Skip to main content Accessibility help
×
Home

Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department

  • Lucas B. Chartier (a1) (a2), Amy H.Y. Cheng (a1) (a3), Antonia S. Stang (a4) (a5) and Samuel Vaillancourt (a1) (a3)

Abstract

Emergency medicine (EM) providers work in a fast-paced and often hectic environment that has a high risk for patient safety incidents and gaps in the quality of care. These challenges have resulted in opportunities for frontline EM providers to play a role in quality improvement (QI) projects. QI has developed into a mature field with methodologies that can dramatically improve the odds of having a successful project with a sustainable impact. However, this expertise is not yet commonly taught during professional training. In this first of three articles meant as a QI primer for EM clinicians, we will introduce QI methodology and strategic planning using a fictional case study as an example. We will review how to identify a QI problem, define components of an effective problem statement, and identify stakeholders and core change team members. We will also describe three techniques used to perform root cause analyses—Ishikawa diagrams, Pareto charts and process mapping—and how they relate to preparing for a QI project. The next two papers in this series will focus on the execution of the QI project itself using rapid-cycle testing and on the evaluation and sustainability of QI projects.

Les fournisseurs de soins au service des urgences (SU) sont soumis à un rythme de travail rapide, dans un milieu souvent trépidant, ce qui comporte des risques élevés d’atteinte à la sécurité des patients et de lacunes en matière de qualité des soins. Toutefois, ces difficultés ont permis aux fournisseurs de soins de première ligne au SU de jouer un rôle dans des projets d’amélioration de la qualité (AQ). Cette discipline s’est développée au point de former un champ d’activité à part entière, pourvue de méthodes qui peuvent améliorer sensiblement les chances de réussite à long terme de projets. Toutefois, cette discipline est rarement enseignée en formation professionnelle. Aussi présenterons-nous, dans ce premier article d’une série de trois, élaborée comme une introduction à l’AQ à l’intention des cliniciens qui travaillent au SU, les méthodes de travail appliquées en la matière et la planification stratégique, et ce, à l’aide d’une étude de cas fictive. Nous verrons comment cerner un problème d’AQ, définir les éléments d’un énoncé clair du problème, discerner les différentes parties intéressées et former l’équipe responsable des changements fondamentaux. Nous ferons également état de trois techniques qui permettent de faire l’analyse des causes profondes : les diagrammes d’Ishikawa, les diagrammes de Pareto et la schématisation des processus, et nous verrons comment ces techniques interviennent dans la préparation des projets d’AQ. Les deux autres articles prévus dans la série porteront sur la réalisation des projets eux-mêmes à l’aide d’essais à cycles rapprochés ainsi que sur l’évaluation et la durabilité des projets d’AQ.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Quality improvement primer part 1: Preparing for a quality improvement project in the emergency department
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Lucas B. Chartier, 200 Elizabeth Street, RFE-GS-480, Toronto, ON M5G 2C4; Email: lucas.chartier@uhn.ca

References

Hide All
1. Kohn, LT, Corrigan, J, Donaldson, MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000, xxi.
2. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001, xx.
3. Baker, GR, Norton, PG, Flintoft, V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170(11):1678-1686.
4. Frank, JR, Snell, L, Sherbino, J, eds. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.
5. Calder, LA, Forster, A, Nelson, M, et al. Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study. CJEM 2010;12(5):421-430.
6. Stang, AS, Wingert, AS, Hartling, L, Plint, AC. Adverse events related to emergency department care: a systematic review. PLoS One 2013;8(9):e74214.
7. Bernstein, SL, Aronsky, D, Duseja, R, et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009;16(1):1-10.
8. Guttmann, A, Schull, MJ, Vermeulen, MJ, Stukel, TA. Association between waiting times and short-term mortality and hospital admission after departure from emergency department: population-based cohort study from Ontario, Canada. BMJ 2011;342:d2983.
9. Stang, AS, Crotts, J, Johnson, DW, Hartling, L, Guttmann, A. Crowding measures associated with the quality of emergency department care: a systematic review. Acad Emerg Med 2015;22(6):643-656.
10. Chartier, L, Josephson, T, Bates, K, Kuipers, M. Improving emergency department flow through rapid medical evaluation unit. BMJ Qual Improv Rep 2015;4(1):epub, 10.1136/bmjquality.u206156.w2663.
11. Chartier, LB, Simoes, L, Kuipers, M, McGovern, B. Improving emergency department flow through optimized bed utilization. BMJ Qual Improv Rep 2016;5(1):epub, 10.1136/bmjquality.u2016156.w2532.
12. Dellinger, RP, Levy, MM, Rhodes, A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580-637.
13. Brugha, R, Varvasovszky, Z. Stakeholder analysis: a review. Health Policy Plan 2000;15(3):239-246.
14. Bryson, JM. Strategic Planning for Public and Nonprofit Organizations: A Guide to Strengthening and Sustaining Organizational Achievement. 3rd ed. San Francisco: Jossey-Bass; 2004.
15. Beatty, CA, Barker Scott, BA. Building Smart Teams: A Roadmap to High Performance. Thousand Oaks: Sage Publications; 2004.
16. Stang, AS, Wong, BM. Patients teaching patient safety: the challenge of turning negative patient experiences into positive learning opportunities. BMJ Qual Saf 2015;24(1):4-6.
17. Landers, T, Abusalem, S, Coty, MB, Bingham, J. Patient-centered hand hygiene: the next step in infection prevention. Am J Infect Control 2012;40(4 Suppl 1):S11-S17.
18. Baker, GR, Fancott, C, Judd, M, O’Connor, P. Expanding patient engagement in quality improvement and health system redesign: three Canadian case studies. Healthc Manage Forum 2016;29(5):176-182.
19. Ishikawa, K. Guide to Quality Control. Tokyo: Asian Productivity Organization; 1976, xiv.
20. Tague, NR. The Quality Toolbox. 2nd ed. Milwaukee: ASQ Quality Press; 2005, xxvi.
21. Langley, GJ. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco: Jossey-Bass; 2009, xxi.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed