Letter from the Chair
What exactly is reliability? Is it showing up for work on time? Is it making sure the mortgage payment is made every month or that our children have a ride home from school?Read More »
Thomas Nolan, senior fellow at the Institute for Healthcare Improvement defined reliability as “failure free operation over time, from the point of view of the patient.”1 For those of you who enjoy formulas, it looks like this:
Number of actions that achieve the desired result
Reliability = _________________________________________________________
Total number of actions taken
QIPS Meeting Keynote: CT Utilization and Choosing Wisely
Gregg A Miller, MD, FACEP is the Program Director of Quality and Performance for Emergency Medicine for CEP America. He has served as the Medical Director for the Emergency Departments at San Joaquin Community Hospital and Swedish/Edmonds Hospital and has been involved in the implementation of multiple operational and quality-related initiatives. Dr. Miller also sits on the Washington state ACEP Board of Directors. He completed an Administrative Fellowship with CEP America with a focus on CMS quality-related programs. Dr. Miller attended medical school at the University of California, San Francisco and did his emergency medicine residency at Harbor-UCLA. Read More »
Quality Improvement & Patient Safety (QIPS) Section Meeting (12-2:30 pm PT)
Mandalay Bay Convention Center: South Pacific Ballroom A
Computers, Measures, and Patients
With great interest, I read Dr Susan Nedza’s article in the March 2016 QIPS Newsletter. Since my wife and I have become greater consumers of health care (I do not like the word consumers, let us say patients), we have experienced medicine from the “Other Side.”Read More »
What we have observed is a disconnect between the actual treatment of the patient and the adherence to protocols and mandatory documentation. I will give a few examples, granted all subjective. My visit to the ED a few years ago for chest pain brought out the myocardial infarction routine/protocol from nursing, before seeing the ED physician even though the pain was totally atypical for myocardial ischemia. A brief history and physical would have sufficed, and saved costs. Here, 2 words triggered a rigid response and protocol, without thinking about what the patient might actually have.
Determining Decisional Capacity
A 62-year-old man with a history of DM, HTN, and HL, and previous myocardial infarction presents to your ED with a complaint of 3 hours of chest pain with onset during activity and radiating to his left shoulder. On arrival to the ED, his pain is improved, he appears comfortable, and his vital signs are normal. His ECG demonstrates new t-wave inversions in the inferior leads and his initial troponin is mildly elevated. You share with him the results and express that you would like to admit him to the hospital for serial troponins, cardiology consultation, and likely cardiac catheterization. At that time he reports that he would like to go home and follow up with his primary care doctor in the next day or two. Given the ECG changes, elevated troponin, and clinical history, you feel he should be admitted to the hospital but he is adamant about going home. He acknowledges your concern that his pain could be the sign of a heart attack or impending heart attack. He reports that he came in to find out if he needed a stent “straight away” from the ED like he has in the past. He otherwise provides multiple reasons for wanting to go home, including a dog to take care of and a desire to sleep in his own bed. You begin to wonder if your patient understands his situation…Read More »
As physicians we are responsible for making recommendations to our patients based upon our knowledge as health care professionals. In the ED we routinely recommend specific treatments, various tests, and admissions to the hospital versus discharge home. While we often encounter patients who choose not to adopt these recommendations, there are times when this refusal becomes very uncomfortable and we struggle with balancing our desire to help patients with respecting their autonomy.
Encouraging Residents to Participate in Hospital-Wide Quality Improvement
As I cleared my voice, preparing to open my first council meeting one year ago, doubt crept back into my mind, would they really listen to me? Will people participate? Is everyone here just for the free food? Read More »
I initially became involved in our hospital’s Resident Quality and Safety Council (RQSC) as an intern, interested in a career in emergency medicine administration and motivated to interact with residents across different specialties. While I sat quietly through my first several monthly meetings, I appreciated the different motivations behind resident comments—exasperation that workflows were inefficient, curiosity as to what a fishbone diagram was, worry that a reported near miss could have just as easily lead to an adverse patient outcome. While many members had no formal training in quality improvement, the counsel served as a venue for residents to get involved in improving quality and safety across the institution.