Quality improvement science in the PICU

Abstract

This chapter describes important aspects of health-care quality, what it is, and how to engage clinical providers in improvement efforts. The case for improving healthcare quality is outlined, with an emphasis on the special considerations within the pediatric intensive care unit setting. Common terminology to facilitate an understanding of quality is reviewed-including near misses, preventable and non-preventable adverse events. Models for understanding system and process performance are discussed-including the system of profound knowledge, aims oriented change, Plan-Do-Study-Act applications of the scientific method, and features of high reliability organizations. Provided is a basic tool kit for implementing change through the use of error proofing, process control, lean engineering, standardization, checklists, and protocols. Additionally, an introductory review of statistical process control and understanding variation through control charts is provided.