 Institute for Healthcare Improvement/R. Lloyd
6 The Control Chart Decision Tree Source: R. Lloyd. Quality Health Care: Guide to Developing and Using Indicators. 2 nd Edition, ones and Bartlett, 2017: Variables Data Decide on the type of data ttributes Data Yes More than one observation per subgroup? No No Occurrences & Nonoccurrences? Yes Yes Is there an equal area of opportunity? No X bar & S verage and Standard Deviation XmR Individual Measurement c-chart The number of Defects u-chart The Defect Rate p-chart The percent of Defective Units
7 You Make the Call! Page 1 Measures Subgroup? Type of Data? Chart? n analyst pulls a sample of 50 orthopedic surgery charts each week and counts all discrepancies from standard documentation practice Each medication order is checked against 5 potential types of errors and the total number of errors on each order is recorded. You also have the total number of orders placed each week You have data on the average length of stay by week for C-section deliveries diabetic patient records 3 blood sugar readings each day Each day the number of home healthcare visits that are more than 15 minutes late on arrival are recorded and compared with the total number of visits scheduled for that day Source: R. Lloyd. Quality Health Care: Guide to Developing and Using Indicators. 2 nd Edition, ones and Bartlett, 2017: R. C. Lloyd & ssociates
8 You Make the Call! Page 2 Measures Subgroup? Type of Data? Chart? Each day the radiology department records the total number of X-rays performed for Emergency Department patients The number of central line insertions each week during which all elements of the bundle were followed divided by the total number of central line insertions that week The monthly total number of catheter-associated urinary tract infections divided by the total urinary catheter days for the month Every week you pull a random sample of 20 inpatient rooms and record the length of time it takes to clean each room The number of hand hygiene observations performed consistent with guidelines divided by the total number of hand hygiene observation opportunities Source: R. Lloyd. Quality Health Care: Guide to Developing and Using Indicators. 2 nd Edition, ones and Bartlett, 2017: R. C. Lloyd & ssociates
9 Selecting the Most ppropriate Chart for Your Measures Measure Name Subgroup? Type of Data? Chart of Choice? 9
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