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Emergency Department Quality Improvement
The document discusses quality improvement initiatives for emergency departments. It notes that timely treatment in the emergency department is key to quality care outcomes for patients. It provides examples of quality indicators for conditions like acute myocardial infarction and pneumonia that can be used to measure and improve care. The document advocates for a multidisciplinary team approach, data sharing between hospitals, and engaging medical staff and customers to support quality improvement goals.
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Emergency Department Quality Improvement
- 1. Emergency Department Quality Improvement AbdulazizSaddique Pharm.D., CPHQ Associate executive Director for Quality Management College of Medicine and the University Hospitals
- 2. Dr. Abdulaziz Saddique2TIMELY SERVICES IS THE KEY TO QULAITY EMERGENCY DEPARTMENT SERVICES
- 3. Why ED QualityProgram To improve quality of care Provided by the Emergency Departments to increase the “early indicator” rates for serious diseases e.g., MI, Pneumonia
- 4. Dr. Abdulaziz Saddique4 Why ED Quality Program Patients Outcome Is Dependant On Initial Treatment Carried Out In The Emergency Department in Timely Manner.
- 5. Dr. Abdulaziz Saddique5 Healthcare Quality Scenario Activity Process (Chain of activities) Product 3 Process quality Throughput time, conformance to protocols, avoidance of wasteful resource usage 1 Effectiveness Fit to customer needs, benefit to the customer's) 2 Product quality • Fit to specifications • Customer satisfaction • Quality as seen by a peer 4 Organizational quality Employee satisfaction Structures, systems
- 6. Dr. Abdulaziz Saddique6 Examples of Indicators Acute Myocardial Infarction Community Acquired Pneumonia
- 7. Dr. Abdulaziz Saddique7 AMI Indicators Aspirin at hospital arrival Beta blocker at hospital arrival unless contraindicated. Thrombolytic agent received within 30 minutes of hospital arrival PTCA received within 90 minutes of hospital arrival
- 8. Dr. Abdulaziz Saddique8 Preliminary Baseline Indicator Rates for AMI 80.5 61.2 33.3 9.1 80.0 60.8 26.5 27.4 95.2 88.0 85.7 85.7 0 10 20 30 40 50 60 70 80 90 100 Quality of Care Measure Percent(%) Michigan National Benchmark ASA within 24 hrs. BB within 24 hrs. Lytic < 30 min. PTCA < 90 min.
- 9. Dr. Abdulaziz Saddique9 Pneumonia Indicators Initial antibiotic received within 4 hours of hospital arrival Initial antibiotic selection for community- acquired pneumonia (CAP) in immunocompetent patients Blood culture performed before first antibiotic received in hospital Oxygenation assessment (arterial blood gas measurement or pulse oximetry)
- 10. Dr. Abdulaziz Saddique10 Preliminary Baseline Indicator Rates for Pneumonia 57.5 59.6 76.2 93.4 59.7 58.8 81.1 93.7 100.0 87.9 95.7 0 10 20 30 40 50 60 70 80 90 100 Quality of Care Measure Percent(%) Michigan National Benchmark n/a ABX < 4 hrs. Rec. ABX BC Before ABX Oxygenation
- 11. Dr. Abdulaziz Saddique11 Whole system Ownership Primary Care ReformingEmergency Care See & Treat A&E Emergency Services Collaborative Triage Bed management Streaming M inors Majors Ambulance SICU Walk-in Centre Social Care MICU Triage
- 12. Dr. Abdulaziz Saddique12 Basics of Quality Improvement Vision, and Mission Strategy Innovation Team Work Momentum Growth Focus Customer Service Attitude
- 13. Dr. Abdulaziz Saddique13Nothing happens unless first a dream
- 14. Dr. Abdulaziz Saddique14 Vision. The vision of the organization begins with its leadership. YOU WILL MAKE $10000000000
- 15. Dr. Abdulaziz Saddique15 Vision Without vision there will be nothing to look forward to. There will be no clear path to follow It will be a Blind leading Blind
- 16. Dr. Abdulaziz Saddique16 Change Requires Shifts in Knowledge, Skills and Attitudes Knowledge Habits Behavior Mindset What? Why? Want ToHow To? Skills Attitude and Desire
- 17. Dr. Abdulaziz Saddique17 Those who are victorious plan effectively and change decisively. They are like a great river, that maintains its course, but adjusts its flow.
- 18. Dr. Abdulaziz Saddique18 Process of Strategy Development Vision, and mission statement and accountability. Evaluation of your organizational performance. Customer’s satisfaction. Market analysis Departments functions. Monitoring of your services. Updating of your services.
- 19. Dr. Abdulaziz Saddique19 If There Is A Better Solution, Find It.
- 20. Dr. Abdulaziz Saddique20 Innovation Development or adaptation of Indicators Critical Pathways Standardized treatment
- 21. Dr. Abdulaziz Saddique21 Teamwork Is The Ability To Work Together Towards A Common Vision. It Is A Fuel That Allows Common People To Attain Uncommon Results.
- 22. Dr. Abdulaziz Saddique22 Why Use Teams ? Participation allows an individual: The opportunity to contribute ideas To experience the change process To have clear understanding of the objective To gain a sense of ownership To become committed to the process and become a change advocate
- 23. Dr. Abdulaziz Saddique23 Medical Staff involvement Medical staff are: The driving force of the healthcare facility. The heads of the healthcare teams. The operators of the organization. Carry the responsibility of the well being of the patients.
- 24. Dr. Abdulaziz Saddique24 A Little Push In The Right Direction Can Make A Big Difference.
- 25. Dr. Abdulaziz Saddique25 Momentum Each organization or Administration have differ motivating factors, find the most appropriate motivating factor for your organization to get your Vision supported.
- 26. Dr. Abdulaziz Saddique26 First Things First Quality Improvement is not valid unless we have the infrastructure for it.
- 27. Dr. Abdulaziz Saddique27 Golden Rule PUT THE HORSE BEFORE THE CARRAGE NOT THE CARRAGE BEFORE THE HORSE
- 28. Dr. Abdulaziz Saddique28 QI Infrastructure Development Set up the Standards of Care Select team members trained in CQI application Develop an Aim Statement Develop Policies and Procedures Develop Indicators for Care Identify areas of deficiencies
- 29. Dr. Abdulaziz Saddique29 The rung of a ladder was never meant to rest upon, but only to hold your foot long enough to put the other foot higher.
- 30. Dr. Abdulaziz Saddique30 Growth Setting the standards is the first stepping stone towards quality services. Your goals should include standards improvement through continuous quality improvement.
- 31. Dr. Abdulaziz Saddique31 Obstacles Are Those Frightful Things You See When You Fail To Focus On Your Goals.
- 32. Dr. Abdulaziz Saddique32 Focus Focusing on the Goals of your organization or department is essential in removing all obstacles or problem related to your service.
- 33. Dr. Abdulaziz Saddique33 Success In Business And Customer Service Go Hand In Hand.
- 34. Dr. Abdulaziz Saddique34 Customer Service Quality is dictated by customers not the organization. Customer satisfaction (either internal or external) is the most valuable assets of the organization.
- 35. Dr. Abdulaziz Saddique35If It Is To Be … It Is Up To Me.
- 36. Dr. Abdulaziz Saddique36 Attitude Nothing is free, you have to work for your goals and objectives Make your goals and objectives visible for others Your staff are your best assets get them involved Dreams can come true if you want them to.
- 37. Dr. Abdulaziz Saddique37 EDQIP Action Plan Launch QI conference Participate in shared-learning sessions Develop QI projects Involve all your staff Identify your customers (internal) Develop project team Listen to your customers
- 38. Dr. Abdulaziz Saddique38 Customers Participation Discussion Points Highlight ED strategies Speak with DATA Don’t criticize any one Compare individual ED rates with peer group and state aggregate rates Outline your plan for Improvement Ask for support to your mission
- 39. Dr. Abdulaziz Saddique39 Quality Improvement Strategies in the ED Join EDQIP! Rapid-cycle initiatives Multidisciplinary team approach Share interventions with other hospitals
- 40. Dr. Abdulaziz Saddique40 What Works to Improve Care? Role of Systems-based Improvement CME and didactic programs have little impact on changing behavior! Effective strategies include reminder systems standing orders clinical pathways or protocols opinion leaders and physician champions self-monitoring and feedback Davis DA, et al. JAMA. 1995;274:700-706.
- 41. Dr. Abdulaziz Saddique41 “QUALITY OF CARE” . . . An elusive concept??? “Like Beauty, quality of care is in the eye of the beholder. It can't be defined or measured.” "Quality of care is like the weather; everyone talks about it, but you can't do anything about it."
- 42. Dr. Abdulaziz Saddique42 ED Quality Improvement Programs Washington University/ Barnes Hospital: Aim: to decrease waiting time in the ED to < 180 min. Process: Patients flow study Adjusting Hours of Operations Expediting initial evaluation, reducing turn-around time for lab radiology and expediting specialty consultations Outcome: The waiting time was decreased to less than 160 min.
- 43. Dr. Abdulaziz Saddique43 Melbourne Metropolitan Hospital Aim: Decrease ED Length of Stay (LOS), and resolve bed access block Process: Use of protocols for common conditions Transparent bed-management processes, Focus on efficient use of the available beds, particularly through admission and discharge planning. Outcome: Decrease waiting time in EDLOS, more beds became available for Critical patients
- 44. Dr. Abdulaziz Saddique44 Principles for Integrated Bed Management 1. There is an organization led commitment to manage all hospital beds. 2. There is a centralized point of authority and accountability for the allocation of all hospital beds. 3. A bed management forum is established to identify and resolve bed management problems. The hospital executive supports this forum. 4. A documented policy framework supports integrated bed management principles. 5. The function of allocating all hospital beds is centralized.
- 45. Dr. Abdulaziz Saddique45 Principles for Integrated Bed Management 6. Bed allocation staff has appropriate authority to allocate beds. 7. Integrated bed management occurs 24 hours per day, every day. 8. Integrated bed management must be linked with the needs of inbound and outbound patient traffic 9. Allocation of hospital beds is based on agreed medical criteria. 10. The allocation of beds to clinical units is notional.
- 46. Dr. Abdulaziz Saddique46 Principles for Integrated Bed Management 11. A flexible bed base is built into the operating requirements to meet fluctuating bed demands. 12. Patients are admitted to their correct specialty ward/unit on admission or within 24 hours where appropriate. 13. A patient’s episode of care is planned from pre- admission/emergency, through admission and discharge back to the community. Patients and carers are partners in this process. 14. An interdisciplinary team plans and coordinates care and support services for a patient’s episode of care.
- 47. Dr. Abdulaziz Saddique47 Principles for Integrated Bed Management 15.Integrated bed management is supported by accurate real time information. Data is continuously collected, audited, analyzed and disseminated to guide resource management and optimize efficiency.
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- 49. Dr. Abdulaziz Saddique49 Questions/discussion
Editor's Notes
- #2 Emergency departments are specialist multidisciplinary units with expertise in managing acutely unwell patients for the first few hours in hospital. Neither the facilities (generally poor privacy, small trolleys, 24-hour lighting) nor the staff are appropriate for providing longer term inpatient care. Very few patients who require an inpatient bed benefit from staying in the ED longer than 4 hours, and no ED benefits by caring for patients beyond this time. If the 30% or so of patients who are admitted spend twice as long in the ED, this represents a 30% increase in workload for ED staff with no change in conventional measures of activity (presentations, admission rate).
- #19 The first step as we stated earlier is the vision of the leadership, vision states the future where the organization wants to be at the said time driven by values which covers the accountability, continuous improvement, customer driven services, and the quality of the services provided.