Taking ACT-ion for Quality Improvement

“Learning is a journey. It is continuous,” said nurse Hellen Okoth, MSN, CCRN, RN-BC, of the Transitional Surgical Unit. She was one of the learners on that journey through ChristianaCare’s professional development program Achieving Competency Today (ACT).

ACT, a 12-week graduate-level program dedicated to health care improvement, will celebrate its 40th session in 2025. Some 1,000 caregivers have graduated from ACT and have tested some 140 innovative project ideas since the program’s launch in 2003.

On April 9, three ACT teams presented their quality improvement projects at the John H. Ammon Medical Education Center on ChristianaCare’s Newark campus.

Interdisciplinary, experiential learning programs like ACT create a rich and dynamic learning environment,” said Tabassum Salam, M.D., MBA, FACP, chief learning officer for ChristianaCare.

“The emphasis on continuous improvement and real-world applications of the educational content sets our ACT graduates up for lifelong learning and repeated application of these new skills.”

The ACT course is a collaborative experience that brings together learners from diverse disciplines to tackle real-world health care challenges. Participants learn from health system leaders and gain a broad perspective on health care through coursework.

They work in teams to complete problem-solving projects from start to finish using the Plan-Do-Check-Act (PCDA) model of continuous improvement. Facilitators, who are experts in improvement science and team effectiveness, guide the teams through the process, ensuring that each project is meticulously planned and executed.

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“The hands-on projects in ACT enable learners to innovate and test out solutions in settings that directly benefit patients, leading to better outcomes and a higher quality of care,” Salam said.

The three most recent teams presented improvement research that has the potential to expand beyond their pilot stage to other areas of the health system.

‘Hush! For the Love of Health’

In “Hush! For the Love of Health,” an interdisciplinary team worked to reduce noise levels on the Cardiovascular Critical Care Unit (CVCCC) at Christiana Hospital. Their goal was to decrease ambient noise levels by 10 decibels during the study period. Intensive care units often experience noise levels that can exceed 80 decibels. A quiet environment is 30 to 40 decibels.

Members of the “Hush” project found creative ways to reduce noise on an intensive care unit.

Ambient noise refers to all sounds present in the background, which research shows can interfere with communication, concentration and comfort. In a hospital setting, these sounds may include alarms, conversations, announcement and pages and carts moving by.

The team looked for opportunities to safely reduce the number of alarms sounding. By collaborating with Philips technology company to lower alarm volumes and eliminate redundant alarms, they reduced the number of alarms sounding from 10,000 to 3,000 daily and successfully decreased noise levels by 13 decibels, exceeding their goal.

“It’s good for patients to have a quiet environment and it fights alarm fatigue for caregivers,” said Dylan Norris, a pre-medical student from the University of Delaware and participant in the ACT course.

‘Show Up and Show Out’

Reducing the no-show rate among patients in primary care practices improves health outcomes and conserves resources. In “Show Up and Show Out: Boosting Patient Attendance in Primary Care,” the project team aimed to reduce the incidence of no-show appointments at the Wilmington Adult Medicine (WAM) practice by 10%.

The “Show Up and Show Out” project team used personalized communication outreach to patients to encourage keeping their primary care appointments.

“Our literature review showed that personal relationships with providers are one thing that can encourage people to attend appointments,” said team member Christi Karawan, MS, BSN, CCRN-CSC.

The key to their problem-solving strategy was using a secure messaging platform for automatic appointment reminders specifically for WAM that were personalized with the provider’s name and thanking the patients for letting WAM be a part of their healthcare team. Other steps on the road to success were signage around the practice encouraging patients to update their contact information and calls from office assistants and medical assistants to unconfirmed patients the day prior to their appointments.

The team achieved a 9.5% reduction in no-shows, just shy of their goal, over a two-week period.

An office assistant who participated in the pilot said, “Outreach has been helpful not only in getting people in but in getting people to reschedule or cancel. We can catch it before it becomes a no-show.”

‘Magnetic Efficiency’

To address delays in patient transport from MRI testing at Newark campus, an ACT team created a new communication workflow to directly connect patient escort dispatch to the MRI charge technician. The ACT team aimed to decrease patient wait times following MRI completion for stretcher transport back to patients rooms by 25% — and “a bold goal,” said one colleague — during the study period.

The “Magnetic Efficiency” team identified a new workflow to get patients back to their hospital rooms faster after MRI testing.

Using Vocera wearable communications tools, the team created a thread for direct communication between Escort Dispatch caregivers and MRI charge technicians. Also, when an Escort transporter dropped off a patient for an MRI, the transporter asked MRI staff if any patients were ready to go back to their rooms. These changes in communication and empowerment consolidated transports and led to a 17% reduction in wait time during the two-week pilot.

“We don’t want people to work harder,” said team member Tim Kane, BSN, RN. “We wanted to avoid preventable delays.”

Both teams expressed satisfaction and improved communication with the new process and they expressed interest in continuing the process after the pilot ended.

Future forward

The ACT course has a rich history, originating from a specific initiative piloted by the Robert Wood Johnson Foundation with ChristianaCare among the early adopters along with Harvard University, the University of Pennsylvania, Johns Hopkins University and Beth Israel Deaconess Medical Center.

Through the years, ChristianaCare ACT team members have seen their projects live on both as permanent changes throughout the health system and, more personally, in their professional growth.

“I was able to enhance my creativity, organizational and problem-solving skills,” said Starr Lumpkin, a staff assistant who was on the “Hush” team. “This was a pivotal journey for me.”

ChristianaCare is growing its program to develop a pipeline for the next generation of health professionals, said Safety and Quality Education Specialist Claire Rudolph, MSM, CPHQ. “We have a varied group of learners and facilitators who are making an impact on health care quality, cost and safety.”

Dylan Norris was the first participant from a new partnership with the University of Delaware for pre-med students to get quality improvement experience.

“I have learned so much about what goes into a quality improvement project. Buy-in from the stakeholders is key in implementing any new project successfully,” she said. “I have also learned about the importance of the initial research that goes into creating a new project and how much pre-planning goes into it.”

Closing the event, Clinical Effectiveness Officer Christian Coletti, M.D., MHCDS, FACEP, FACP, called on the ACT graduates to use their newfound “superpowers” — “vision, seeing the future, catching something before it breaks.

“It’s not a glitch in the matrix,” he said. “You are the most important people at the bedside – hearing the alarms going off or the stretchers piling up. Work to identify problems and move toward solutions in your own microenvironments. Pass on your powers with reckless abandon.”