Create a PDSA ( plan-do- study- analyze) cycle for the following case study, taking miscommunication as core problem and also taking all the challenges occurred in the case study. Implement a communication plan regarding the same.

Case Study: a summary Carla is a 29 year old girl with a congenital disease of renal failure due to polycystic kidney disorder. She is suffering from a chronic medical condition, so requires frequent dialysis (3 times a week). During her treatment process, Carla feels that healthcare system is too complex as it has numerous rules before any process. Carla's Journey: o Day1 (Monday): When Carla goes for dialysis, nephrologist notices poor blood flow through her arteriovenous fistula Nephrologist orders for an ultrasound. An appointment is given: HANDWRITTEN, at a location which has complex bus schedule, which is not feasible for her to reach on time (at 9am the next day). Day 2 (Tuesday): Carla reaches late by 30 minutes. She is rescheduled for ultrasound two days later (Thursday), as the hospital has policy to reschedule the appointment for those who are late by 15 minutes. Case Study: a summary Day 3 (Wednesday) Day 7 (Sunday) Day 25 (Thursday) Day 36 (Monday) Day 39 (Thursday) Day 40 (Friday) + No flow of blood through fistula, test is ordered by Nephrologist Carla is sent to ED Ultrasound shows a significant blood clot Carla is hospitalised medications are given to break clot (tPA heparin, warfarin) Dialysis is done . Nurse gives written Discharge instruction, discharge summary is mailed to primary care physician [PCP). Nurse suggests Carla to see PCP 10 check INR on weekly basis, which is resolved to be done at dialysis Nutritionist appointment done by nurse, which is unclear as did Carla received it or not, no contact with Carla Carla is discharged. Carla feels low and sick, skips the dialysis. Nurse calls Carla, but gets absorbed in another patient Carla's face tingling feeling exhausted Carla is admitted to ED as she has deep venous thrombosis. Carla says she informed for checking INR during dialysis, but it wasn't checked as assistant did not know about the process Carla ate spinach from day 8-24, as she did not meet nutritionist which counteracts the effect of warfarin Her INR level was 1.1. for which she was given medication Miscommunication was the key issue Carla is rehospitalized Walt time for 2 hours before lab tests arrive Physician gives "CURSORY EXAM Potassium levels high, at critical value. Technician calls ED nurse about same, who further inform ED physician, and an immediate dialysis is done INR levels entered on computer Medical Student notices Carla's condition, but did not voice it INR level checked and emergency CT scan was done. Acute subdural hematoma found. Surgery done She has slow recovery, with short term memory deficits. Carla is dependent on others now and ends up at LTCH o here PDSA Worksheet for Testing Change Aim: (overall goal you wish to achieve) Every goal will require multiple smaller tosts of change Describe your first (or next) test of change: Person When to Where to responsible be done be done Plan List the tasks needed to set up this test of change Person When to Where to responsible be done bo done Predict what will happen when the test is carried Measures to determine if prediction succeeds out Do Describe what actually happened when you ran the test Study Describe the measured results and how they compared to the predictions Act Describe what modifications to the plan will be made for the next cycle from what you learned