Adopting a New Nurse Triage Guideline: A H1N1 Case Study

SironaHealth is committed to offering quality healthcare contact center services, and therefore constantly monitors all business processes. In the following article by SironaHealth statistician, Allison Levesque, we review how Statistical Process Control techniques are among the tools used to determine appropriate areas of focus, and how SironaHealth uses them to ensure guideline adoption.

This year the country and the world have been hit with the devastating H1N1 Virus.  With this new pandemic, a new telephone triage guideline was created in order to properly triage those affected.  To ensure that nurses were well versed in the new guideline and utilizing it properly, SironaHealth's quality team provided updated training to the nursing staff, followed by control chart analysis to determine compliance and training effectiveness. Control charts illustrate variation in a process and put limits on that variation, which are considered statistically acceptable. Instances that extend beyond the acceptable limits indicate that processes are out of statistical control. Anything outside the control limits needs investigating.

As a statistician, I wanted to see the proportion of H1N1 guideline usage compared to all other guideline usage for each nurse relative to volume. The H1N1 guideline was new in 2009.  As with anything new, adoption takes time. However, we did not want to leave this up to time. So, we rolled out the latest H1N1 guidelines and began tracking their use against traditional flu guidelines and symptomatic guidelines (fever, diarrhea, vomiting, headache, sore throat, cold, and cough).  Control charts were used to detect slow adopters very early.

Appropriate use of guidelines is critical to patient safety. Positive triage statements and care advice vary with each guideline. So it is imperative that quality programs detect process issues before a break down occurs.

Statistical methods allow us to see processes “creep” toward non-compliance.  In this sense, we were able to measure H1N1 guideline adoption from the moment the guideline was released – on any interval necessary. This early detection trigger allowed SironaHealth to take corrective actions such as refreshing and retraining staff and management almost immediately.  The measurement is continuous, so the corrective actions are measured and adjusted if necessary as well.

Applications of statistical process control within the healthcare industry are needed to establish the foundation of quality, which drives patient safety. At SironaHealth, it has repeatedly proven to be effective in improving the quality of our healthcare services.  We continue to implement and refine statistical techniques to reduce process variability, ultimately ensuring that only the highest quality and safest services are being offered.