"Best practices" guidelines can facilitate quality of care improvements in the emergency department

Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, ‘THERMoSTAT’ (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women’s Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222 645 presentations, 68 000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24 h or first 4 h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.

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How to improve quality of care in overcrowded emergency departments? Development and evaluation of a virtual research environment. (Preprint)

10.2196/preprints.13993 ◽

2019 ◽

Author(s):

Charles-Henri Houze Cerfon ◽

Christine Vaissié ◽

Laurent Gout ◽

Bruno Bastiani ◽

Sandrine Charpentier ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Quality Of Care ◽

Simulated Patients ◽

Emergency Physicians ◽

Research Environment ◽

Significant Difference ◽

Ed Overcrowding ◽

Virtual Research Environment

BACKGROUND Despite wide literature on ED overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. OBJECTIVE We sought to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviours on quality of care in the context of emergency department overcrowding. METHODS A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in Emergency Medicine combining virtual reality and simulated patients has been designed and developed. Then, twelve emergency physicians took part in simulation scenarios and had to manage thirteen patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency and mastering. The realism was the resemblance perceived by the participants between virtual and real Emergency Department. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% of the participants. RESULTS The virtual emergency department was considered realistic with no significant difference from the real world concerning facilities and resources except for the length of time of procedures that was perceived to be shorter. 100% of participants deemed that patient information, decision-making and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. CONCLUSIONS The new simulation tool, Virtual Research Environment in Emergency Medicine has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared to real EDs and thus offers another way to study human factors, quality of care and patient safety in the context of ED overcrowding.

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National Trends in Emergency Department Use, Care Patterns, and Quality of Care of Older Adults in the United States

Journal of the American Geriatrics Society ◽

10.1111/jgs.12072 ◽

2013 ◽

Vol 61 (1) ◽

pp. 12-17 ◽

Cited By ~ 153

Author(s):

Jesse M. Pines ◽

Peter M. Mullins ◽

James K. Cooper ◽

Lisa B. Feng ◽

Katalin E. Roth

Keyword(s):

United States ◽

Older Adults ◽

Emergency Department ◽

Quality Of Care ◽

The United States ◽

Emergency Department Use ◽

Care Patterns ◽

National Trends

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Abstract WP237: Improved Thrombolysis Rates and Quality of Care for Stroke Patients Through a Provincial Emergency Department Quality Improvement Initiative

Stroke ◽

10.1161/str.44.suppl_1.awp237 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Devin R Harris ◽

Robert Stenstrom ◽

Eric Grafstein ◽

Mark Collison ◽

Grant Innes ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Of Care ◽

Performance Measures ◽

Large Scale ◽

Primary Outcome ◽

Baseline Data ◽

Quality Improvement Initiative ◽

Stroke Patients

Background: The care of stroke patients in the emergency department (ED) is time sensitive and complex. We sought to improve quality of care for stroke patients in British Columbia (B.C.), Canada, emergency departments. Objectives: To measure the outcomes of a large-scale quality improvement initiative on thrombolysis rates and other ED performance measures. Methods: This was an evaluation of a large-scale stroke quality improvement initiative, within ED’s in B.C., Canada, in a before-after design. Baseline data was derived from a medical records review study performed between December 1, 2005 to January 31, 2007. Adherence to best practice was determined by measuring selected performance indicators. The quality improvement initiative was a collaboration between multidisciplinary clinical leaders within ED’s throughout B.C. in 2007, with a focus on implementing clinical practice guidelines and pre-printed order sets. The post data was derived through an identical methodology as baseline, from March to December 2008. The primary outcome was the thrombolysis rate; secondary outcomes consisted of other ED stroke performance measures. Results: 48 / 81 (59%) eligible hospitals in B.C. were selected for audit in the baseline data; 1258 TIA and stroke charts were audited. For the post data, 46 / 81 (57%) acute care hospitals were selected: 1199 charts were audited. The primary outcome of the thrombolysis rate was 3.9% (23 / 564) before and 9.3% (63 / 676) after, an absolute difference of 5.4% (95% CI: 2.3% - 7.6%; p=0.0005). Other measures showed changes: administration of aspirin to stroke patients in the ED improved from 23.7% (127 / 535) to 77.1% (553 / 717), difference = 53.4% (95% CI: 48.3% - 58.1%; p=0.0005); and, door to imaging time improved from 2.25 hours (IQR = 3.81 hours) to 1.57 hours (IQR 3.0), difference = 0.68 hours (p=0.03). Differences were found in improvements between large and small institutions, and between health regions. Conclusions: Implementation of a provincial emergency department quality improvement initiative showed significant improvement in thrombolysis rates and adherence to other best practices for stroke patients. The specific factors that influenced improvement need to be further explored.

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A Recent Systematic Review on Simulation Modeling and Emergency Departments

Emergency and Disaster Management ◽

10.4018/978-1-5225-6195-8.ch057 ◽

2019 ◽

pp. 1232-1264

Author(s):

Soraia Oueida ◽

Seifedine Kadry ◽

Pierre Abi Char

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Patient Satisfaction ◽

Quality Of Care ◽

Simulation Modeling ◽

Recommended Care ◽

Recent Systematic Review ◽

Increase Patient Satisfaction ◽

System Review

Healthcare, being a complex and huge system, suffers from low quality of care delivered to arriving patients. The quality of care depends on the patient's condition and the availability of hospital's resources. Therefore, many authors have studied the problems faced by such systems and emphasized in their articles the importance of a system review for better performance. In healthcare, different departments interact with each other in order to deliver a certain service to arriving patients and provide the recommended care. In particular, the emergency department (ED) is proven to be the busiest unit of the hospital; thus, the exiting problems and recommended solutions are highlighted in this study by a literature systematic review. The main goal of this article is to study the problems that EDs face nowadays and how simulation modeling can interfere in order to alleviate these problems, propose corresponding solutions and increase patient satisfaction.

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