Quality management and benchmarking in emergency medicine

Purpose of review Being critical in terms of time and complexity, emergency medicine is exposed to an emerging imperative for quality improvement strategies. We review current concepts and recent advances in the management of quality in emergency medicine. Recent findings There is a strong interdependence between quality of emergency healthcare provision and the education of emergency healthcare providers. Introduction of emergency medical residencies and highly qualified triage liaison physicians helps prevent the overcrowding of emergency departments, accelerate access to emergency medical care and improve patient satisfaction. New advances in detecting and reducing patient management errors include the collection of healthcare provider complaints and the classification of unpreventable and preventable deaths of patients within 1 week of admission via the emergency department. Medical record review and video recording have revealed that frequent patient management problems relate to shortcomings in the diagnostic process, clinical tasks, patient factors, and poor teamwork. Communication skills and patient data/documentation systems may effectively resolve these problems. Summary According to the available evidence, more performance improvement strategies need to be tested to delineate which process changes would be most effective in improving patient outcome in emergency medicine.

[1]  Larry A Nathanson,et al.  Where's the beef? The promise and the reality of clinical documentation. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[2]  Daryl A Jones,et al.  Long-term effect of a Medical Emergency Team on mortality in a teaching hospital. , 2007, Resuscitation.

[3]  E. Boudreaux,et al.  The use of performance improvement methods to enhance emergency department patient satisfaction in the United States: a critical review of the literature and suggestions for future research. , 2006, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[4]  J. Grabowski,et al.  The perceived effectiveness of total quality management as a tool for quality improvement in emergency medicine. , 1999, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[5]  C. Madler,et al.  [Quality assurance in emergency medicine]. , 1998, Der Internist.

[6]  S. Poloczek,et al.  Qualitätssicherung in der Notfallmedizin , 1998, Der Notarzt.

[7]  Shari J. Welch,et al.  Time for a rigorous performance improvement curriculum for emergency medicine residents. , 2006, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[8]  K. Kizer The emerging imperative for health care quality improvement. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[9]  Tobacco control interventions in the emergency department: a joint statement of emergency medicine organizations. , 2006, Annals of emergency medicine.

[10]  K. Mackway-Jones,et al.  Immediate anticoagulant management of unstable angina , 2000 .

[11]  Rory Wolfe,et al.  Complaints from emergency department patients largely result from treatment and communication problems. , 2002, Emergency medicine.

[12]  R. Russell,et al.  Audit of deaths less than a week after admission through an emergency department: how accurate was the ED diagnosis and were any deaths preventable? , 2007, Emergency Medicine Journal.

[13]  S. Thakore,et al.  A survey of the perceived quality of patient handover by ambulance staff in the resuscitation room , 2001, Emergency medicine journal : EMJ.

[14]  J. Carr,et al.  The business of emergency medicine: a model for success. , 2004, Emergency medicine clinics of North America.

[15]  José Maria Paganni,et al.  Evaluating the quality of medical care. , 1966, The Milbank Memorial Fund quarterly.

[16]  Anthony Bleetman,et al.  Retention of information by emergency department staff at ambulance handover: do standardised approaches work? , 2007, Emergency Medicine Journal.

[17]  Lorenz Ertl,et al.  Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device. , 2007, Resuscitation.

[18]  Ed Oakley,et al.  Using Video Recording to Identify Management Errors in Pediatric Trauma Resuscitation , 2006, Pediatrics.

[19]  A. Donabedian Methods for deriving criteria for assessing the quality of medical care. , 1980, Medical care review.

[20]  C. Spies,et al.  The resistance to changing guidelines--what are the challenges and how to meet them. , 2006, Best practice & research. Clinical anaesthesiology.

[21]  John Vinen Doctors beware: why a patient complains is not always what it seems. , 2002, Emergency medicine.

[22]  J A Espinosa,et al.  Reducing errors made by emergency physicians in interpreting radiographs: longitudinal study , 2000, BMJ : British Medical Journal.

[23]  Robert H Christenson,et al.  Improving the care of patients with non-ST-elevation acute coronary syndromes in the emergency department: the CRUSADE initiative. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[24]  Improving patient safety reporting systems. , 2007, Critical care medicine.

[25]  S. Shapiro,et al.  Determining Severe Respiratory Distress in Older Out-of-Hospital Patients , 2005, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[26]  Brian H Rowe,et al.  Impact of a triage liaison physician on emergency department overcrowding and throughput: a randomized controlled trial. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[27]  David McD Taylor,et al.  Handover in the emergency department: Deficiencies and adverse effects , 2007, Emergency medicine Australasia : EMA.

[28]  P. Croskerry,et al.  Quality and education. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[29]  A. Donabedian Evaluating the quality of medical care. 1966. , 1966, The Milbank quarterly.

[30]  J. Metlay,et al.  Emergency department operational changes in response to pay-for-performance and antibiotic timing in pneumonia. , 2007, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[31]  W. Dick,et al.  Anglo-American vs. Franco-German Emergency Medical Services System , 2003, Prehospital and Disaster Medicine.

[32]  J. Pines Measuring antibiotic timing for pneumonia in the emergency department: another nail in the coffin. , 2007, Annals of emergency medicine.

[33]  G. Braitberg,et al.  Multidisciplinary assessment at triage: a new way forward. , 2004, Emergency medicine Australasia : EMA.

[34]  S. Schneider,et al.  The effects of the absence of emergency medicine residents in an academic emergency department. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[35]  R. Roberts,et al.  Characteristics of patient care management problems identified in emergency department morbidity and mortality investigations during 15 years. , 2008, Annals of emergency medicine.

[36]  M. Messelken,et al.  Realistic assessment of the physican-staffed emergency services in Germany , 2006, Der Anaesthesist.

[37]  E. Weber,et al.  Identification of 90% of patients ultimately diagnosed with community-acquired pneumonia within four hours of emergency department arrival may not be feasible. , 2007, Annals of emergency medicine.

[38]  J. Kelly,et al.  Impact of an emergency medicine residency program on the quality of care in an urban community hospital emergency department. , 1992, Annals of emergency medicine.

[39]  D. Spaite,et al.  Measuring and improving quality in emergency medicine. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[40]  C. Hobgood,et al.  Emergency medicine resident errors: identification and educational utilization. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.