Emergency Department Intervention Program for Enhancing Choice at the End of Life: A Quality Improvement Project at a Comprehensive Cancer Center

242 Background: Emergency Department (ED) surges at MD Anderson Cancer Center (MDACC) lead to overcrowding, safety risks, privacy concerns, staff burnout, and adverse events associated with delays in care, including death. In 2015, the ED Interdisciplinary Quality & Safety Committee (EDIQSC) at MDACC was developed to review and address safety events. We report on the preliminary results of a quality improvement project with a long-term goal of developing a systematic solution of proactively responding to ED surge and overcrowding (EDSO). Methods: First, EDIQSC reviewed the current literature regarding EDSO. Subsequently an ED Surge and ED Overcrowding Committee (EDSOC) was established to identify solutions to address patient safety risks and improve patient experience in the ED. Results: Literature review showed that NEDOCS (Weiss, SJ et al) was the best scoring tool to calculate ED Overcrowding levels. EDSOC’s weekly meetings facilitated by the Office of Performance Improvement (OPI) explored factors related to EDSO via FMEA a quality improvement tool that proactively evaluate process associated risks. In addition, the following immediate solutions were implemented in the ED: daily status reporting by ED to institutional leaders, a “fast-track” care area implementation, senior executive rounding during ED Surge, electronic medical record (EMR) configuration for high census accommodation, continuous ED Nursing Leadership unit needs assessment, and prioritization of needs based on hospital throughput. Additional interventions in current development include a real-time EMR dashboard accurately reflecting ED capacity, and a NEDOCS guided interdisciplinary operational action plan. Conclusions: ED Surge & Overcrowding is a complex issue with various external and internal contributing factors that cannot be solved with one approach. It is a dynamic, interdisciplinary system that requires vigilant planning, assessment of downstream change effects, stakeholder agility and continuous risk anticipation. EDSOC continues these efforts in an attempt to develop and implement a comprehensive, interdisciplinary tool to direct institutional operations during times of ED Surge & Overcrowding.

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Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting

Spartan Medical Research Journal ◽

10.51894/001c.21376 ◽

2021 ◽

Author(s):

Tomasz Przednowek ◽

Camille Stacey ◽

Katherine Baird ◽

Robert Nolan ◽

Jesse Kellar ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Emergency Department Setting ◽

Post Code

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Chameleon project: a children’s end-of-life care quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2021-001520 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001520

Author(s):

Toni Wolff ◽

Caroline Dorsett ◽

Alexander Connolly ◽

Nicola Kelly ◽

Jennifer Turnbull ◽

...

Keyword(s):

Quality Improvement ◽

End Of Life ◽

End Of Life Care ◽

Quality Improvement Project ◽

Care Planning ◽

Life Care ◽

Marginal Rate ◽

Improvement Project ◽

Care Plans ◽

Bed Days

In response to there being no specialist paediatric palliative care (PPC) team in a region of England, we undertook a 12-month quality improvement project (funded by National Health Service England’s Marginal Rate Emergency Threshold and Readmission fund) to improve children’s end-of-life care.Improvements were implemented during two plan–do–study–act (PDSA) cycles and included specialist experts, clinical champions, focused education and training, and tools and materials to support identification, care planning and communication. A lead paediatrician with expertise in PPC (10 hours/week) led the project, supported by a PPC nurse (3 days/week) and a network administrator (2 days/week).Children who died an expected death were identified from the child death review teams. Numbers of non-elective hospital admissions, bed days, and costs were identified.Twenty-nine children died an expected death during the 12 months of the project and coincidentally 29 children died an expected death during the previous 12 months. The median number of non-elective admissions in the last 12 months of life was reduced from two per child to one. There was a reduction in specialist hospital (14%) and district general hospital (38%) bed days. The percentage of children who died an expected death who had anticipatory care plans rose from 50% to 72%.The results indicate that a network of clinicians with expertise in PPC working together across a region can improve personalised care planning and reduce admissions and bed days for children in their last year-of-life with reduced bed utilisation costs.

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