**9.3 Continuous quality improvement (CQI)**

As discussed above, the tracking of outcome data should be a key component to helping measure program growth and success. Such initiatives must be established from the onset and involve the program champions—both clinical and administrative leaders to be successful. While it is important to review cases in the context of


**45**

**10.2 Marketing**

**10.3 Outreach**

*Clinical and Administrative Steps to the ECMO Program Development*

means, comprehensive, various CQI topics are listed in **Table 3**.

referral sources easily retain a connection to the program.

tracking outcomes—both good and bad—from a programmatic standpoint, it is also important to examine outcome summary data with the focus of exploring potential opportunity for improvement. It should be a primary objective of the ECMO team to consider periodic continuous quality improvement (CQI) activities. The activities should be viewed as opportunities to review best practices, current literature on various topics, and metrics with the focused goal of improving outcome metrics—while the primary focus should always be on improving patient survival, other metrics, program practices, and guidelines should also be considered as topics for review. Key topics can be identified, champions identified, and a timeline established for review and the development of potential action plans. While the specific details of how to develop and implement CQI is out of the scope of this topic—it does emphasize the importance of engaged administrative leadership individuals and team who have established experiences with these programmatic and institutional activities. By no

Once the complex set of internal processes, personnel, and patient care skills are established, the ECMO program has the potential to serve patients in a wide area around the ECMO center. To assure that other hospitals and emergency facilities have the information to know of the resources available, and when to engage them, the primary facility should engage a multi-pronged approach to raise awareness and clinical decision-making skills of potential patient care partners. As with all endeavors, this should be done in the WIIFM (What's In It For Me) with the patient and practitioner at the outlying facilities interests' in mind. A good place to begin this is to address the benefits to the patient, the current science that supports the need for ECMO, the parameters for consideration of ECMO support, the process to easily move the patient, and the resources to enhance education of the topic. This is accomplished by marketing informational materials, individual outreach to create awareness, an education program that includes lectures, publication of successes, a plan for follow-up communication to the referring institution to help them understand the results of their referrals, and finally, by creating branding that helps the

Marketing materials should ideally be created to reflect the ECMO program as a larger system of care around ARDS and shock. In addition to the organization housing the ECMO program, clear guidance on referral processes (see Call Center Section), there should also be some succinct explanation of the use of VV and VA ECMO, parameters for initiation of referral, as well as references to studies supporting the decision. Consideration should be given to having two sets of guidance; one for critical access lower acuity facilities/ER's and one geared toward facilities with ICU care directed by intensivists, as the threshold for referral will be different.

The personal touch of a visit cannot be underestimated when establishing trusted referral center status for complex procedures such as ECMO. It affords a chance to create personal trust, as well as allowing answers to questions are procedures and

*DOI: http://dx.doi.org/10.5772/intechopen.84838*

**10. Miscellaneous topics**

**10.1 Referral sources engagement**

#### **Table 3.**

*Suggested topics for continuous quality initiatives*

*Clinical and Administrative Steps to the ECMO Program Development DOI: http://dx.doi.org/10.5772/intechopen.84838*

tracking outcomes—both good and bad—from a programmatic standpoint, it is also important to examine outcome summary data with the focus of exploring potential opportunity for improvement. It should be a primary objective of the ECMO team to consider periodic continuous quality improvement (CQI) activities. The activities should be viewed as opportunities to review best practices, current literature on various topics, and metrics with the focused goal of improving outcome metrics—while the primary focus should always be on improving patient survival, other metrics, program practices, and guidelines should also be considered as topics for review. Key topics can be identified, champions identified, and a timeline established for review and the development of potential action plans. While the specific details of how to develop and implement CQI is out of the scope of this topic—it does emphasize the importance of engaged administrative leadership individuals and team who have established experiences with these programmatic and institutional activities. By no means, comprehensive, various CQI topics are listed in **Table 3**.
