Title: Laboratory Medicine Best Practices Project (LMBP)
OMB Control Number: 0920-0848
Expiration Date: 3/31/2016
LMBP Quality Improvement (QI) Project Summary Form
Instruction: To assist you with completing this form, please refer to the Instructions
Submitter’s Name: ________________________________ Today’s Date: ________________
Position: ________________________________________
Institution: ______________________________________
Organization / Department: ________________________
E-mail: _________________________________________ Phone: _______________________
Mailing Address: _________________________________
City: ________________________ State: _____________ Zip Code:_____________________
Do you want your organization to be identified ____ or remain anonymous? ____
If identified, please provide the name(s) of person(s) the data are attributed to:
__________________________________________________________________
If any information on the submission form is not familiar to you or needs explanation, please note “not familiar” as an answer choice.
Thank you for taking the time to submit your information.
Please call 206-528-3155 with questions. Email completed forms to futurelabmedicine@battelle.org.
LMBP Quality Improvement (QI) Project/Study Summary Form
(Note: Please complete separate form for each study/evaluation you conducted)
If you do not have room to fill in the answer, use the next page and refer to question number.
Background Information |
QI Project/Study |
QI Practice |
Outcome Measures |
Results/Findings/ Considerations |
1. LMBP Quality Problem (topic): ____________________________
2. a.Quality Problem/ Issue Description
b. IRB approval obtained
Waived YES NO {Stop here and submit form, our staff will follow up with you} ** 3. Funding Source(s): In-house Manufacturer: Describe: Grant/Contract: Describe: Other – Describe:
4. Facility Description a. Facility type Hospital: Type:_______________ Physician Office Laboratory Public Health Laboratory Blood Center Independent laboratory Other: Specify_____________________
b. Number of Beds N/A <100 beds 100-300 beds >300 beds
c. Total test volume per yr ____________ |
5. a.QI Project Design: Observational: Pre-post (before-after) Observational: Case – Control Controlled Experiment/ Randomized Control Time Series Cohort Other: Specify___________________
b. Briefly describe aim for the design:
6. QI Project Setting: Emergency Dept. ICU/PICU/NIUC Ob/Gyn Hospital inpatient Physician office Hospital outpatient Other-Describe:
7. Sample Size and Description: (describe totals for new and usual practice) a. Sample is: Tests Specimens
b. Sample size for Original (Usual) Practice is:
c. Sample size for New QI Practice (if applicable) is: |
8. Describe Original (Usual) Practice:
9. Describe New Intervention/ Practice:
10. Practice Duration a. Original (Usual) Practice Start date (mo/yr): _________ / End date (mo/yr): __________ Is Practice Currently Being Used? YES NO
b. New QI Practice Start date (mo/yr): ________ / End date (mo/yr): _________ Is Practice Currently Being Used? YES NO
11. Resource Requirements/Costs: A. Staff: Medical technologist Laboratory phlebotomist Nursing personnel Resident Medical student Physician B. Training: __________________________________ __________________________________
C. Equipment/Supplies: __________________________________
D. Cost: __________________________________
E. Other:_________________________ |
12. Outcome Measure(s) Description: a. Description: ___________________________________ ___________________________________ b. How determined: ___________________________________ ___________________________________ ___________________________________
13. Measurement Duration a. Original (Usual) Measurement Start date (mo/dd/yr): ____/____/____ End date (mo/dd/yr): ____/____/____
b. New QI Practice Measurement Start date (mo/dd/yr): ____/____/____ End date (mo/dd/yr): ____/____/____
14 a. Recording method (how data were collected / note any differences between the original (usual) and new/intervention practices: Occurrence logs Incident / adverse events reports Audit – direct observation Electronic information system monitoring Other
Please Describe each checked method: ___________________________________ ___________________________________ ___________________________________ 15. Potential Limitations to the QI Project/Study: __________________________________ |
16. Results/Findings (as related to /outcome measure):
17. Data Analysis- Significance (if applicable): For Pearson correlations F-Test T-Test Fischer Exact Chi-square Odds Ratio Rates Other: ____________________
18. Barriers to Implementation:
19. Requirements to sustain the new QI practice:
20. Lessons Learned: |
Topic Suggestions
The Laboratory Medicine Best Practices Initiative accepts suggestions for future evidence review topics from anyone.
All suggestions for future reviews are carefully considered based on a set of criteria. Priority is given to topics for which there is/are:
A defined quality issue/problem (pre- and post-analytic) of broad stakeholder interest consistent with IOM domains (safety, timeliness, effectiveness, equity, efficiency, patient-centered)
Potential practices that demonstrate impact on quality
To nominate a topic
Please fill in the form below as completely as possible and click on "submit" at the end. If you prefer, you may fill out the rich text format (rtf) version of the form, which can be edited in any text editing program (e.g., MS Word, Wordpad), and e-mail the completed form to [insert email address]
Briefly describe a question, or set of related questions, about the effectiveness of a laboratory related practice in the pre- or post- analytic testing phase that you would like to have evaluated.
Examples:
What practices are effective at reducing blood culture contamination?
What practices are effective in improving test interpretation of elevated troponin?
What are appropriate blood cultures or other testing related to timely diagnosis and treatment of sepsis?
Examples:
Reduction of blood culture contamination rates can reduce costs of retesting, decrease treatment of false positive results, increase the timeliness and accuracy of bacteremia diagnoses and treatments, and, indirectly, reduce the rate of healthcare acquired infections
Appropriate test result interpretation improves diagnosis and follow-up testing and or treatment
What are some current quality improvement practices to address this quality issue? Explain each practice and provide literature references or other sources that describe its effectiveness, risks and benefits.
Examples:
Use of dedicated phlebotomy teams to draw blood culture specimens
Use of clinical decision support (IT/Electronic health record interventions)
To what patient population does your question/quality issue apply? (Include details such as age, gender, diagnoses, or other factors is they are not general)
Examples:
Inpatients
Patients with signs and symptoms of acute coronary syndrome
To what care setting(s) is your question/quality issue applicable? ( e.g. Emergency Department, Hospital inpatient, surgical, physician offices, nursing homes, public health laboratories, reference laboratories)
Background Information
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b. IRB approval obtained: Indicate if IRB approval was obtained or waived for submission of your project information If no IRB approval was obtained, mark “no” and submit the form. A member of our team will contact you.
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Prior to submitting de-identified information, you should consult with your institution’s designated official or
Institutional Review Board concerning required approvals or clearances.
If you have questions or need assistance, email us at futurelabmedicine@battelle.org or call 206-528-3155.
QI Project/Study
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b. Briefly describe the aim of your project design (e.g., counting all inpatient care phlebotomy service blood collections, we compared the monthly rate of mislabeled collections before and after use of a bar coding mobile system)
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QI Practice
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Outcome Measures
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Results/Findings
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Example:
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Additional Considerations |
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Public reporting burden of this collection of information is estimated to average 40 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-xxxx.
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