Donabedian's Structure-Outcomes Model: A Case Study

The steps for Donabedian’s structure-process-outcomes model include defining the setting and personnel involved, describing the intervention or process taking place and how it can be improved, and assessing the outcomes by measuring goal attainment (Naranjo & Kaimal, 2011). The detailed steps were not explicitly stated within the article, but were implied through the methods the authors mentioned were used for the quality improvement process.
The authors defined the setting or structure, as the pediatric intensive care unit (PICU) where they identified the need for “a standardized review of respiratory and cardiac arrests occurring in the PICU” (Kane et al., 2012, p. 510). This was based upon data which “showed a survival to discharge rate of 13.7%... [in] children undergoing cardiopulmonary resuscitation in the hospital” (Kane et al., 2012, p.
In the process step, the team came up with metrics they found to be potentially “useful for assessing the process and quality of resuscitation events in the PICU” (Kane et al., 2012, p. 510). They then categorized the metrics by “demographics, patient risk factors, staffing, resuscitation-specific documentation, and patient outcome measures” (Kane et al., 2012, p. 510). It was considered a code event if chest compressions or intubation was provided. The data collection tool created allowed for real-time data input as the code was occurring along with a database to store the collected data for analyzation (Kane et al., 2012, p. 511). The other tool created, according to Kane et al. (2012), was directly “related to the resuscitation process” (p. 511) called the “Code Review QI Tool [and] included 5 main quality themes: pre-code recognition, clear communication, optimal code process, system failures, and points for future education” (p.