Number of Hospitalizations, Last Year of Life

14370

10

20

30

40

Control Group, Last Year of Life EOL Group, Once Admitted

Reprinted with Permission of Franciscan Health System, Tacoma, WA

Advance Care Planning Documentation

15% 90%0%

20%

40%

60%

80%

100%

Before After

Reprinted with Permission of UA Health Care System, Dayton, OH

P

Hunches,theories,and ideas

Changes thatresult inimprovement

A

P D

SAD

S

APS

A

DP

DS

General Approach to Ongoing PDSA Cycles

Several PDSA Cycles to Tackle One Problem

Family Discussion Ventilator Weaning Sedation Usage

PD

SA

DS

AP

S

AP

D

AP

DS

PD

SA

D

S

AP

SA

PD

AP

DS

PD

SA

DS

AP

SA

PD

AP

DS

System

TechnicalDay-to-day

Essential Areas of Expertise in a Good Team

Spread the Word: Improvement Throughout the SystemSpread the Word: Improvement Throughout the System

OncologyOncology

Pain Management Out-Patient

Medical-Surgical Units

ICU

Patient Satisfaction with Pain Relief

62% 90%92% 100%56% 100%36% 90%0%

20%

40%

60%

80%

100%

Before After

Pts satisfied that painneeds met

Pts assessed within 30min. of arrival inoncologyDocumentation of painlocation

Documentation of targetpain level

Worst Pain Scores: Algorithm vs. Standard Care

3.5

4

4.5

5

5.5

6

6.5

Baseline 2 Weeks 1 Month 2 Months 3 Months

Assessment time point

Wor

st p

ain

Algorithm

Standard

Reprinted with permission, DuPen, 1999

Wong/Baker Faces

Descriptive Scale

Numerical Scale

No Pain Least Pain Mild Pain Moderate Pain Severe Pain Excrutiating Pain

0 2 3 4 5 6 7 8 9 101

Pain Assessment Scales

Episodes of Severe Dyspnea

26% 26% 40% 40% 10% 7% 8% 8%0%

10%

20%

30%

40%

50%

Jan. Feb. March Mar.-Apr.

April Apr.-May

May May-June

Per

cent

Rat

e of

Dys

pnea

Sev. Dyspnea

2-Month MovingAverage (SevereDyspnea)

Reprinted with Permission of Hospice Care of Rhode Island

Rates of Dyspnea not Relievced by End of Shift

53% 14% 20% 20% 10% 1% 1%0%

10%

20%

30%

40%

50%

60%

Jan. Feb.,N=20

March,N=10

March-April,N=13

April,N=11

May,N=21

June,N=15

Per

cent

Rat

e of

Dys

pnea

Severe dyspnea notrelieved

2-Month Moving Average(Severe Dyspnea NotRelieved)

Reprinted with permission of Hospice of Rhode Island

Percentage of Patients with Acceptable Symptom Scores at the Time of Discharge from ICU

95% 87% 60%80% 87% 50%96% 93% 70%0%

20%

40%

60%

80%

100%

Dyspnea Pain Sedation

Dec-97Mar-98May-98

Reprinted with permission of Queen Elizabeth II Hospital, Halifax, Nova Scotia

Participants/Caregivers

Interdisciplinary

Team

Primary careSpecialists

Day Health Nursing Social service OT/PT Nutrition Recreation Personal care Transportation

Lab/X-ray/Pharmacy

Hospital

NursingHome

Home care

Coordinated Care Model, PACE

Reprinted with permission of the National PACE Association, San Francisco, CA

Patient Satisfaction per Month in EOL Program 253 Surveys Completed

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1st month

2nd month

3rd month

4th month

5th month

6th month

7th month

A Lot Better/Excellent

Somewhat Better/Good

No Better/Poor

Reprinted with permission of Frasciscan Health Systems, Tacoma, WA

Number of Hospitalizations Last Year of Life

14370

10

20

30

40

Control Group EOL Group Once Admitted

N = 51

Reprinted with Permission of Fransiscan Health Services, Tacoma, WA

Increasing Cardiac Referrals via Inpatient Facility via Educational Intervention

8.0% 7.8% 7.9%

9.9% 9.2%

13.5% 13.0%

15.8% 15.5%14.0%

17.1%

21.5%

13.8%

9.3%

14.2%12.5%

11.4%

0%

5%

10%

15%

20%

25%

1-3 4-6 7-9 10-12 13-15 16-18 19-21 22-24

25-27

28-30

31-33 34-36

37-39

40-42

43-45

46-48

49-51

Weeks of the Study

Perc

enta

e of

Car

diac

R

efer

rals

/Tot

al R

efer

rals

Denotes Inpatient Facility Training Regarding Hope

Hospice Protocols

New Employee

Being Trained for Inpatient

Facility

Inpatient Facility Layoff

Reprinted with permission of Franciscan Health System