QI Team and Specific Measurable Achievable Relevant and Timely (SMART) Aim
After reviewing the data from our retrospective study revealing high prevalence of Vitamin D deficiency and insufficiency, we assembled an inter-professional QI team.
Our QI team followed the Institute for Healthcare Improvement’s Model for Improvement14 and the QI leader completed formal QI training. The QI leader was a pediatric Hematology/Oncology physician who worked closely with the team that included physician champions, nursing staff, QI advisors, and content experts from pediatric hematology/oncology, hospital medicine, pediatric endocrinology and information technology (IT).
In person QI team meetings were held biweekly beginning with the planning phase and throughout the project to address interventions, discuss unexpected observations and problems encountered, review study data and decide on interventions to be implemented.
The entire team participated in development of the Key Driver and Ishikawa diagrams (Figures 1 & 2), the SMART Aim, the decision-making tree (Figure 3) and reviewed the Plan-Do-Study-Act (PDSA) cycles. Input from other key stakeholders (physicians, advance practice providers, oncology case managers, pharmacists, inpatient and outpatient nurses) was obtained about potential barriers and facilitators to Vitamin D testing at the time of initial cancer diagnosis and proposed supplementation strategies. The QI team leader contributed approximately six hours of time each week during the first four months of the project and then approximately four hours per week during subsequent months.
Our SMART Aim was: From February 1 to June 30, 2016, compliance with institutional guidelines for Vitamin D testing and supplementation in children with newly-diagnosed cancer (aged 2-18 years old) will be ≥80% from a baseline of 0% and sustained over subsequent months.