Quality Improvement & Patient Safety Section Newsletter - January 2007, Vol 8, #1
From the Chair
Jack Kelly, DO, FACEP
It is an honor to serve as this year's Chair of the ACEP Quality Improvement and Patient Safety Section. Standing on the shoulders of the past Chairs and section members, our Section really has made some fantastic strides! We reap the benefits, and so do our patients.
Let me start with our success at the Section Meeting at the ACEP Scientific Assembly in New Orleans. The meeting was called to order by Helmut Meisl, and a summary of the year's accomplishments was given.
Our Newsletter was produced for five editions this past year! (edited by Dickson Cheung). Bob Broida has been elected this year's Editor, and he will be challenged to meet last years' goal and improve the newsletter even more...with the goal of achieving ACEP Recognition for Newsletter
Another major accomplishment was the successful ACEP Grant to create an ACEP QA Course for Spring 07. Congrats to David John and team! This will really thrust our section into the mainstream of ACEP. David John and this task force continue to plan and finalize this course set for the spring. Our section also participated with other ACEP Leaders/ACEP Quality and Performance Committee to help shape/design the next Core Measures from CMS.
We also reviewed our current unfinished business, and new ideas for this year. There are several fresh ideas that may lead to a new ACEP Grant...I'll keep you posted in the weeks ahead!
The elections for officers placed Dickson Cheung as Chair-elect, Bob Broida as Newsletter Editor.
An advanced lecture on Patient Safety by Dr. Bob Wears (University of Florida) kept us all very entertained and advanced our knowledge of the subject. Thanks, Bob!
Finally, I must also welcome Angela Franklin, Esq., who is our new ACEP Section liaison. Glad to have you helping us make this section great, Angela.
In closing, I ask you all to consider an important strategy: Be the leader that you are. Lead by example. Make our patient our only boss. Bring quality and patient safety into every venue and meeting that you attend. Make it an agenda item. Make it part of your department's Mission and Vision. If you have not created a Quality Assurance Bulletin Board in your coffee room, please plan to do it this year! Post the National Patient Safety Goals (NPSG), and what your Department has been doing to accomplish these Safety Goals. If you have not strategized a measurement (pre/post innovation) process for several NPSG, you really must get this going!
Recently, we spent several shifts measuring our compliance with "Preventing Falls Strategies" i.e.: bedrails up, bed to lowest position. We posted our findings in the coffee room, and "talked it up." We found we all learned to be more vigilant, and more safety minded. We will again measure our compliance with this Preventing Falls Strategy, and hopefully we can prove that we are making strides...and we will show this to the Joint Commission when they arrive, sometime soon...unannounced.
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Chair: John (Jack) Kelly, DO, FACEP
Dr. Kelly is Associate Chair and Director of Emergency Department Quality Improvement and Patient Safety, and Director of the Senior Resident Administration Rotation at Albert Einstein Medical Center (AEMC) in Philadelphia. He is Vice President of the AEMC Medical Staff Board and Chair of the Physician Advocacy Committee of the Medical Staff Board. He holds the rank of Associate Professor at Jefferson Medical College.
Dr. Kelly also is Chair of the AEMC Pneumonia Task Force and a member of the Hospital Board's Finance/Mission Resources Committee, Medical Leadership Executive Committee, Performance Improvement Council, Cath Alert QA Group, Stroke Task Force/JHS Stroke Workgroup, and Network Mission/Vision "Alignment" Leadership Group.
He is Vice President and Board Member of the Pennsylvania Chapter of the American College of Emergency Physicians (PaACEP), and is Board Liaison and member of the Education Committee.
Nationally, he Chairs the ACEP Academic Affairs Committee, and Chairs the ACEP Quality Improvement and Patient Safety Section. Dr. Kelly has published in peer reviewed journals on Quality of Emergency Care, Patient Safety, and Emergency Airway Safety/Assessment. Recently he was awarded the AEMC Physician Partnership Award.
Chair-Elect: Dickson S. Cheung, MD, FACEP
Dr. Cheung was born and raised in Chicago. He attended MIT for undergraduate degree in mechanical engineering, returning to Chicago for medical school and emergency medicine residency at Northwestern. He has lived in Boston, Chicago, Denver, San Francisco and currently resides in Baltimore where he is an Assistant Professor at Johns Hopkins School of Medicine. His research and administrative focus is on patient quality, safety and operational efficiency.
Dr. Cheung served as the Newsletter Editor of the QIPS Section in 2005. He was Co-leader of the Syncope subsection for the Chief Complaint-based Quality Indicator grant. He also served ACEP as the emergency medicine representative for the Sinusitis Guideline Panel sponsored by the Academy of Head and Neck Surgeons.
Secretary / Newsletter Editor: Robert I. Broida, MD, FACEP
Dr. Broida is Chief Operating Officer of Physicians Specialty Limited, Risk Retention Group (PSLRRG), a South Carolina captive insurance company serving the Ohio-based Emergency Medicine Physicians, Ltd. group. He serves on the Board of Directors of PSLRRG, the Ohio Chapter of the American College of Emergency Physicians and of the Northeast Ohio Society of Emergency Medicine in Cleveland.
Dr. Broida is a member of the national ACEP Medical-Legal and Quality and Performance Committees. He is also a member of the ACEP Sections on Quality Improvement / Patient Safety and Emergency Medicine Practice Management and Health Policy.
Co-Editor: Elaine A. Thallner, MD, MS, FACEP
Dr. Thallner is an emergency physician at Cleveland Clinic Foundation and recently completed the National Veteran's Administration Healthcare Quality Fellowship and earned a MS in Organizational Development and Change. She has served on state governmental affairs committees, is an ACEP Councilor for Ohio, and is on the national ACEP State Legislative and Regulatory Committee. She has led quality improvement efforts, taught residents how to design quality improvement projects and coached them through their projects, done research in patient safety, and is an executive coach, a wife, and a proud parent of five children.
Councillor / Past Chair: Helmut W. Meisl, MD, FACEP
Dr. Meisl is the Quality Improvement Director for the Emergency Department at Good Samaritan Hospital in San Jose, and practices clinically in San Jose with California Emergency Physicians. Dr. Meisl's background has involved quality improvement activities for over 25 years. Dr. Meisl graduated from the University of British Columbia in Canada in 1976, and was lured by warmer and drier climates to California for an internship in San Jose. Wanting to leave the urban areas, he started an emergency practice in a rural emergency department in northern California, which was both a challenge and a learning experience.
He then moved back to the urban San Francisco area, practicing at Good Samaritan since 1981. Dr. Meisl has been the Quality Improvement Director for the ED at Good Samaritan since 1982, and since 2001, he has served as chairperson of the hospital's Medication Safety initiatives. He also served as part-time Clinical Instructor in the emergency department at Stanford University Hospital in the 1990s.
His other activities over the years include numerous committees, such as Medical Staff Executive, Critical Care, Utilization Review, Library, and PI projects, such as the Stroke Program, Shock Treatment, Coronary Programs, and EMTALA issues. Since 1992, he has been the Medical Director of an American Heart Association Training Center in San Jose, with Regional Faculty and Instructor capacities. Activities of the past have been involvement in organization of a local DMAT team and Cruise Ship physician.
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The National Patient Safety Foundation
Matthew Rice, MD, JD, FACEP
An awareness of the National Patient Safety Foundation (NPSF) is critical to practicing Emergency Medicine physicians who are serious about involvement in improving patient safety. The National Patient Safety Foundation is the leading organization with a primary focus on Patient Safety.
Created in 1996 through the efforts of many groups, particularly the American Medical Association, the organization has flourished and grown in scope and influence. It is a charitable and tax exempt organization under the IRS Code 501C (3), supported mostly by financial grants and revenues from educational forums and educational products. It is currently located in North Adams, Massachusetts and is represented by a dedicated full time staff, and governed by a Board of Directors and Board of Governors. ACEP has a representative on the Board of Directors representing Emergency Medicine for the past eight years. This individual keeps the ACEP president and Board of Directors informed on NPSF activities.
The mission of NPSF is generally to "Improve the safety of Patients through … creating a core body of knowledge, identify pathways to apply the knowledge, enhance receptivity to patient safety, raise public awareness and foster communication about patient safety… and enhance the transition from a culture of blame to a culture of safety".
NPSF believes that:
- Patient safety is central to quality health care
- Prevention is key to safe health care
- Safety improvement is attainable through open honest communication
- Patient involvement in safety is essential
- System issues are key to improving safety
- An integrated body of scientific knowledge and an infrastructure to support safety is essential to significantly advance patient safety
NPSF has been very successful thus far in its lofty goals and mission to improve safety. Though educational forums, regional and state initiatives, research grants, national speaker's bureau, Safety Awards, and affiliations with other groups and organizations, NPSF has been the leader in enhancing patient safety in through meaningful initiatives and programs. NPSF has recognized the importance of Emergency Medicine through encouraging participation in the safety movement by the specialty of Emergency Medicine, awarding financial grants to several Emergency Medicine researchers, and by identifying emergency departments and patients as key places to focus for further safety advancement.
For those individuals interested in patient safety, the NPSF web site at www.npsf.org provides a tremendous resource to seminal articles, research and organizational activities and information about educational opportunities including the annual Spring Safety "Congress" May 7, 2007 in Washington, D.C. The site includes the largest bibliography library of over 5500 articles and reports on safety, Publications, access to the section on patients and families, a speaker's bureau, information about the research program and a host of other information for practicing physicians, researchers or those with a practical curiosity.
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QIPS Quality Course at Spring Congress
David P. John MD, FACEP
The quality improvement and patient safety section received a grant to develop a quality course. The course will be presented at the ACEP Spring Congress in San Diego in late April 2007. As with all of our previous grants, you're welcome to join in the development of the course. All section members de facto are involved in quality, and therefore are the experts.
The course is intended to teach people how to develop a quality program in their emergency departments. We will have four one-hour slots on day number two of the Spring Congress. I have tentative commitments from Cheri Hobgood, Board member and section member, and Sue Nedza, regional medical director for CMS, to be faculty.
We will try to focus on the following:
- The case review
- Data collection
- Systems improvements
- Panel discussion/success stories
The course will need to be created over the next five months. Depending on how many individuals sign up, the division of labor should be reasonable. Most of the leadership of the section is on board, but we need your help. We need your favorite cases, your methods of data collection, your success stories, etc.
As far as I know, this is the first course of its kind. Even if you do not want to help design the course, plan to attend, let anyone you know that works in quality know about it.
If we are successful and have good attendance, the course may create standards for quality in emergency medicine. It will be offered to physicians, nurses, physician assistants, APRNs, and residents. Please join us and spread the word.
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CMS Plans to Implement Risk-Adjusted 30-Day Mortality Measures
Robert I. Broida, MD, FACEP
CMS recently announced its plan to implement risk-adjusted, 30-day mortality measures. QualityNet's notice of November 6, 2006 is reproduced below.
The Centers for Medicare & Medicaid Services (CMS) and its Hospital Quality Alliance (HQA) partners will begin publicly reporting risk-adjusted, 30-day mortality rates on the Hospital Compare website in June 2007. The rates will include data for all Medicare patients with principal hospital discharge diagnosis of acute myocardial infarction (AMI) or heart failure (HF), from all acute care and critical access hospitals in the nation. A plan to add a 30-day mortality measure for pneumonia to the public reporting process is contingent on National Quality Forum (NQF) endorsement.
In making the announcement, CMS and its HQA partners stated they will begin reporting the risk-adjusted mortality rates "in the interest of high-quality, patient centered care and accountability" and in compliance with the Deficit Reduction Act (DRA) of 2005. Publicly reporting mortality measures, the two groups said, can illustrate the variation in patient outcomes across the country and create a visible incentive for hospitals to improve patient short-term survival.
The 30-day, risk-adjusted AMI and HF mortality measures were developed by a team of clinical and statistical experts from Yale and Harvard Universities. The HQA has approved these measures as appropriate for public reporting. The measures have also been endorsed by the NQF, a voluntary standard-setting, consensus-building organization representing providers, consumers, purchasers, and researchers.
The 30-day measures will be calculated by CMS for Medicare patients, using the administrative claims data already submitted by hospitals under the Medicare program. Thus, hospitals will not need to submit new or additional information to CMS or to the QIO Clinical Data Warehouse.
Prior to the national implementation of mortality measures reporting in June 2007, CMS will conduct a "dry run" of the process, to familiarize hospitals with the background of the measures and their facility's mortality rates. In December 2006, each hospital will receive a hospital-specific report describing its mortality rates, based on 2003 Medicare claims. The rates contained in these initial reports will not be posted publicly on the Hospital Compare website.
In order to implement these measures, CMS has contracted with Colorado Foundation for Medical Care (CFMC), Colorado's Quality Improvement Organization (QIO). Questions about the public reporting of mortality measures may be sent to CFMC at: firstname.lastname@example.org. After receiving their respective reports, hospitals will have 30 days to send comments and questions regarding the hospital-specific reports to CFMC.
CMS will post additional information-including documentation regarding development of the mortality models and frequently asked questions-throughout the November 2006 on QualityNet.
Editorial Note: AMI 30 day mortality may reflect back on the ED care...especially if there were delays to ECG, delays to Lytics, Delay to Cath Lab, or omission of ASA and Beta Blockade in the ED. We will watch this database develop, and you know this type of news is very, very hot info that the Sunday newspapers like to have as cover stories!
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Federal Quality and Efficiency Initiatives Move Forward
Angela Franklin, JD, Staff Liaison
National efforts to measure quality and efficiency are gaining momentum, both in the public and the private sector. The Medicare program is developing the major initiatives, including the Physician Voluntary Reporting Program (PVRP) and several demonstration projects, however Medicaid and private insurers are also implementing programs. The federal government estimates that hospital and physician pay for performance initiatives will result in saving Medicare and hospitals nationwide $1.3 billion in health care costs.
ACEP has always demonstrated leadership in quality improvement and patient safety, but has now increased input on the development of measures in these areas, as lawmakers increasingly seek to link physician reimbursement to progress on reporting of performance measures, and eventually want to link payment to performance based on these measures. ACEP is advocating that such measures:
- Be developed by the medical specialty societies with expertise in the area of care in question and through open and transparent processes that promote consensus from a broad range of health care stakeholders;
- Be evidence-based, valid and reliable, relevant to a significant part of emergency medicine practice, based on factors emergency physicians directly control, kept current and risk adjusted, while being least burdensome for physicians and other stakeholders; and
- Be pilot-tested and phased-in across a variety of specialties and practice settings, to help determine what does and does not improve quality.
Physician Voluntary Reporting Program (PVRP). As a first step toward aligning Medicare's physician payment system with the goals of quality improvement, CMS, the federal agency that administers Medicare and Medicaid funding, launched the Physician Voluntary Reporting Program (PVRP) in January 2006. The goals of the PVRP include:
- Developing methods for collecting data submitted by physicians' offices on the quality measures; and
- Providing physicians' offices with confidential feedback reports detailing their performance rate and reporting rates on applicable measures.
CMS is working to expand the current set of quality measures in the PVRP to cover medical specialties that account for the majority of Medicare payments. In September, 2005, CMS contracted with Mathematica to develop physician specialty measures. Mathematica chose the AMA Physician Consortium for Performance Improvement (AMA-PCPI) and the National Committee for Quality Assurance (NCQA) as sub-contractors for this work that is being carried out through the AMA-PCPI process. Additionally, the AMA signed an agreement with Congress promising to develop 140 standard measures of physician performance by the end of 2006.
AMA PCPI EMERGENCY MEDICINE MEASURES
Developed by ACEP/EM Measures Workgroup
||Electrocardiogram Performed for Non-Traumatic Chest Pain
||Aspirin at Arrival for AMI
||Electrocardiogram Performed for Syncope
||Vital Signs for Community-Acquired Bacterial Pneumonia
||Assessment for Oxygen Saturation for Community-Acquired Bacterial Pneumonia
||Assessment of Mental Status for Community-Acquired Bacterial Pneumonia
||Empiric Antibiotic for Community-Acquired Bacterial Pneumonia
Quality Improvement Only (Not for PVRP)
||Fibrinolytic Therapy Ordered within 20 Minutes of ECG Performed for AMI
||Care Coordination for PCI
ACEP Activities. To ensure ACEP meets these requirements, the College served as the lead organization of the ACEP/Emergency Medicine Workgroup of the AMA-PCPI this year. The Workgroup was co-chaired by Dr. Bruce Auerbach, MD, FACEP, chair of the Quality and Performance Committee (QPC). The Workgroup produced nine measures in four areas: AMI, Chest Pain, Syncope and Pneumonia. [link to specification sheet] The measures (see chart) were selected because they represent a subset of the most frequent visits to emergency departments by Medicare patients. In addition, 100 percent of practicing emergency physicians treat these conditions or use these procedures and these measures have applicable ICD-9, CPT and G codes.
This fall, the measures went through the National Committee for Quality Assurance (NCQA) public comment process, were approved by the AMA Physician's Consortium, and were submitted to the National Quality Forum (NQF) for its December through May endorsement process, and submitted to the AQA Alliance (formerly the Ambulatory care Quality Alliance), a multi-stakeholder entity including health plans, employers and physicians) for its adoption process beginning in January. Per CMS, the purpose of the AQA is to promote uniformity in the implementation of physician quality measurement programs.
PVRP Codification. On December 20, President Bush signed the Tax Relief and Health Care Act of 2006, (H.R. 6111), which includes numerous health care provisions, including prevention of a 5% reduction in physician reimbursement in 2007, and provides that doctors who voluntarily report on quality measures under the Physician Voluntary Reporting Program between July 1, 2007, and December 31, 2007, will receive a 1.5% bonus payment.
The Emergency Medicine measures referred to above are currently included on CMS' list of 66 measures that physicians may voluntarily report on in 2007 to receive a bonus, pending NQF endorsement and AQA adoption. ACEP will continue to work with CMS and these groups these initiatives evolve.
The AQA Alliance has provided definitions on its website to clarify the terms currently being used in the measurement arena:
"Quality of care" is a measure of performance on the six IOM-specified health care aims (safety, timeliness, effectiveness, equity, efficiency and patient centeredness).
"Cost of care" is a measure of the total health care spending, including total resource use and unit price(s), by payer or consumer, for a health care service or group of health care services, associated with a specified patient population, time period, and unit(s) of clinical accountability.
"Efficiency of care" is a measure of cost of care associated with a specified level of quality of care. "Efficiency of care" is a measure of the relationship of the cost of care associated with a specific level of performance measured with respect to the other five IOM aims of quality.
"Value of care" is a measure of specified stakeholder's (such as an individual patient's, consumer organization's, payer's, provider's, government's, or society's) preference-weighted assessment of a particular combination of quality and cost of care performance.
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Quality and Performance Committee Plans for '07
David Meyers, MD, FACEP
The Quality and Performance Committee held its first post-Scientific Assembly meeting via conf call on November 20, 2006 with Dr Bruce Auerbach, Chair. An update took place regarding the status of the Emergency Medicine quality measures submitted to the AMA Physician Consortium. Discussion ensued about the role of the Committee in the shepherding of the quality measures further through the process. The QPC's 2006-2007 Objectives were reviewed and member assignments made:
Objective 1. Ensure that emergency medicine is represented with relevant and appropriate measures in reporting initiatives and in particular those that impact practice and reimbursement.
- Focus on an expanded set of reportable measures for the ED, covering:
- HHS/CMS priorities: measures of efficiency across episodes of care and
- ACEP priorities: measures of quality that are clinically-based.
There was discussion of the need for measures of over- and under-use, the impact of crowding on quality and the value of developing an Emergency Medicine Registry, with anonymous collection of data gathered from the initial core EM measures were also discussed.
Objective 2. Develop and submit recommendations to the Board that protect and enhance those areas of emergency medicine impacted by quality of care/performance measures.
- Ensure that the Committee communicates all appropriate developments to the Federal Government Affairs Committee, to help guide advocacy efforts regarding quality.
Objective 3. Insure emergency physician representation and appointments to internal and external bodies developing quality measures that have relevance to the practice of emergency medicine. (an objective continued from prior years)
Objective 4. Monitor, review and report to membership on external quality measure activities.
Objective 5. Develop informational materials for members explaining quality measures, Physician Voluntary Reporting Program (PVRP), and Pay for Performance (P4P) and other programs deemed important to our specialty. Within that context, develop and provide input for an ACEP research agenda and a plan for communicating better with the membership on these and other topics related to quality and performance.
Another topic of discussion was, looking to the future, how to incorporate quality measures, such as prompts, reminders, guidelines, into information technology systems (electronic medical records, for example) for use at the patient bedside. The QPC will discuss this further and consider collaboration with the ACEP Informatics Section on this subject.
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Section Report 2005-2006
Helmut Meisl MD, FACEP
As of Oct 25, 2006:
Officers for 2005-2006
Chair: Helmut W. Meisl, MD, FACEP
Chair-elect: John (Jack) Kelly, DO, FACEP
Secretary/Newsletter Editor: Dickson S. Cheung, MD, FACEP
Councilor: David Meyers, MD, FACEP
Alt. Councilor: Helmut W. Meisl, MD, FACEP
Web Site Editor: Robert I. Broida, MD, FACEP
Staff Liaison is currently Angela Franklin, JD, and earlier in year Marilyn Bromley
Board Liaison is Cherri D. Hobgood, MD, FACEP
Section Activities for 2005-2006
- Production of 4 full Newsletters, with quality articles on QI topics, CMS measures, Patient Safety and Literature updates.
- Update of Website
- Increase in membership from 189 to 221
- Message to EMRA encouraging membership
- Establishment of regular conference calls for communication with officers, to be expanded to general QIPS membership
- E Mail communications to members encouraging exchange of information
- Joint meeting with QI Interest group of SAEM in San Francisco
- Recipient of Section to College Award
- Completion of the Section Grant on Chief Complaint Indicators. This was a successful grant application by the QIPS Section under the direction of Dr. David John to develop quality measures for prevalent, potentially serious, and high risk presenting complaints in the ED. Syncope, Headache, Chest pain, Abdominal pain, Shortness of breath, Altered level of consciousness were chosen, and practical quality indicators were carefully chosen after many e-mails, conference calls and review of the literature. The challenge was to develop quality indicators for presenting complaints, rather than actual diagnoses, the latter being easier to do. These quality measures were presented to ACEP, with the Clinical Practices Committee reducing these to 9, and the Quality and Performance Committee selecting one (use of the EKG in patients with syncope). This then went to the ACEP Board, which then submitted this to CMS, and use as one of the Physician Specialty Measures.
- Successful grant application to produce QI and Patient Safety Course. This will be directed to those involved in quality and scheduled for the ACEP Spring Congress in 2007. It is planned to consist of a series of four lectures supported by case studies, with the goal of providing strategies to implement a successful quality program. At present there does not exist a course specifically devoted to ED quality improvement programs.
Section Objectives for 2006-2007
- Involvement with ACEP Board and Quality and Performance Committee on QI and Performance Measures
- Completion of grant on QI and Patient Safety Course, with Spring Congress in 2007. If successful, the course may be expanded to become more frequent, and also adapted to physicians in training
- Pursue further avenues to increase membership, including academic centers and residency physicians
- Increased mutual co-operation on QI issues with SAEM
- Continuation of conference calls and E mail communications
- Continuation of production of 4 Newsletters and updating of Website
- Pursuit of another Grant Application
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Minutes of the Quality Improvement & Patient Safety Section Meeting
Ernest N. Morial Convention Center, New Orleans, Louisiana, October 16, 2006
Participants: Present for all or part of the meeting were: Helmut W. Meisl, MD, FACEP, Chair; and 38 additional members and guests. Others participating for all or part of the meeting included Cherri D. Hobgood, MD, FACEP, Board Liaison, Bruce Auerbach, MD, FACEP, Chair, Quality and Performance Committee, and Angela Franklin, JD, Staff Liaison.
- Introductions and Welcome
- Activities of Section of prior year
- Councilor's Report
- Open Forum with Membership
- Structure of Meetings
Major Points Discussed
Dr. Helmut W. Meisl, Chair, welcomed everyone to the section meeting and discussed the section activities in 2005-06: four issues of the newsletter were published, QIPS won a section Award for Service to the College, one Section Grant on Quality Indicators was completed and a new one for a Quality Improvement Course was approved, and the section website was updated. Dr. Meisl discussed goals for 2006-07, including pursuit of the section web site award, section Newsletter Award, and requested ideas from members for section resolutions and section grants for 2007.
Dr. David L. Meyers presided over the election of the Chair-Elect and Secretary/Newsletter Editor, and introduced the section officers for the 2006-2007 year:
Chair: John (Jack) Kelly, DO, FACEP
Chair-elect: Dickson S. Cheung, MD, FACEP
Secretary/Newsletter Editor: Robert I. Broida, MD, FACEP
Co-Editor: Geoffrey L. Ruben, MD, FACEP
Co-Editor: Elaine A. Thallner, MD, FACEP
Councillor: Helmut W. Meisl, MD, FACEP
Alt. Councillor: John (Jack) Kelly, DO, FACEP
Dr. Cherri D. Hobgood, Board Liaison, made recommendations on the section's direction for 2006-07, that QIPS pursue objectives that would establish ACEP as a thought leader in quality improvement, by: defining what quality is in emergency medicine; interfacing with the Reimbursement Committee, Coding and Nomenclature Committee, Clinical Policies Committee, and the Quality and Performance Committee in considering emergency medicine quality improvement measures. Dr. Hobgood noted that measurement should be transparent across groups and episodes of care. Dr. Hobgood said that the planned QIPS quality improvement course at Spring Congress is good initiative, and urged that it ultimately be disseminated nationally. Dr. Meyers cited the mandated CDC HIV screening testing as an example of another educational task QIPS could pursue: QIPS could help guide members, via the QIPS newsletter, as to how to proceed with implementation-particularly with regard to improving interfaces, and outline the implications for the emergency department.
Dr. Helmut W. Meisl led a discussion about how the section could best benefit its members. Discussed were the Core Measures/Physicians Specialty Measures drafted by the AMA Physician Consortium for Physician Improvement and the general state of quality improvement measure development. Dr. Bruce S. Auerbach also reported on the deliberations that took place at the AMA-PCPI and reasons the 10 selected emergency medicine measures were put forward for public comment, and were progressing. Dr. Hobgood advised that going forward ACEP would be using clinical policy guidelines to generate clinically-based emergency medicine measures. Dr. Hobgood also recommended that QIPS broadly disseminate information on quality measure development and process by improving the QIPS website; creating a QIPS newsletter column that could also be exported to other newsletters, including chapter newsletters; seeking and disseminating information on chapter activities as well as linking those to activities within national ACEP; and by the QIPS course, that could eventually be offered annually. Dr. Hobgood urged QIPS to challenge the ACEP Board and staff to commit the needed resources to these efforts. Dr. William Schumacher estimated that approximately 1,000 doctors in his group were enrolled in CMS' Physician's Voluntary Reporting Program (PVRP), but there were challenges.
Dr. David P. John, MD, FACEP provided a report on the QIPS Patient Safety Course scheduled for Spring Congress in 2007. Pursuant to its section grant, QIPS will provide a quality improvement course that consists of a series of four lectures supported by case studies. The goal is to share important successes in quality, and show physicians and nurses who work in emergency medicine how to implement a successful quality program. The course is designed for both novices and experienced physicians and nurses, and will teach individuals to adapt their skills to any setting.
Dr. Jack Kelly, further discussed goals for the coming year, including pursuing Dr. Hobgood's recommendations.
Dr. Robert L. Wears presented a lecture covering quality improvement and health information technology in the emergency department.
Dr. Jack Kelly adjourned the meeting at 12:00 p.m.
Recent Quality and Safety Articles
Helmut Meisl, MD, FACEP
A further list of recent articles that may interest you. These are compiled by AHRQ PSNet at (http://psnet.ahrq.gov/).
Forum: The 100,000 Lives Campaign: a scientific and policy review [with IHI response].
Wachter RM, Pronovost PJ. [Reply: Berwick DM, Hackbarth AD, McCannon CJ]. Jt Comm J Qual Patient Saf. 2006;32:621-627, 628-633.
Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.
Kachalia A, Gandhi TK, Puopolo AL, et al. Ann Emerg Med. 2006 Sep 22;
Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study.
Masoudi FA, Magid DJ, Vinson DR, et al, for the Emergency Department Quality in Myocardial Infarction Study Investigators. Circulation. 2006;114:1565-1571. Epub 2006 Oct 2.
Graduate medical education and patient safety: a busy--and occasionally hazardous--intersection.
Shojania KG, Fletcher KE, Saint S. Ann Intern Med. 2006;145:592-598.
A model for building a standardized hand-off protocol.
Arora V, Johnson J. Jt Comm J Qual Patient Saf. 2006;32:646-655.
Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims.
Gandhi TK, Kachalia A, Thomas EJ, et al. Ann Intern Med. 2006;145:488-496.
Learning from different lenses: reports of medical errors in primary care by clinicians, staff, and patients: a project of the American Academy of Family Physicians National Research Network.
Phillips RL, Dovey SM, Graham D, Elder NC, Hickner JM. J Patient Saf. 2006;2:140-146.
Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths.
Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV. Ann Surg. 2006;244:371-380.
Accountability sought by patients following adverse events from medical care: the New Zealand experience.
Bismark M, Dauer E, Paterson R, Studdert D. CMAJ. 2006;175:889-894.
Impact of a statewide reporting system on medication error reduction.
Rask K, Hawley J, Davis A, Naylor D, Thorpe K. J Patient Saf. 2006;2:116-123.
Medication reconciliation for reducing drug-discrepancy adverse events.
Boockvar KS, Carlson Lacorte H, Giambanco V, Fridman B, Siu A. Am J Geriatr Pharmacother. 2006;4:236-243.
Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive care unit.
Gillman L, Leslie G, Williams T, et al. Emerg Med J. 2006;23:858-861.
Application of the IV Medication Harm Index to assess the nature of harm averted by "smart" infusion safety systems.
Williams CK, Maddox RR, Heape E, et al. J Patient Saf. 2006;2:132-139.
Assessing patient safety culture: a review and synthesis of the measurement tools.
Singla AK, Kitch BT, Weissman JS, Campbell EG. J Patient Saf. 2006;2:105-115.
Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable?
Seiden SC, Barach P. Arch Surg. 2006;141:931-939.
A trigger tool to identify adverse events in the intensive care unit.
Resar RK, Rozich JD, Simmonds T, Haraden CR. Jt Comm J Qual Patient Saf. 2006;32:585-590.
The intensive care unit, patient safety, and the Agency for Healthcare Research and Quality.
Clancy CM. Am J Med Qual. 2006;21:348-351.
Observational assessment of surgical teamwork: a feasibility study.
Undre S, Healey AN, Darzi A, Vincent CA. World J Surg. 2006;30:1774-1783.
Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit.
Kane-Gill S, Rea RS, Verrico MM, Weber RJ. Am J Health Syst Pharm. 2006;63:1876-1881.
The care transitions intervention: results of a randomized controlled trial.
Coleman EA, Parry C, Chalmers S, Min SJ. Arch Intern Med. 2006;166:1822-1828.
Rapid response teams--walk don't run.
Winters BD, Pham J, Pronovost PJ. JAMA. 2006;296:1645-1647.
MRI suites: safety outside the bore.
Gilk T. Patient Saf Qual Healthc. September/October 2006;3:16-18, 20-21.
National surveillance of emergency department visits for outpatient adverse drug events.
Budnitz DS, Pollock DA, Weidenbach KN, et al. JAMA. 2006;296:1858-1866.
Risk reduction for adverse drug events through sequential implementation of patient safety initiatives in a children's hospital.
Leonard MS, Cimino M, Shaha S, McDougal S, Pilliod J, Brodsky L. Pediatrics. 2006;118:e1124-e1129.
Clinical problem-solving. Lost in transcription.
Kalus RM, Shojania KG, Amory JK, Saint S. N Engl J Med. 2006;355:1487-1491.
Reducing medical error in the Military Health System: how can team training help?
Alonso A, Baker DP, Holtzman A, et al. Hum Resource Manage Rev. 2006;16:396-415.
Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs.
Sharek PJ, Horbar JD, Mason W, et al. Pediatrics. 2006;118:1332-1340.
Systematic review of medication errors in pediatric patients.
Ghaleb MA, Barber N, Franklin BD, Yeung VW, Khaki ZF, Wong IC. Ann Pharmacother. 2006;40:1766-1776. Epub 2006 Sep 19.
An observational study of practice during transfer of patients from anaesthetic room to operating theatre.
Broom MA, Slater J, Ure DS. Anaesthesia. 2006;61:943-945.
Teaching but not learning: how medical residency programs handle errors.
Hoff TJ, Pohl H, Bartfield J. J Org Behav. 2006;27:869-896. Epub 21 Sep 2006.
Drug-induced hypoglycaemia--new insight into an old problem.
Ching CK, Lai CK, Poon WT, et al. Hong Kong Med J. 2006;12:334-338.
Surgeon age and operative mortality in the United States.
Waljee JF, Greenfield LJ, Dimick JB, Birkmeyer JD. Ann Surg. 2006;244:353-362.
Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy.
Poon EG, Cina JL, Churchill W, et al. Ann Intern Med. 2006;145:426-434.
Care management implementation and patient safety.
Alexander JA, Weiner BJ, Baker LC, Shortell SM, Becker M. J Patient Saf. 2006:2:83-96.
A piece of my mind. Mistakes.
Lesnewski R. JAMA. 2006;296:1327-1328.
Apology in medical practice: an emerging clinical skill.
Lazare A. JAMA. 2006;296:1401-1404.
Hospital internet site content on patient safety and medical errors.
Heffner JE, Webster L, Ellis R. J Patient Saf. 2006;2:72-77.
Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders.
Palen TE, Raebel M, Lyons E, Magid DM. Am J Manag Care. 2006;12:389-395.
Types of unintended consequences related to computerized provider order entry.
Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. J Am Med Inform Assoc. 2006;13:547-556. Epub 2006 Jun 23.
Effects of nursing rounds on patients' call light use, satisfaction, and safety.
Meade CM, Bursell AL, Ketelsen L. Am J Nurs. 2006;106:58-70.
Are the Agency for Healthcare Research and Quality obstetric trauma indicators valid measures of hospital safety?
Grobman WA, Feinglass J, Murthy S. Am J Obstet Gynecol. 2006;195:868-874.
Quality improvement to decrease specimen mislabeling in transfusion medicine.
Quillen K, Murphy K. Arch Pathol Lab Med. 2006;130:1196-1198.
Patient safety moves forward in some hospitals but, seven years after the "Quality Chasm" report, progress is still spotty.
Hagland M. Healthc Inform. August 2006;23:30, 32-34.
Antiretroviral medication errors among hospitalized patients with HIV infection.
Rastegar DA, Knight AM, Monolakis JS. Clin Infect Dis. 2006;43:933-938. Epub 2006 Aug 22.
Safety in the academic medical center: transforming challenges into ingredients for improvement.
Blumenthal D, Ferris TG. Acad Med. 2006;81:817-822.
The importance of establishing regimen concordance in preventing medication errors in anticoagulant care.
Schillinger D, Wang F, Rodriguez M, Bindman A, Machtinger EL. J Health Comm. 2006;11:555-567.
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