Clinical Tracer

1
Clinical Tracer
For department PCT
12 ??????? 2553
2
JOURNEY TRACER
DESTINATION
CHALLANGES
CONTEXT
BEGIN THE JOURNEY
RECORD
CHEER SHARE
3
?????????????????????????
VISION
MISSION
GOAL
BRAND / STRATEGY
??????????
?????????????????
????????????
4
TRACER ORG. SUCCESS
TRACER
TRACER
TRACER
???.
5
Clinical Tracer ???????

• ??????????????????????????????????????????????????
  ?? ??????
• ???????????????????? (Patient Care Process)
• ???????????????????? (Quality Improvement
  Process)
• ??????????????? ??????????????????????
• ???????????????????????????????????
• ???
• ???????
• ???????????
• ?????????????
• Lab, x-ray ???? process tracer

6
Clinical Tracer ?????????????????

• ????????????????????????
• ??????????????????????????????????????????????
• ????????????????????????????
• ??????? Clinical CQI
• ??????????????????????????????????????
  ??????????????????????????

7
Thai HA Clinical Tracer

• ???????????????????????????????????????????
  ??????????
• ??????????????????????????????
• ???????????????
• ????????????????????????????????????
• ?????????????????????
• ????????????????????????????????????????????????
  ???
• ?? Core Value Concept ????????????? ????
• Focus on Results
• Management by Fact
• Evidence-based Practice
• Patient Focus

8
Clinical Tracer ?????????????????

• ??????????????????????????????????????????????????
  ?????????????
• ??????????????? Clinical QI Team ???? Patient
  Care Team ???? Clinical Lead Team
  ?????????????????????? trace quality ??????????
• ?? ??.???????? ????????????????? Clinical Lead
  Team/Patient Care Team (?????? ??.???????)

9
????????????????????? ???????????

• ????????????????????????????????
  ????????????????????????????????????
• ???????????????????????????? ?????????????????????
  ???????????? ?????????????????????
• ????????????????????? ????
• ?????????????????????????? ????
• ????????????????????????????? ????????????,
  ?????????????, ????????
• ???????????????? ?????????????????????????????????
  ???????????????????????? ????????????????????????
  ??????????? ?????????????????????????????????????
  ?????
• ??????????????????????????????????????????????????
  ????? (??????????????????????????????) ??????????

10
?????????????????????????? Clinical Tracer ???????

• ??????????????????????????????????????????????
• ?????????? Clinical Tracer ???? ?
  ??????????????????????????????????????????????
  ???? ?? CQI , ???????????????????? ?
  ????????????????????????????????
  ????????????????????????
• ????????? ? ?? ???? ??????????????????
  ?????????????? , ??????????????????
  ??????????????????????????????????????
  ??????????????????????????????????????????????????
  ??? ? ?????? ????????????? Plot ??????
  ???????????????????????? Plot ??? ?????????????
  ???????????????????????????????????????????????
  ?????????????????? ? ???????????????????

11
Step ???????? clinical tracer

• 1. ??????????????? Tracer
• 2. ????????????
• 3. ????????????????????????
• 4. ????????????
• ?????????????????????????????
• ????????????????????
• ????????????????????
• 5. ????????????????????

12
1. ??????????????? Tracer

• What ?????????????????????????????? tracer
  ??????????????? ??. ??????????????????????? ??.
• Why ???????????????????????????????????????
  tracer ?????????????
• How

13
1. ??????????????? Tracer

• How ??????????????????????
• ?????????????? tracer ???????
• ????????? tracer ????????????????????????????? /
  ?????????????
• ?????????????????????????????????????????
• ??????????????????????????????
• ??????????????????????????????????????
• ??????????????????????????????????????????????????
  ?????

14
Retinopathy of Prematurity (ROP) Context
15
Total Knee Replacement Context
16
Open heart surgery and anesthesia

• ?????????????????????????????????????????????
  ??????????????????????????????????? (?????????)
  ????????????????????????????????????????????
  ?????????????????????????????????????????????????
  ???????????????????????? ?????????????
  ??????????????? ??????????????????????????????????
  ????? ????????????????????????????????????????????
  ?? 40 ??? (??????????????????? ?)
  ?????????????????????????????????
  ??????????????????????????? ??????????????????
  ?????????????????? ???????????? ?????????????
  ??????????????????????????????????
  ??????????????????????????????????????????????????
  ??? 10 ?????

17
???????????????????????(?????? 2549-????????
2550)
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2. ????????????

• ??????????????????? (clinical risk)
• ????????????????????????????????????
• ???????????????????????/????????
• ???????????????????????/???????
• ??????????????????????
• ????????????????
• ??????????????????????????????????

19
Retinopathy of Prematurity Key Issue Indicator
20
Open heart surgery and anesthesia

• ???????????? / ??????????????? (Critical
  issues/risks) ???????????????????????/????????
  ???????????????????????/???????
  ?????????????????????????????????????????
• 1. ???????????????????????????????????? ???????
  informed consent
• 2. ??????????????????????????? ???????????????????
  ?????
• 3. ????????????????????????????????

21
3. ????????????????????????

• ???????????????????????????????????????????????
• ????????????????????????????????????????????
• ????????????????????????????????????????
• ?????????????????????????????????????
• ???????????????????????????????
• ????????????????????????????????
• ??????????????????????????????????????????????????
  ????
• ??????????????????????????????????????????
• ???????????????? run chart ???? control chart
  ????????

22
Open heart surgery and anesthesia

• ???????????? / ??????????????? (Critical
  issues/risks)
• 1. ???????????????????????????????????? ???????
  informed consent
• 2. ??????????????????????????? ???????????????????
  ?????
• 3. ????????????????????????????????

• ????????
• ?????????????????????????????????????????????
  ????????? ????????????????????????? ???????
  ?????????????????
• ?????????????
• informed consent
• ?????????????????????
• Morbidity and mortality rate ?????????????????????
  ???????

23
?????????????????

• ????????????? 2549 - ??????? 2550
• ???????????????????????

24
(No Transcript)
25
KPI ??????????? aortic valve replacement
(?????????)
26
(No Transcript)
27
(No Transcript)
28
??????????????????????????? atrial septal defect
(?????????)
29
(No Transcript)
30
??????????????????????????? ventricular septal
defect (?????????)
31
(No Transcript)
32
(No Transcript)
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4. ????????????

• ?????????????????????????????
• ????????????????????
• ????????????????????

34
4.1 ???????????? (tracer) ????????????????????????
??????
????????????
????????????????
???????????
???????
??????
????
???????
??????
??????? ???????????????? ?????????
??????????????????????????????????????????????????
?????????/??????? ????????????????????????????????
???????????????? ???????????????????????????? ????
??????????????????????????????????????????????????
? ????????????????????????????????????????????????
??
35
4.2 ???????????? (tracer) ????????????????????????
??????
???????????????????????????????????????
?????????????????? ???????????????????????????????
?? ????????????????????????????????
36
4.2 ???????????? (tracer) ????????????????????????
??????

• ??? PCT ??????????????????????????????????????????
  ????? PCT ????????? PCT ?????????????????????????
  ????
• clinical practice guideline, care map, discharge
  planning
• ????????????????????????????????????????????
  ???????
• ???????????????????????? ???????
• ?????????????????????????????????????????????
• ????? RCA ??????? ????????????????????????????
  ??????????????????????????????????????????????????
  ???????????? RCA
• ??????????????????????????????????????????????????
  ????????????????? ??????????????
• ????? Benchmarking ???????????????????????????????
  ?????????
• ??????????????? KPI ?????????????????????
  ???????????????????????????

37
4.3 ???????????? (tracer) ???????????????????????
????????????????
- ???????????????????????????????????????????????
?????????????????????????????????????? -
????????????????????????????????????????????????
????????????/??? ????????????????????????
38
5. ????????????????????

• ?????????????????????????????????????????????????
  ?????????????????????????????????

39
4.??????????????????????????????? (Key Process
for Quality)

• 4.1 ????????????????????
• Entry-Access
• Patient assessment ( surgeon, anesthesiologist,
  perfusionist, scrub nurse)
• Operation-anesthesia
• ( time out, induction, maintenance
  pre-bypass-bypass-off pump, emergence)
• Postoperative care ( transfer, ICU care ward
  care)
• Discharge
• follow up

??????????????????????/????
40
4.2 ???????????? (tracer) ????????????????????????
??????
4.2 ??????????????? (??????????)
???????????????????????????????????????? ??????
Care MAP ?????????????????????????????????
??????????????????
Clinical CQI
Heparin-HR, protamine allergy
41
Care map
42
4.3 ?????????????????????????
4.??????????????????????????????? (Key Process
for Quality)

• ??????????????????????????????????????????????
  ???????????????????? ? ????????????????????????
  ??????
• ???? ????????? ????????????????????
  ????????????????????????????????????
• ????????????????????? ?????? blood bank,
  ???????????????????????????? ????????????????
• ??????????????????????? (operative note,
  anesthetic record, ICU note)
• ?????????????????????? ( ????????? ????????????
  ????????????? perfusionist , scrub nurse)
• ???? maintenance ??????????????? ???? anesthetic
  machine, heart lung machine, etc
• ???????????????????????????? ???? ???????? ,
  tubing, suture material, graft

43
5 .???????????????? / ????????????

• ??????????????????????????????????????????????????
  ?
• Facility ????????????????????????? ???? TEE
• ?????? CVT ????????????????????????????
• Intermediate care unit
• Competency ??????????
• ?????????????????????? ????????????????????????
• ICU_CVT ???????????????????????????????????
  (??????? 2554) ???????????????????????????????????
  ???? ??????????????????
• ??????????????????

44

• One page summary
• clinical tracer

45
Clinical Tracer Ac Appendicitis
Research Link
Prevention Form/CPG/ CareMap Link
KPI Link
CQI Link
Risk
Entry
Care Process
Initial Assessment
Consultation
Predictive value of US
Investigation
Delayed/missed diagnosis
Patho. Diag. confirmed
Use of clinical sign
Diagnosis
Planning
Undetected change
Observation
Operation
Anesthesia
OR
Transfer
Preop Care
Anes complication
Anesthesia
Delayed operation
Door to operation time
Operative Procedure
Postanes Care
SSI
SSI rate
Postop care monitoring
D/C plan
Follow up
46
(No Transcript)
47
????????????

• ????? clinical tracer ???????? PCT
• ??????????????????????????????????????????
• ???????????????????????????????????
  ??????????????????? ??????
• ?????
• ????????????
• ????????????????????????
• ????????????????????? (???????????????????????????
  ?? ???????????????????? ???????????????????????)
• ????????????????????

48
One page summary open heart
Care process risks prevention KPI CQI Research
Access/entry ????????????
assess ????????????????? CPG, guideline ?????? lab
plan ?????????? Preop. conference
care ???????????? ??????????? Time out Antibiotic prophylaxis Bypass care Mortality rate Reop. SSI Safe transfer, monitoring Glucose tight control, heparin
Information/ empowerment ??????????????? ?????????????????? ??????????????????????????
D/C process
Continuity of care
49
One page summary
Care process risks prevention KPI CQI Research
Access/entry
assess
plan
care
Information/ empowerment
D/C process
Continuity of care
50
One page summarylab, x-ray
Key process risks prevention KPI CQI Research