FACRRM Quality Assurance and Improvement 2 — Questions and Answers
Question 1: In a rural practice, you notice a pattern of delayed diagnosis of sepsis. Which QI methodology is BEST suited to rapidly test a small-scale change before wider implementation?
- Root Cause Analysis
- Plan-Do-Study-Act (PDSA) cycle (Correct answer)
- Failure Mode and Effects Analysis
- Clinical audit
Correct answer: Plan-Do-Study-Act (PDSA) cycle
The PDSA cycle is designed for iterative, small-scale testing of changes before broader rollout.
Question 2: A critical incident review finds that a patient with chest pain waited 45 minutes before ECG. The MOST appropriate immediate systemic response is:
- Discipline the triage nurse
- Implement a chest pain protocol with mandatory ECG within 10 minutes (Correct answer)
- Increase staffing levels
- Retrain all nursing staff in triage
Correct answer: Implement a chest pain protocol with mandatory ECG within 10 minutes
Systemic protocol change addresses the process failure rather than blaming individuals.
Question 3: Which type of clinical indicator measures the percentage of diabetic patients with HbA1c checked in the past 12 months?
- Outcome indicator
- Process indicator (Correct answer)
- Structure indicator
- Sentinel event indicator
Correct answer: Process indicator
A process indicator measures whether a recommended care step was performed.
Question 4: When reviewing patient safety incidents, a 'near miss' is defined as:
- An event that caused minor patient harm
- An event that was caught before reaching the patient (Correct answer)
- An event requiring mandatory notification
- An event involving medication error only
Correct answer: An event that was caught before reaching the patient
A near miss is an event that could have caused harm but was intercepted before reaching the patient.
Question 5: The Donabedian framework for healthcare quality assessment uses which three domains?
- Input, Process, Output
- Structure, Process, Outcome (Correct answer)
- Prevention, Treatment, Rehabilitation
- Safety, Effectiveness, Patient-centeredness
Correct answer: Structure, Process, Outcome
Donabedian's framework evaluates Structure (resources), Process (care delivery), and Outcome (results).
Question 6: In a rural emergency department, a fishbone (Ishikawa) diagram is used to investigate a medication error. This tool primarily helps to:
- Quantify error frequency
- Identify all potential contributing causes (Correct answer)
- Prioritize corrective actions by cost
- Compare error rates between facilities
Correct answer: Identify all potential contributing causes
The fishbone diagram is a cause-and-effect tool that maps all potential contributing factors to a problem.
Question 7: A practice wants to reduce missed cervical cancer screening. Which approach follows the clinical audit cycle correctly?
- Set standard → measure → implement change → re-audit (Correct answer)
- Identify problem → implement change → set standard → measure
- Measure → set standard → implement change → close file
- Implement change → measure → identify problem → re-audit
Correct answer: Set standard → measure → implement change → re-audit
The correct audit cycle is: set standard, measure current performance, implement change, then re-audit to close the loop.
FACRRM Quality Assurance and Improvement 2
In a rural practice, you notice a pattern of delayed diagnosis of sepsis.
Which QI methodology is BEST suited to rapidly test a small-scale change before wider implementation?