Quality Improvement and Patient Safety Section Newsletter - July 2017

QIPS: Your How-to-Guide for Improving Patient Safety and Quality in Healthcare

Letter from the Editor

Joshua M. Glazer, MD Joshua Glazer After troubleshooting some technical difficulties with the email listserv this month, we had a really nice response to the Spring call for article submission. It’s great to see so much involvement by the section, not just within the Emergency Department, but across entire hospital systems. We here at QIPS are truly impressed and humbled by your achievements. Keep up the good work, and please continue to share your stories with the QIPS membership!

CareSTART: A physician in triage front-end model improves patient safety and ED efficiency

Jamie Santistevan, MD; Andrew Lee, MD; Azita Hamedani, MD, MPH, MBA There is nationwide recognition that the demand for emergency department services has grown faster than capacity leading to overcrowded EDs and long wait times.^1,2 Redesign of front-end processes encompasses many different operational strategies to improve ED throughput and decrease wait times.³ Involving a physician in triage of ED patients is one strategy that allows for rapid discharge of low-acuity patients and rapid sorting and initiation of treatment for the remainder of patients. Published studies of physicians-in-triage demonstrate decreased door-to-assessment time, reduced ED length of stay, and reduced left without being seen (LWBS) rates^.4-8

Improving and Standardizing Care of Patients with Atrial Fibrillation in a Community Emergency Department

Bekki Hess, MD; Kara LeClerc, MD; Susanne DeMeester, MDAtrial fibrillation affects 3 million people in the United States each year and roughly one in four patients will develop atrial fibrillation (AF) or atrial flutter (AFL) during their lifetime.¹ Most patients that present to the Emergency Department with AF or AFL are admitted to the hospital, accounting for much of healthcare expenditure associated with this condition. The annual cost for treatment of atrial fibrillation has been estimated at $6.65 billion, with up to 73% of that being attributable to inpatient hospitalizations.^2,3

QIPS Website Redesign

Jamie Santistevan, MD Jamie Santistevan_2017 Hello QIPS-ers,

It’s the QIPS Website Editor here. I wanted to remind you to keep an eye on the QIPS website for the next wave of website updates. In an effort to make the website as helpful as possible, I am asking for your feedback and suggestions!

My goal is to keep the content relevant and exciting by including news and research related to Quality Improvement, tools for Quality Improvement work, and links to useful websites.

Letter from the Chair

Brenna M. Farmer, MD, FAAEM, FACEP, FACMT Brenna Farmer Welcome to our QIPS newsletter. The year has been very productive thus far.

We are completing our 2016-17 section grant on behavioral health emergencies, and it was recently announced that Dr. Brian Sharp was awarded a 2017-18 section grant on opioid education.

We have enjoyed 2 webinars: Drew Fuller led our “The Safer Airway Project” webinar and more recently, we enjoyed a webinar on team training in the ED with experts from the University of Michigan and Yale University.

QIPS TIPS #33: Falling for You!

Shari Welch, MD, FACHE, FACEPAs you now know, in 2008 CMS identified ten categories of conditions that will no longer be reimbursed. The implementation of this rule is now being felt by hospitals and providers. On a gut level the change does not seem unreasonable. The new rule basically says that if something bad happens to a patient in the hospital, the hospital does not get paid to treat that condition. These so-called Hospital Acquired Conditions include one entity particularly relevant for the emergency department: Falls and Trauma.

Closing the Back Door: Fixing a Workaround Improves Medication Safety

Gerald Maloney, DO, FACEP, FACMTWhile there is data showing some patient safety advantages to computerized physician order entry (CPOE), such as reduction in errors due to transcription, there have been new errors that have been identified, such as those associated with developing workarounds to complicated ordersets. As boarding hours increased at our facility, the number of patients on IV infusion medications, such as heparin, that were boarding in the ED also increased.