Clinical Immersion Project/Project Development Part A


1.Conduct an assessment of the Microsystem in which you are completing your clinical immersion experience using the 5P’s framework from your readings.

  1. Identify a specific patient cohort within a Microsystem.

3.Identify a particular problem associated with the clinical management of this selected patient cohort.

4.Perform a root cause analysis of the identified problem. Med/Surg Unit at a VA Hospital- Problem Post-Infection in Total Knee Arthoplasty. Please include Reference page.  5P-purpose,patients,professionals,processes, and patterns.


Clinical Immersion Project

Assessment of the Microsystem

Purpose – an effective microsystem should have a purpose and clearly outlined mission statement. The purpose helps in outlining the sole reason for the existence of the microsystem. It also helps in developing common goals. The purpose of VA Hospital is to provide care to those who have “borne the battle” including their close relatives (U.S. Department of Veterans Affairs, 2016).

Patients – all members within the microsystem develop professional relationships with the patients they attend to in order to gain more knowledge about them. Members learn about the patients’ lifestyle, work-life, their perception on the quality of care provided, the pain they undergo from the condition(s) being treated, and among other details.

Professionals – all members providing care to patients within the microsystem are regarded as professionals. Staff members at VA develop positive relations and work as a team towards accomplishing the hospital’s goals. In order to gain a better understanding of the microsystem, staff surveys are conducted on regular basis. In such surveys, staff members are able to express their opinion on how services can be improved.

Processes – in a hospital setting, there are numerous processes to be observed in the care of patients. Tasks may at times overlap, while at other times they may be complementary. Often, a flowchart is developed to indicate how the sequence of events inn caring for the patients.

Patterns – in any microsystem, there are patterns which are the result of routine procedures. At VA Hospital, meetings are held weekly to review quality of care provide to patients and to discuss new events.

Specific patient cohort

Specific patient cohorts describe a group of patients who share a particular characteristic.  In the microsystem, a specific patient cohort can be the risk of post-infection in total knee arthroplasty in patients suffering from diabetes mellitus. Poor surgical outcomes are associated with patients suffering from diabetes mellitus. This is associated with poor glycemic control among patients suffering from diabetes. Poor glycemic control leads to post-operation infections with adverse impacts on patients’ health. The most common type of post-operation infection is deep vein thrombosis.

Problem associated with management of the particular cohort

Diabetes is a risk factor following a total knee arthroplasty surgery among patients (Yang et al., 2015). Diabetes mellitus, among other patient-factors such as smoking, obesity, and age have been attributed to the development of deep vein thrombosis. The particular problem associated with the management of the particular cohort is the severe impact of diabetes on multiple organs of the patients. Combined with total knee arthroplasty, diabetes may lead to severe outcomes following surgery. This occurs especially in the diabetes is poorly controlled among patients. When diabetes is poorly controlled, bone, tissue and tendon healing are negatively impaired (Yang et al., 2015). Diabetes may lead to certain diseases such as renal disease and neuropathy which may impact the healing process and contribute to post-operation infections such as deep vein thrombosis.

Root cause analysis of the identified problem

Post-infection in total knee arthroplasty is a common problem affecting most patients. Contamination during surgery is the most common cause of deep infections following a total knee arthroplasty. Wound contamination may arise from both the patient as well as the surgeon (Bryan & Yarbrough, 2013). This makes it difficult to pinpoint the specific cause of the problem. The surgical wound is least resistant to bacterial and other microorganisms which cause disease. This makes it particularly vulnerable to deep infections which may affect the bone tissue. The presence of other risk factors such as diabetes mellitus, obesity, smoking, and age also impact the risk of developing deep infections following surgery.


Bryan, C. S., & Yarbrough, W. M. (2013). Preventing Deep Wound Infection after Coronary       Artery Bypass Grafting: A Review. Texas Heart Institute Journal40(2), 125–139.

U.S. Department of Veterans Affairs. (2016). About VA. Retrieved from:   

Yang, G., Meng, F., Liu, Y., Kong, L., & Shen, Y. (2015). Diabetes mellitus and risk of deep       vein thrombosis after total knee replacement: a meta-analysis of cohort studies. International Journal of Clinical and Experimental Medicine,8(6), 9086–9092.

Improvement Science Research Network.  Class is for Clinical Nurse Leader (CNL). I work at a VA Hospital