Table 3. Example: CUS Contact Person On-Call Response to an Escalated Urgent Concern Name of Activity: Response to Escalation of an Urgent Concern Role performing Activity: CUS contact person (CUS contact person needs to be onsite and assigned every day the center is open to see patients; if primary contact person offsite, then another contact person must be designated.) Location: Our Surgical Center Activity Owner: Center Unit originating this activity description: Administrator Our Surgical Center Last Revision: Date Approved: Date Prepared: 4/29/2016 4/15/2016 Step Step Definition Time to (Brief summary of task) complete PDSA What question(s) are you trying Preparation (examples) Cycle # to answer? Can we draft an "escalation from CUS event" procedure Find your organization’s procedure format or 1 acceptable to organization use our default format. leaders? (Table 3) Can we run a tabletop exercise Step through the escalation procedure. 2 using the escalation procedure? How well does the escalation Following the first escalation from a CUS event, procedure actually work? prepare to debrief: (a) How well did the 3 (Commit to review by senior escalation procedure work? (b) Do you need leaders.) any changes to the steps or in training staff? For one day: Adjust the daily huddle agenda to Can we integrate CUS language ask about use of CUS language tool the 4 review into the Daily Huddle? previous day.
PDSA Cycle # What question(s) are you trying to answer? Preparation (examples) 1 Can we draft an "escalation from CUS event" procedure acceptable to organization leaders? (Table 3) Find your organization’s procedure format or use our default format. 2 Can we run a tabletop exercise using the escalation procedure? Step through the escalation procedure. 3 How well does the escalation procedure actually work? (Commit to review by senior leaders.) Following the first escalation from a CUS event, prepare to debrief: (a) How well did the escalation procedure work? (b) Do you need any changes to the steps or in training staff? 4 Can we integrate CUS language review into the Daily Huddle? For one day: Adjust the daily huddle agenda to ask about use of CUS language tool the previous day. Table 3. Example: CUS Contact Person On-Call Response to an Escalated Urgent Concern Name of Activity: Response to Escalation of an Urgent Concern Role performing Activity: CUS contact person (CUS contact person needs to be onsite and assigned every day the center is open to see patients; if primary contact person offsite, then another contact person must be designated.) Location: Our Surgical Center Activity Owner: Center Administrator Unit originating this activity description: Our Surgical Center Date Prepared: 4/15/2016 Last Revision: Date Approved: 4/29/2016 Step Step Definition (Brief summary of task) Time to complete
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