Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 40-year-old man with acute myocardial infarction is admitted to a community hospital's cardiac care unit. He receives timely reperfusion therapy and is discharged after an uncomplicated 3-day hospitalization. The hospital's quality improvement team reviews the past 2 years of in-hospital mortality data for acute MI patients and finds a rate of 3.1% compared to the national benchmark of 2.8% (p = 0.18). The hospital administrator, concerned about the hospital's reputation, requests that the team immediately implement new protocols and purchase expensive cardiac monitoring equipment to improve outcomes. Which of the following best represents the appropriate next step based on principles of statistical quality control and process improvement?
Answer choices
- AImplement the new protocols and equipment immediately, as any difference from the national benchmark warrants intervention regardless of statistical significance
- BRecognize that the observed difference is likely due to random variation and focus improvement efforts only on identified special cause variation with statistical significanceCorrect answer
- CRepeat the analysis monthly and implement interventions as soon as statistical significance (p < 0.05) is achieved, even if based on small sample sizes
- DEliminate the collection of mortality data to avoid unfavorable comparisons that create pressure from administration
- EIncrease the sample size by including data from 5 years or more to determine whether a true difference exists before considering any interventions
- FAssume the 0.3% difference represents a genuine quality problem and implement interventions without further statistical analysis
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