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Improving Apparent Cause Analysis Reliability: A Quality Improvement Initiative.

Kristen M Crandall¹, May-Britt Sten¹, Ahmed Almuhanna¹

¹Children's National Medical Center, Washington, DC.

Pediatric Quality & Safety

|September 20, 2018

Summary

Implementing high reliability principles significantly improved apparent cause analysis (ACA) action plan reliability and reduced turnaround time. This quality improvement initiative enhanced patient safety processes within a pediatric hospital.

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Area of Science:

Healthcare Quality Improvement
Patient Safety
Process Optimization

Background:

Apparent cause analysis (ACA) is a critical quality improvement tool for event examination.
Baseline ACA assessments at a pediatric academic hospital indicated ineffectiveness due to poor analysis, unreliable action plans, and limited spread, resulting in recurring errors.

Purpose of the Study:

To enhance the reliability of ACA action plans.
To maintain or decrease the turnaround time for ACA processes.

Main Methods:

Utilized the Model for Improvement framework, including key driver diagrams and plan-do-study-act cycles.
Developed a high reliability toolkit to score ACA action plan reliability, requiring revisions for low-scoring plans.
Implemented effective interventions based on iterative testing.

Main Results:

Average ACA action plan reliability scores rose from 86.4% to 96.1%.
ACA turnaround time decreased from a baseline of 13 days to 8.6 days.
Stakeholders reported increased satisfaction with the improved ACA process.

Conclusions:

Integrating high reliability principles into ACA action plan development boosts effectiveness and reduces turnaround time.
The high reliability toolkit served as a vital organizational resource for developing reliable solutions.
This approach enhances patient, family, and staff safety through improved cause analysis.