IMPROVING HEALTH-CARE .3. CLINICAL BENCHMARKING FOR BEST PATIENT-CARE

Background: Benchmarking, which shows that a much better way of doing something may be possible, stimulates local interest in changing and i n making changes previously thought not possible. A planning worksheet : The Worksheet has five basic steps: Identify measures, determine res ources needed to find the ''best of the best,'' design a data collecti on method and gather data, measure the best against own performance to determine gap, and identify the best practices producing best-in-clas s results. Case example-Bowel surgery: The Accelerating Clinical Impro vement Bowel Surgery Team at Dartmouth-Hitchcock Medical Center (Leban on, NH) was formed in November 1994 to improve the care of patients wi th diagnosis-related group (DRG) 148 or 149. Consulting two large, adm inistrative databases and the medical literature, the team found that a substantial gap existed between the bowel surgery delivery process a nd the best results, as far as they were known, among comparable organ izations. After flowcharting the delivery process, the team identified the high-leverage steps: same-day services, general surgery clinic, a nd routine care. The team then planned three successive PDCA (plan-do- check-act) cycles: utilization of same-day services for all elective s urgery patients, establishment of a standardized preoperative bowel pr eparation, and utilization of pre- and postoperative routine care orde rs. These improvement cycles results in a reduction in length of stay from 9.66 to 8.29 days. Implementation of a critical pathway resulted in a further reduction to 5.04 days. Conclusion: Benchmarking can play an integral role in clinical improvement work and can stimulate wise clinical changes and promote measured improvements in quality and valu e.