QI™ Toolkit Roadmap

AHRQ Quality Indicators™ Toolkit for Hospitals

The QI Toolkit Roadmap is a "shopping list" you can use to quickly identify which tools to use at any point in time. Your hospital may choose to use only those tools that you find helpful. View the toolkit as a "resource inventory" from which you can select the tools that are most useful, given your hospital's current quality improvement capabilities and efforts.

The QI Toolkit Roadmap is a "shopping list" you can use to quickly identify which tools to use at any point in time. Your hospital may choose to use only those tools that you find helpful. View the toolkit as a "resource inventory" from which you can select the tools that are most useful, given your hospital's current quality improvement capabilities and efforts.

Successful improvement requires involvement by multiple positions in the hospital. Therefore, while your hospital's quality leaders are the primary audience, many tools are aimed at several audiences. The Roadmap shows the intended audiences for each tool.

Organization of the Toolkit

The tools are organized into the following sections:

Section A: Determining Readiness To Change.

Section Action Steps Tool That Supports Action Audiences Lead Role
A.1. Getting To Know the PSIs/IQIs. Tool A.1a. Fact Sheet on Inpatient Quality Indicators (IQI) (updated September 2014)

Tool A.1b. Fact Sheet on Patient Safety Indicators (PSI) (updated September 2014)

All Hospital Board and Staff Members Senior Staff and Quality Leaders
A.2. Help Board members and relevant staff understand the importance and financial and clinical implications of the AHRQ Quality Indicators. (The "notes" view in PowerPoint® has additional instructions for using this tool.) Tool A.2. Board/Staff PowerPoint® Presentations on the Quality Indicators Board Members, Senior Management Staff, Quality Staff Quality Leaders
A.3. Assess your hospital's organizational infrastructure and its readiness to support effective implementation efforts. Tool A.3. Getting Ready for Change Self-Assessment Senior Management Staff and Quality Leaders Senior Staff and Quality Leaders

Section B: Applying QIs to the Hospital Data.

Section Action Steps Tool That Supports Action Audiences Lead Role
B.1. Perform the QI calculations using the AHRQ 4.1 software. Tool B.1. Applying the AHRQ Quality Indicators to Hospital Data Quality and Safety Leaders, Data Analysts, Statisticians, and Programmers Quality Leaders, Data Analysts
B.2. Review this example of the output from the AHRQ QI 4.1 software. Tool B.2a. IQI and PSI Rates Generated by the AHRQ SAS Programs (updated September 2014)

Tool B.2b. IQI and PSI Rates Generated by the AHRQ Windows QI Software (updated September 2014)

Data Analysts or Programmers calculating rates; Quality Leaders Data Analysts, with Quality Leaders
B.3. Use this PowerPoint® to understand and review the AHRQ QI data, trends, and rates. Tool B.3a. Excel® Worksheets for Charts on Data, Trends, and Rates To Populate the PowerPoint® Presentation (updated September 2014)

Tool B.3a. Instructions (updated September 2014)

Tool B.3b. PowerPoint® Presentation: The AHRQ Quality Indicators, Results, and Discussion of Data Analysis (updated September 2014)

Quality Leaders, Senior Leaders, Analysts Quality Leaders
B.4 Understand documentation and coding issues that affect PSI and IQI rates. Tool B.4. Documentation and Coding for Patient Safety Indicators (updated September 2014) Providers, Clinical Documentation Specialists, Coders, Quality Leaders Quality Leaders
B.5 Analyze the hospital's performance on the QIs by assessing trends in rates and using benchmark comparisons. Tool B.5 Assessing Indicator Rates Using Trends and Benchmarks Quality and Safety Staff, Senior Leaders, Hospital Board, Analysts Quality Leaders

Section C: Identifying Priorities for Quality Improvement.

Section Action Steps Tool That Supports Action Audiences Lead Role
C.1. Determine direction of organizational focus and decisions about which QIs should be addressed. Tool C.1. Prioritization Matrix (updated September 2014)

Tool C.1. Instructions (updated September 2014)

Senior Leaders and Quality Staff Senior Leaders and Quality Staff

C.2.

Review this example of a completed prioritization matrix. Tool C.2. Prioritization Matrix Example (updated September 2014) Senior Leaders and Quality Staff Senior Leaders and Quality Staff

Section D: Implementing Improvements.

Section Action Steps Tool That Supports Action Audiences Lead Role
D.1. Evaluate current systems in place, modifications to existing protocols and electronic order sets, and development of new systems and processes of care. Tool D.1. Improvement Methods Overview Multidisciplinary improvement team Quality Leaders
D.2. Define the implementation team and its goals. Tool D.2. Project Charter Multidisciplinary improvement team Quality Leaders
D.4. Identify existing best practices that may help in assessing options for action. Tool D.4. Selected Best Practices and Suggestions for Improvements: Introduction to the Best Practices Tools (for 14 PSIs and IQIs) (added September 2014)

Tool D.4a. PSI 7: Central Venous Catheter (CVC)-Related Bloodstream Infections (BSIs) (updated September 2014)

Tool D.4b. PSI 12: Perioperative Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) Rate (updated September 2014)

Tool D.4c. PSI 3: Pressure Ulcer Rate (updated September 2014)

Tool D.4d. PSI 5: Retained Surgical Item or Unretrieved Device Fragment Count (updated September 2014)

Tool D.4e. PSI 6: Iatrogenic Pneumothorax Rate (updated September 2014)

Tool D.4f. PSI 8: Postoperative Hip Fracture (updated September 2014)

Tool D.4g. PSI 9: Postoperative Hemorrhage or Hematoma (updated September 2014)

Tool D.4h. PSI 10: Postoperative Physiologic and Metabolic Derangement Rate (updated September 2014)

Tool D.4i. PSI 15: Accidental Puncture or Laceration Rate (added September 2014)

Tool d.4j. PSI 14: Postoperative Wound Dehiscence Rate (added September 2014)

Tool D.4k. PSI 18 and 19: Obstetric Trauma Rate—Vaginal Delivery With and Without Instrument (added September 2014)

Tool D.4l. PSI 11: Postoperative Respiratory Failure Rate (added September 2014)

Tool D.4m. PSI 13: Postoperative Sepsis Rate (added September 2014

Tool D.4n. IQI Mortality Review Best Practices (added September 2014)

Multidisciplinary improvement team Quality Leaders
D.5. Understand the extent to which current practices align with best practices. Tool D.5. Gap Analysis Multidisciplinary improvement team Quality Leaders
D.6. Assign team responsibilities and set timeline. Tool D.6. Implementation Plan Multidisciplinary improvement team Quality Leaders
D.7. Measure progress in improving work and clinical care processes. Tool D.7. Implementation Measurement Multidisciplinary improvement team Quality Leaders
D.8. Understand what worked in the implementation process and what needs improvement. Tool D.8. Project Evaluation and Debriefing Multidisciplinary improvement team Quality Leaders

Section E: Monitoring Progress for Sustainable Improvement.

Section Action Steps Tool That Supports Action Audiences Lead Role
E.1. Conduct an ongoing, standardized process for reporting trends in the measures developed and acting upon issues identified by those trends. Tool E.1. Monitoring Progress for Sustainable Improvement Quality Staff Quality Leaders

Section F: Analyzing Return on Investment.

Section Action Steps Tool That Supports Action Audiences Lead Role
F.1. Estimate the return on investment from the interventions implemented to improve performance on the QIs. Tool F.1. Return on Investment Estimation Senior Leaders, including the Chief Financial Officer  

Section G: Using Other Resources.

Section Action Steps Tool That Supports Action Audiences Lead Role
G.1. Obtain further guidance for conducting effective quality improvements. Tool G.1. Available Comprehensive Quality Improvement Guides Quality Staff and Improvement Team Quality Leaders
G.2. Identify specific analytic or action tools to use in improvement processes. Tool G.2. Specific Tools To Support Change (updated September 2014) Quality Staff and Improvement Team Quality Leaders
G.3. Review this case study for an example of how one hospital used the toolkit. Tool G.3. Case Study of PSI Improvement Implementation Senior Leaders, Quality Staff, Improvement Team Quality Leaders
Page last reviewed September 2014
Internet Citation: QI™ Toolkit Roadmap: AHRQ Quality Indicators™ Toolkit for Hospitals. September 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/qiroadmap.html