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TRANSCRIPT
Quality and Safety in the ED
Douglas Sinclair, MD St. Michael’s Hospital
Quality Improvement: The Why and What
Slide 2
• Understand the important of paDent safety/quality improvement in Emergency Medicine
• Develop an approach to beginning a QI project in the ED
• Appreciate how a career in QI might be for you!
ObjecDves
Quality Improvement: The Why and What
Slide 3
• “To Err is Human” (1999), InsDtute of Medicine – at least 44,000 Americans die each year due to medical error, other
studies have shown that this could be as high as 98,000
– More people die in a given year as a result of medical error than from car accidents, breast cancer or AIDS
• Canadian Adverse Events Study (Baker, et al 2004) – Out of 2.5 million hospital admissions annually in Canada, about
185,000 are associated with an adverse event and close to 70,000 of those are preventable
Why: Issues Brought to the Forefront
…before embarking on quality improvement it is important to define What “QUALITY” is
National Health Service (NHS), United Kingdom
Safety Patient Experience
Effectiveness
What: Varying definiDons of “Quality”
Institute of Medicine & Institute for Healthcare Improvement (IOM, IHI), United States
Safety Patient Experience, Equity, Access
Effective, Efficiency
Ontario Health Quality Council (OHQC), Canada
Safety
Patient Experience, Equitable, Accessible, Integrated
Effective, Efficiency, Resourced, Population Health
Excellent Care for All Act (Bill 46)
Safety Patient Centred, Accessible, Equitable, Integrated
Appropriate, Effective, Efficient, Population Health Focused
What is “QUALITY” at St. Michael’s?
S afety O utcomes A ccess P aDent experience E quity E fficiency
*Consistent with the 6 dimensions of quality from the InsDtute for Healthcare Improvement
Quality Improvement
Juran Deming Berwick
Quality Journey
QI in Context
Evidence Based Medicine
Knowledge TranslaDon Quality Improvement
Safe and Quality
Healthcare
Quality Improvement: The Why and What
Slide 10
• PaDent flow/wait Dmes • Clinical pathways • PaDent Experience • DiagnosDc error • Human Performance/SimulaDon • CriDcal Events-‐ Disclosure/Second VicDm
Quality Improvement – Where to start
WHAT would SMH have to do to rank #1 among our LHIN?
Assuming everyone performs the same next year
No. Performance Best Performers
SMH (71,568 ED visits)
Change Needed (Hrs)
Change Needed (%)
1. ED LOS for Admits 15.1 23.7 -‐8.6 -‐36%
2. ED LOS Non-‐
Admits CTAS 1-‐3 6.9 8.7 -‐1.8 -‐21%
3. ED LOS Non-‐
Admits CTAS 4-‐5 4.2 5.4 -‐1.2 -‐22%
4. PIA 1.6 3.1 -‐1.5 -‐48%
5. DTA to Bed 6.7 16.3 -‐9.6 -‐59%
Judgment Decision IniDal
percept or problem
Pacern Processor
RECOGNIZED
TYPE 1
processes
TYPE 2
processes
NOT RECOGNIZED
Type 1 and Type 2 Processes (dual process theory)
Quality Improvement: The Why and What
Slide 17
• DefiniDon of criDcal incident • How do you know when they occur? • InvesDgaDon/review process • Disclosure to paDent/families • Care of the caregiver
Quality Improvement – Critical incidents
Quality Improvement: The Why and What
Slide 18
• Define your project/interest • Get expert help-‐ corporate/university resources • Data sources • Clear endpoints • Change management/buy in • Be prepared to fail
Quality Improvement- Next Steps
Quality Improvement: The Why and What
Slide 19
• The future of health care • Academic career • Make a difference for your paDents/families • Fewer night ships?
Quality Improvement- Why me?
Quality Improvement: The Why and What
Slide 20
• PaDent Safety in Emergency Medicine – Textbook edited by Pat Croskerry
• Taitz,JM, et al.A Framework for engaging physicians in quality and safety BMJ Quality and Safety July 2011
• Shojania,KG, Levinson, W Clinicians in Quality Improvement – A new career pathway in Academic medicine JAMA Feb,2009
References