Continuous Quality Improvement in Dialysis

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• Improving patient outcomes by giving high-quality, efficient care has become a goal of the dialysis industry.
• There are efforts by CMS and insurance companies to control costs and improve quality.
• One way to meet these goals is the use of continuous quality improvement (CQ1).
• Like quality assurance, CQI is a way to improve care.
• The focus of quality assurance is on audits and reviews to look for problems. The focus of CQI is to see how things are working, take steps to make them better, and , prevent future problems

 CQI can be both "top-down" and "bottom-up"
• Top-down means management commits to a CQI culture and uses resources to help CQI projects succeed.
• Bottom-up means workers find best practices and barriers to better care, and make changes to improve care.

CQI projects can be:
• Clinical (e.g., anemia, adequacy, vascular access).
• Technical (e.g., water treatment, dialyzer reuse).
• Organizational (e.g., staff schedules, patient safety).

Example of a four-step CQI process:
Steps 1 through 3 are where the CQI models may differ.

I. Identify Improvement Needs
Goal: To find an area that needs to be improved. There arc four sub steps to finding improvement needs:
     1. Collect data
     2. Analyze the data
     3. Identify the problem / need for improvement
     4. Prioritize activity

II. Analyze the Process
• This step has four substeps:
     1 .Choose a team - CQI teams should include different members of the care team based on the problem: doctors, nurses, dietitians, technicians, social workers, and patients.
     2.Review the data - The CQI team should review the data collected in the first step.
     3.Study the process / problem - Review the literature on the problem to see if there are standards or guidelines for it. Find reasons why the problem may have occurred.
     4.1dentify patterns / trends - Review all of the possible reasons for the problem, using the data.


III. Identify Root causes
From research, discussion, and data, decide the exact causes of the problem.

IV. Implement the "Plan, Do, Check, Act" Cycle
• The last step is to use the plan, do, check, act (PDCA) cycle.
• The four steps to the PDCA Cycle are:
     1. Plan - Make a plan to address the problem. Include outcomes, solutions to the problem, a task list for each team member, and a time frame.
     2. Do - Implement the plan.
     3. Check - Monitor the results of the plan, assess results after the plan is done, and assess the plan for any needed changes.
     4. Act - Adopt the plan in the center on a formal basis and continue to monitor progress.

The PDCA cycle is an ongoing process. Once a solution to the problem is started in the center, you cant assume that the problem is solved. The new process needs to be checked to ensure that it is being used in a day-to-day practice.

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