NR 720 Week 6 Measurement Plan Example

Measurement Plan: Testing Whether Line Film Priority and Clinician Clearance Explain the Wait Before a Central Line Is Used

Student Name

College of Nursing, Chamberlain University

NR 720: Topics in Healthcare Systems Leadership I

Instructor Name

Month Day, Year

Measurement Plan: Testing Whether Line Film Priority and Clinician Clearance Explain the Wait Before a Central Line Is Used

The Claim, Stated So It Can Fail

The claim is that, in the medical unit's 20 beds, the median of 122 minutes between a central line's completion and its first infusion is long mainly for two reasons: confirmation films default to routine priority and so wait in the radiologists' queue, and no role owns clearing the line and telling the nurse. If the claim is right, two changes, a line confirmation priority in the order set and a rule that the credentialed placing clinician clears the line on a documented personal reading and tells the nurse directly, should bring the median below 60 minutes within three months. The claim also predicts what should not happen: reading times for emergency department studies should not rise by more than five minutes, and lines found malpositioned on the radiologist's over-read should not rise. If the median stays above 90 minutes with both changes in place, the claim is wrong.

One Wording, Two Departments

Each measure is worded so that radiology and the intensive care unit read it the same way. "Image taken" is the technologist's exam-complete time, the moment radiology already uses to start its own turnaround clock. "Read posted" is the time the radiologist's report appears in the record. "Cleared" is the time of a note that documents tip position and the absence of pneumothorax, written by the placing clinician or derived from the radiologist's report, whichever comes first. Agreeing these words with both managers before collecting anything avoids the problem found in the comparison between units, where the same word described two different acts.

Few Measures, Fully Specified

Table 1

Measurement Plan, Central Line Clearance

Note. Note. Baseline January to March 2027; test period May to July 2027 after both changes start on 1 May.

Measures 1 to 3 test the mechanism, and each corresponds to a crossing on the process map. Measures 4 and 5 are balancing measures, each owned by radiology, so that the department asked to change its queue holds the evidence on whether the change harmed its other work (Langley et al., 2009).

Fixing the Reading in Advance

The plan states now how each result will be read. If measure 1 falls below 60 minutes and measures 2 and 3 both fall, the claim is supported. If measure 1 falls but only measure 2 does, the priority change did the work and the clearance rule did little. If measure 1 falls but only measure 3 does, the reverse. If measure 1 does not fall below 90 minutes, the claim is wrong, and the search turns to a cause the map did not show. If measure 4 rises by more than five minutes or measure 5 exceeds 1 in 20, the change is paused regardless of measure 1, because the cost would fall on other patients. Monthly figures will be plotted on run charts, and a shift will be declared only by the standard run chart rules, not by a single good month (Provost & Murray, 2022).

Why These Measures and Not Others

Two tempting measures were left out. Patient outcomes, such as peripheral infiltration of vasopressors, are too rare in 64 placements a quarter to move detectably, and none was recorded in the baseline. Staff satisfaction would say whether people like the change, not whether it explains the delay. The plan measures mechanism, the time at each crossing, because the claim is about mechanism.

Threats to the Test

Three things could make the results misleading, and each has a check. First, volume: if fewer lines are placed in the test months, or the radiology queue is lighter in late spring, times could fall with no help from the changes. The plan therefore reports, beside each month's medians, the number of placements and the radiology department's total daytime volume, so a quiet month can be recognized as one. Second, partial adoption: if only some clinicians use the new clearance rule, the medians will mix two practices. The record report will flag each line as cleared by the clinician or by the radiologist, and measure 1 will be reported separately for each group. Third, credentialing: the clearance rule applies only to clinicians who have completed a supervised reading of ten line films, and if credentialing lags, the change will start late in practice even though it starts on 1 May on paper. The unit manager will report the number of credentialed clinicians at each monthly review.

Feasibility in Plain Terms

Every measure comes from a system that already records it. The unit data analyst estimates two hours a month to run the report for measures 1 and 3; the radiology analyst already produces turnaround reports by study type and can add a line film filter for measures 2 and 4; and the radiology quality lead already logs over-read disagreements in peer review. No new data collection is needed, and no measure depends on observation, which was used earlier to build the map but cannot be sustained. The plan also does not depend on the student: both analysts and the quality lead have agreed to their rows. The evidence that bedside clinicians can identify line position and pneumothorax accurately, especially with ultrasound, supports the clearance rule's safety in principle (Ablordeppey et al., 2017), but measure 5 tests it here.

References

Ablordeppey, E. A., Drewry, A. M., Beyer, A. B., Theodoro, D. L., Fowler, S. A., Fuller, B. M., & Carpenter, C. R. (2017). Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: A systematic review and meta-analysis. Critical Care Medicine, 45(4), 715-724. https://doi.org/10.1097/CCM.0000000000002188

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Provost, L. P., & Murray, S. K. (2022). The health care data guide: Learning from data for improvement (2nd ed.). Jossey-Bass.