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Quality Improvement and Patient Safety Section Newsletter - December 2015

Looking Back While Moving Forward: A History of QIPS and Advances in Emergency Medicine Quality

Chair’s Letter - December 2015

Jeff PothofI wanted to say thanks to all of you who attended the section meeting this year in Boston. The presentations were remarkable, and the food was exceptional. Congratulations to Dr. Farmer who was elected Chair-Elect of the section, Dr. Sharp who was elected to be our Secretary and Newsletter Editor, and Dr. Mendoza who was elected our Website Editor. We have a great leadership team going into this year, and it’s exciting to think about what the section will accomplish.

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History of ACEP’s Section on Quality Improvement and Patient Safety (QIPS): A Personal View of the Early Years

In my first year out of residency, my new boss thought it would be a great idea for me to do quality and risk management for our emergency department. He thought the best way for me to learn was through the mistakes of others. It also helped that the guy who was doing continuous quality improvement (CQI) for us was tired of doing it. I got really excited and went looking for literature. There was very little at that time, but Jim Espinoza, who founded ACEP’s Continuous Quality Improvement (CQI) Section, had got a section grant and wrote a book on CQI in the 90s. It became my bible.

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Bridging the Grayscale Gap: Guiding Emergency Physicians through Ultrasound Credentialing

Clinical ultrasound has been shown to improve patient satisfaction and patient safety. It is currently best practice and standard of care to guide central line placement and other high-risk procedures. Specifically, ultrasound guidance for central lines has been shown to reduce the number of attempts and decrease complications, such as bloodstream infections, arterial punctures and pneumothoraces (1-3).

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ED Sepsis Alert: Improving Sepsis Care in the NMH Emergency Department

Severe sepsis and septic shock are clinical entities encountered frequently in the ED. Mortality related to severe sepsis is directly related to the time to antibiotic and fluid resuscitation. The most recent guidelines established by the Surviving Sepsis Campaign have been adopted by the Center for Medicaid Services (CMS) as a benchmark measure in quality as of October 2015. This bundle includes broad-spectrum antibiotic therapy after blood cultures, measurement of a serum lactate level and intravenous crystalloid resuscitation of 30 milliliters/kilogram.

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Editor’s Notes - December 2015

It was great seeing everybody at ACEP’s Scientific Assembly in Boston, MA. The QIPS section meeting was well attended and packed with several great presentations including:

  • Bobby Turelli, MD, FACEP and QIPS Immediate Past Chair, recognized the past chairs of the QIPS section whose work has led to QIPS being such a strong section today
  • Arjun Venketash, MD, MBA, MHS delivered the keynote speech, highlighting the different ways that quality measures are being implemented. Beyond the expected sources (CMS etc.), make sure to check out your ED’s Yelp review—it can make for quite the interesting read

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Breaking Down the IOM Committee Report On Diagnostic Error—Part One

On September 22, 2015, the Institute of Medicine (IOM) of the newly renamed National Academies of Science, Engineering and Medicine issued the report of its Committee on Diagnostic Error. As many of you know from my prior reports in this newsletter, the Committee was convened in early 2014 at the urging of the Society to Improve Diagnosis in Medicine (SIDM) and a number of other interested parties, among them government agencies such as the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention; professional societies – the American College of Radiology.

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Pediatric Seizure Management in the Out-Of-Hospital Environment

If you were to ask the average person to describe a seizure, they would likely compare it to the portrayals they have seen in television and film - a person lying on the ground, eyes closed and unconscious with rhythmic shaking of the extremities while foaming at the mouth. Indeed, even some medical providers would paint a similar picture. But because they have incompletely myelinated neurons, pediatric seizures often lack this stereotypical presentation and may be exceptionally subtle as a result. They are often overlooked or misinterpreted, resulting in a delay to appropriate termination of the seizure. These nuanced presentations are further highlighted when Emergency Medical Services (EMS) Providers are tasked to quickly and accurately assess the pediatric patient with undifferentiated altered mental status. They often receive minimal collateral information and usually have a limited clinical exposure to these relatively infrequent patients.

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