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Quality Improvement and Patient Safety Section Newsletter - March 2015

Letter from the Chair

TurelliAs we launch into the Spring, it is valuable to reflect upon the section’s accomplishments and emphasize and expound on the future goals of the Quality Improvement and Patient Safety (QIPS) section.

The QIPS Section is dedicated to engaging the members of ACEP and emergency medicine physicians nationwide and abroad, in achieving the goals of improving the safety and quality of patient care that we are delivering in our emergency departments.

As emergency physicians, we have now successfully evolved into a powerful consortium of health care leaders, who through the influence of healthcare reform, have taken ownership and, more importantly, the lead on the expansive efforts of quality reporting, as well as the development and evolution of cost-containment strategies and value-based purchasing. With our constantly changing and evolving health care system, the novel ideas and inspirational leaders that exist amongst our group make the work performed by the QIPS section an increasingly valuable and fundamental contribution to our specialty.

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IOM’s Committee on Diagnostic Error

Over the past year or so, I have been following the efforts of the Institute of Medicine’s Committee on Diagnostic Error. The committee is charged to develop recommendations to reduce diagnostic error across health care and identify action items for key stakeholders who focus broadly on education, the culture of health care, information technology, systems engineering, measurement approaches, changes in payment, and further research - all areas which play a role in this problem.

Awareness of the scale of the problem of diagnosis errors has been growing in recent years as more and more notorious cases have come to public attention, including, most recently, the misdiagnosis of Thomas Duncan’s Ebola infection in Texas a few months ago. Surveys of the public have shown that more than 50% of Americans have personally or know someone who has experienced a diagnostic error. Of course, these could be non-significant in terms of true health impact or very serious up to and including death or permanent severe disability. The human costs, as well as monetary costs, are huge. A recent scholarly article, authored by Dr. Mark Graber, of the IOM panel, on this subject can be found here.  Another very good review of the entire field was published last spring by the Urban Institute’s Dr. Robert Berenson, also a member of the Committee. In this article, the many unconscious bases influencing our decision-making and other behavior are reviewed.

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The Transport Quality Metrics and Improvement Project

The transport of patients to medical centers for specialized care demands monitoring the quality of care provided during transport and its impact on patient outcomes. Accurate assessment of quality indicators and patient outcomes requires the use of a standard language permitting comparisons among transport programs. Prior to 2013, no consensus existed in the literature on a set of quality metrics for transport.

In June 2011, transport leaders from the six largest neonatal and pediatric transport teams in Ohio convened to achieve consensus on a set of transport-specific metrics and definitions. Candidate quality metrics were identified through literature review and those metrics were tracked by each program already. Consensus methodology facilitated the group’s identification of 23 agreed-upon metrics and definitions. These programs began collecting metric data and overcoming the early obstacles associated with a new project. Although this set of metrics generated a lot of interest from programs across the country, there was concern that these “Ohio” metrics may not be generalizable outside that state.

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QIPS TIPS: Improving Laboratory Operations in the ED


Shari WelchThe efficiency of laboratory operations in the ED is important, as a critical component of ED workflow and patient flow. That said, we have a lot of work to do as a specialty to determine best practices for the ancillary services that support the ED. Improving laboratory turnaround times can improve overall length of stay (Storrow AB et al 2008).

Emergency departments typically manage lab specimens in one of three ways, and some use a combination of all three:

1) An ED Stat Lab
2) Point of Care (POC) Testing
3) An ED based Lab Technician

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Letter from the Editor

DavidSomand

Thanks to all who made the QIPS section meeting at the ACEP Scientific Assembly a success, and welcome to all of our new members. For our first newsletter following ACEP14 in Chicago, I wanted to introduce the new QIPS Section Officers for 2014 and 2015. 

Also in this month’s issue are contributions from Dr. Meyers, who provides an update on the Institute of Medicine’s Committee on Diagnostic Error. We will hear from Ryan Thompson, MD, who discusses a project aimed to decrease interruptions during patient care handoffs. Michael Bigham, MD, describes a project to capture transport quality data, and Samia Farooqi, MD, describes an airway and sedation quality improvement project. Shari Welch, MD, provides a QIPS Tips article on ED Laboratory Optimization. Enjoy!

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Pardon the Interruption(s)—Enabling a Safer Emergency Department Sign-Out

Patient ‘handoffs’ in medicine are widely recognized as a highly vulnerable time for medical errors to occur. The ED is uniquely susceptible with its fast pace and propensity for frequent distractions. Significant attention has recently been given to checklist-based initiatives such as the EMPSF’s “SAFER Signout” that aim to standardize ‘handoffs’ in the ED. Despite emphasizing the content of patient sign-outs, we recognized a high rate of interruptions in our ED that compromised the effectiveness of sign-out. Our primary objective was to evaluate whether simple interventions prior to sign-out could minimize interruptions.

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Airway and Procedural Sedation Quality Improvement at Northwestern: A Model for Resident-Led Change

Airway and sedation management are some of the most crucial skills in the emergency physician’s repertoire. Borne from a critical evaluation of our institution’s airway and procedural sedation practices, the Northwestern Airway and Procedural Sedation Quality Committee is a resident-led group developed to achieve the following mission: to create and enact a comprehensive and sustainable quality improvement framework for airway and procedural sedation management. Our committee’s resident members are dedicated to overseeing activity in one of three main realms: 1) Documentation/Research, 2) Equipment/Operations, and 3) Education – and are responsible for formally reporting quarterly quality metrics to the Northwestern Emergency Department’s QM Committee.

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