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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
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