PC 10: Quality Improvement in the Emergency department: Protecting your patients, your department, and yourselves

Course Director

  • Barbara Masser, MD

Faculty 

  • Jonathan Edlow, MD. USA
  • Barbara Masser, MD. USA
  • Michael Cocchi, MD. USA
  • Roberta Petrino, MD. Italy
  • Ian Higginson, MD. UK

Participants

The course is designed for 24 participants. 

Target group: emergency physicians and nurses interested in emergency department quality improvement 

Course description 

The goal of this course is to provide a hands-on practicum in quality review for emergency medicine incorporating both US and European perspectives.

Learning objectives

After this one day course, participants will learn:

  1. The necessity of having a well-run quality program in their EDs and the importance of using quality metrics to measure ED performance, drive intended clinical behaviors, and ensure high-quality care delivery to patients in emergency medicine clinical practice through the creation of a blame-free culture.
  2. The structured review technique, applying it to three specific clinical cases with the goal of determining the presence or absence of error and its most likely source (provider, systems, supplies, protocol deficiency, administrative).
  3. The creation of a clinical pathway (through hands-on practice), and important concepts regarding the use of clinical pathways to improve patient safety.
  4. The function and importance of departmental review and why it is important to the QA process, through practical M&M review of two actual cases.
  5. Important concepts regarding ED crowding and its significant impact on the real time provision of quality care, from a variety of international perspectives.
  6. How to define an error (versus “judgment”), differentiate errors in planning (mistakes) from errors in execution (slips and lapses), distinguish between errors and adverse events, rate an error using the AHRQ Adverse Event Severity Scale, discuss factors contributing to errors, and understand the relationship between error and standard of care.

ETR

This course addresses Section 2.6 - 4 Health care evaluation and improvement from the European EM curriculum

Schedule

Saturday 19 September

8.00-8.15 Why Quality Assurance is Essential to Every Emergency Department

This introductory session will be a discussion of the necessity of having a well-run quality program and the importance of using quality metrics to measure ED performance, ensure high-quality care delivery, and create a blame-free culture. Jonathan Edlow, MD

8.15 – 8:35 Current State of Quality Assessment Protocol in the Vercelli, Italy Hospital EDs.
In this session, participants will discuss QA issues facing Italian and European practice. Roberta Petrino, MD

8:35-10:30 Workshop 1: Performing Case Review and Objectifying Error:
How to perform a structured case review & objectifying error. 

After a brief instruction, learners will break into a group discussion, facilitated by all course faculty, and jointly “review” three specific clinical cases applying the technique of the introduced structured review. At the end of this exercise, participants will have determined the presence or absence of error and its most likely source (provider, systems, supplies, protocol deficiency, administrative). All faculty

10:30-11:00 Break

11:30-12:30 Workshop 2: Reducing Error through Pathways

First, we will discuss the development of multi-disciplinary clinical pathways to reduce error in the emergency department (introduction to the clinical problem, what was the scenario that led the department to feel the need to create a clinical pathway?). After the introduction, we will take the “error” identified in our earlier workshop for each specific case and discuss ways in which this could be prevented in the future. The group will engage in strategic brainstorming and discussion of potential clinical pathway development around these specific clinical issues, as well as multi-disciplinary considerations (dealing with consulting services, interaction with hospital administration).  All faculty.

12:30-13:30 Lunch

13:30-14:30 (Workshop 2 continues)

14:30-15:30 Workshop 3: The M&M Conference

Participants will be introduced to the function and importance of departmental review - why it is important to the QA process. After this brief introduction, two actual cases will be presented and discussed in M&M format.  All faculty

15:30-16:00 Coffee break

16.00-16.40 Quality Round Table: ED Crowding

During this session, participants will be asked to share examples of their own ED crowding challenges for discussion and problem solving with faculty and other participants. This will be a facilitated group discussion on the issue of ED crowding and its significant impact on the real time provision of quality care, from a variety of international perspectives. Moderator: Ian Higginson, MD.

16.40-17.00 Conclusion

During this session, we will summarize the techniques reviewed (structured case assessment, objectifying error, clinical protocol and pathway development, departmental M+M conference), encouraging further implementation and collaboration between US and European interests. Jonathan Edlow, MD