(^154) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
become more mature in their QI efforts, they become more rigorous in the ap-
proach, the analysis of results, and the use of established measures as metrics
(Newhouse, Pettit, Poe, & Rocco, 2006). In contrast to research studies, the find-
ings from QI studies are not meant to be generalized to other settings. Organiza-
tions that may benefit from the findings need to make decisions regarding imple-
mentation based on the characteristics of their organization.
QI reporting is an internal process; nevertheless, the desire to share the results
from such projects is evident in the growing number of collaborative efforts tar-
geting risk-prone issues. For example, the Institute of Healthcare Improvement
(IHI) sponsored a learning and innovation network of quality-focused organi-
zations working together to achieve improvement in healthcare areas such as
perinatal care and the reduction of re-hospitalization. The IHI expanded these
efforts and worked across organizational boundaries and engaged payers, state
and national policymakers, patients, families, and caregivers at multiple care
sites and clinical interfaces through the STate Action on Avoidable Rehospital-
izations (STARR) Initiative (IHI, 2013). As the number of quality improvement
reports has grown, so has concern about the quality of reporting. In an effort to
reduce uncertainty about what information should be included in scholarly re-
ports of health improvement, the Standards for Quality Improvement Reporting
Excellence (SQUIRE: http://www.squire-statement.org)) were published in 2008
and revised in 2015. The SQUIRE guidelines list and explain items that authors
should consider including in a report of system-level work to improve healthcare
(Ogrinc et al., 2015). Although evidence obtained from QI initiatives is not as
strong as that obtained by scientific inquiry, the sharing of successful QI stories
has the potential to identify future EBP questions, QI projects, and research stud-
ies external to the organization.
An example of a quality improvement project is a report from an emergency de-
partment (ED) and medical intensive care unit (MICU) on transfer time delays of
critically ill patients from ED to MICU (Cohen et al., 2015). Using a clinical mi-
crosystems approach, the existing practice patterns were identified, and multiple
causes that contributed to delays were determined. The Plan-Do-Study-Act model
was applied in each intervention to reduce delays. The intervention reduced
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