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Emergency Department Weekly Stand-up Quality Meetings Improves Cadence of Change

James Heilman, MD

James HeilmanOur emergency department operations leadership was struggling with how to move departmental quality goals forward on a consistent basis. Equipment, staffing, and process problems were also not being resolved in a timely fashion. In September 2014, we implemented weekly stand-up meetings in our adult and pediatric emergency departments that have a combined annual volume of 50,000 patients.

Members of the team include physicians, nurses, registration, social workers and administrative support staff. Rounds occur at 7:30 am, every Tuesday, and last 20 minutes. We use a standard presentation format and team members have assigned roles in advance. The assigned leader guides the discussion and the scribe documents progress on the project tracker. We use a standard process by having the team leader use a prompting card each week to review one quality project by using the Plan, Do, Study, Act (PSDA) methodology. The card asks five questions that prompt the group to discuss the last PDSA cycle process in a clear and direct fashion.

ED leadership presence every week has been critical to the success of the rounds and helps to hold other members, and the ED leadership team, accountable to making progress on the quality goals on a weekly basis. The weekly stand-up meetings help to keep the group action focused by making progress on the “to dos” associated with each quality project. As a multidisciplinary group we have been able to identify the barriers for why items are not being completed, create a plan of attack and then hold each other accountable that each item is completed by the agreed upon deadline. Key standardization elements include meeting the same time every week, assigning roles in advance and maintaining a standard format for the quality project board that is regularly updated. Using a standardized PDSA improvement science approach each week has kept up focused and has been a great education tool for members of the team that have limited experience in improvement science. The card was developed by Mike Rother and available at no charge at http://www-personal.umich.edu/~mrother/KATA_Files/5Q_Card.pdf.

Challenges have included developing processes to update our data weekly for some of our quality project metrics, making sustained progress on departmental goals that involve services outside our emergency department, and engaging staff physicians and nurses in the quality rounding process.

However, since implementation we have objectively completed 152 “quick hits” (i.e. resolution of equipment, staffing, and process issues), achieved our goal for improving our time to provide pain medication for long bone fracture core metric by 31% (OP-21 Medial Time to Pain Management for Long Bone Fracture), and met our goal of 90% compliance with use of the procedural sedation timeout checklist and documentation. Subjectively, we have noted improved teamwork and communication between disciplines and departments within the hospital. This has allowed our team to resolve a larger number of problems in a shorter time period.

Keys for effective and sustainable weekly stand-up rounds:

  1. Consistent ED Medical Director and ED Nursing Director presence 
  2. Focusing on action by holding each other accountable 
  3. Utilizing a standardized approach
  4. Employing improvement science 

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