Any Which Way You Can. Remember this silly Clint Eastwood movie? No? The theme dovetails perfectly with today’s post on getting the maximum impact from your PI requests.

There are a number of stages for processing trauma performance improvement items:

• Identify the issue
• Determine the best level or venue for the review
• Decide the best person(s) to answer the request
• Process the findings
• Make a determination for loop closure
• Document everything!

Let’s say that the issue identified involves a patient who was admitted directly to a nonsurgical service. But your trauma service has been aggressively trying to reduce the number of nonsurgical admissions. This seems like a simple single-service issue, right?

But is it? They say it takes two to tango. In this case, it’s more like four. Or maybe even more!

Sure, a hospitalist accepted the patient for admission. But who asked her to? Most likely one of the emergency physicians. You immediately have two people to communicate with.

You already have an emergency medicine liaison to the trauma program who normally takes care of PI requests to their department. And if you are forward thinking, you should also have a hospitalist liaison to your trauma program. That’s two more people. Finally, were any advanced practice providers involved in the handoff? If so, their names go on the list, too.

I have a “technique for progressive annoyance” that I use throughout the PI process. Sure, I utilize my liaisons to do higher level reviews, and for counseling and education within their respective departments. But I firmly believe that the end providers have an aversion to receiving PI requests from the trauma program. So I send them out to everyone involved.

The emergency provider request contains a recommendation to consult trauma with similar future requests. The hospitalist request suggests that they should ask the emergency physician if trauma has been consulted when they are called. This makes both think twice the next time such a situation arises. And the liaisons are asked to re-educate all of their respective providers about the importance of the consult process.

By looping in all these providers and sending requests “any which way you can”, you can maximize the gentle negative feedback loop for undesired behavior and improve compliance with future PI initiatives.