- Email: [email protected]
333 Creating a Regional Quality Collaborative in Emergency Medicine: The Michigan Emergency Department Improvement Collaborative
Research Forum Abstracts appropriate care, such as not prescribing antibiotics in uncomplicated sinusitis. We determined the rates of following the CW guidelines for sinusitis among DTC telemedicine, Urgent Care (UC), and the emergency department (ED). Methods: Within our DTC telemedicine health records, we searched for chief complaints for the terms cough, sinusitis, upper respiratory infection, cold, sore throat, and congestion (Sept 2015 thru Feb 2016) (82 cases). We matched on date and chief complaints 82 cases from our UC and EM services (246 cases total). Two trained abstractors then used a standardized form to determine adherence to the CW recommendations. Results: Patients were 35 +/- 17 years old, 57% female. Overall, the rates of antibiotic prescription were 59% for DTC telemedicine, 76% urgent care, and 65% in the ED (p<0.05). Rates of following CW guidelines for sinusitis were 73% in DTC telemedicine, 62% in urgent care, and 69% in the ED (p¼0.41). Conclusions: DTC telemedicine had the lowest rate of antibiotic prescriptions and the highest rate of Choosing Wisely guideline adherence for sinusitis.
333
Creating a Regional Quality Collaborative in Emergency Medicine: The Michigan Emergency Department Improvement Collaborative
Kocher KE, Pribble JM, Uren BJ, Macy ML, Ham JJ, Proudlock AL, Didyk JS, White EN, Nypaver MM/University of Michigan, Ann Arbor, MI
Study Objectives: The measurement of health care quality and provider performance evaluation leads to better patient care. While emergency physician leaders have often made use of local data to drive decision-making and operations, large scale quality measurement and performance evaluation across different hospitals and groups has been lacking. We describe the development of the Michigan Emergency Department Improvement Collaborative (MEDIC), an integrated pediatric and adult, emergency physician-led quality improvement project advancing emergency care throughout Michigan. Methods: MEDIC is supported by Blue Cross Blue Shield of Michigan and Blue Care Network as part of their Value Partnerships program. MEDIC measures, evaluates, and enhances the quality of emergency care and outcomes for adults and children treated in 15 Michigan EDs by leveraging shared knowledge and experience of site participants. A committee-based governance structure provides vision and direction for the collaborative. Cooperation between sites is supported by triannual collaborative-wide in-person meetings. General and children’s hospital EDs are recruited annually. Each participating ED selects an emergency physician clinical champion who serves as the liaison between the coordinating center and their site. Sites contribute operational data for all visits to their EDs. Data abstractors from each site conduct chart review on specific cases eligible for quality improvement initiatives that have been selected by the collaborative. Data are submitted to a central clinical data registry via a Web-based portal. Inter-institutional performance on each quality initiative is measured and shared. Performance is reported in blinded fashion at both the site and individual physician level relative to peers via an on-demand Web-based reporting platform. Results: Since inception in 2015, MEDIC has: (1) built infrastructure (staff, clinical registry); (2) collected data (novel system of automated data flow from electronic medical records supplemented by strategic chart abstraction); (3) recruited 8 inaugural sites representing diverse settings (academic/community, rural/urban, pediatric/adult/general) with 7 new sites on-boarding in 2017; (4) specified measures and reported performance for 4 quality initiatives (minor head injury CT appropriateness for children and adults; chest x-ray [CXR] use for common pediatric respiratory conditions [asthma, bronchiolitis, croup]; diagnostic yield of pulmonary embolism [PE] CTs; and creation of clinical care pathways to provide alternatives to admission from the ED). After the first year of data collection, the MEDIC registry contains operational data on more than 550,000 ED visits, including 138,000 pediatric (<18 years old) visits. Specific to the quality initiatives, there were 20,000 minor head injury visits screened with 4,100 head CTs performed on eligible cases, 10,000 pediatric respiratory visits with 4,400 CXRs performed, and 7,000 PE CT cases. Three additional initiatives are in development. When fully operational, these 15 sites will contribute data from roughly 1.2 million annual ED visits, 25% of which are for children. The total ED volume of participating sites represents about 30% of all ED visits in Michigan.
S132 Annals of Emergency Medicine
Conclusions: MEDIC provides a robust platform for emergency physician engagement across a variety of practice settings working together to improve patient care and serves as a model for other states.
334
Patient Satisfaction: It’s Just a Matter of Time
Salehpoor A, Soudachanh T, Howse B, Sinaloa F, Segura A, Bussmann S, Fullerton L, Femling J/University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
Study Objectives: We examined the effect of a Patient Liaison in the University of New Mexico Hospital (UNMH) emergency department (ED) waiting room on patient satisfaction. Methods: From June 2015 to June 2016, an interventionist known as the “patient liaison” was present in the UNMH ED waiting room during the time when new patient registration volume peaked on alternating Mondays and Wednesdays. The liaison was trained to provide patients and visitors with general information about the patient care process in the UNMH ED. The liaison wore a uniform to distinguish them from clinical staff and made attempts to approach patients or visitors in the waiting room to solicit questions and offer assistance and information. After the peak on both days, a cross-section of patients assigned a room was surveyed about their understanding and satisfaction with their ED visit and waiting room experience. Results: Patients who spent time in the waiting room (n¼292) reported a mean satisfaction with time being taken to receive care of 6.7 out of 10. Patients who did not go to the waiting room reported an average satisfaction of 7.8 (n¼201). Among patients who were present in the waiting room on a liaison day, 41.7% (63/151) reported they were aware of the liaison and 21.2% (32/151) reported that they spoke to the liaison. Among patients who had gone through the waiting room, those who spoke to the liaison did not report a significant difference in their satisfaction. We found a negative relationship between time spent in the waiting room and patient satisfaction (p < 0.001). A linear regression analysis indicated that for every hour spent in the waiting room, patient satisfaction decreased by 0.28 points on a 10-point scale. The data shows a strong positive relationship between patient understanding and patient satisfaction (p < 0.001). Conclusions: Our results are consistent with previous findings of the impact of ED wait times on patient satisfaction. An unexpectedly low proportion of patients who went through the waiting room were aware of or spoke to the liaison. While our intervention did not impact patient satisfaction, information about the scale and rate of decline in patient satisfaction and its strong association with patient understanding of the steps being taken to provide them with care are informative for design of future interventions. Aspects of future waiting room interventions that may be more effective in improving patient satisfaction include targeting patients with the longest wait times and adopting a more personalized, proactive intervention method designed to improve each individual patient’s understanding of the steps being taken to provide them with care.
Volume 70, no. 4s : October 2017
333
Creating a Regional Quality Collaborative in Emergency Medicine: The Michigan Emergency Department Improvement Collaborative
Kocher KE, Pribble JM, Uren BJ, Macy ML, Ham JJ, Proudlock AL, Didyk JS, White EN, Nypaver MM/University of Michigan, Ann Arbor, MI
Study Objectives: The measurement of health care quality and provider performance evaluation leads to better patient care. While emergency physician leaders have often made use of local data to drive decision-making and operations, large scale quality measurement and performance evaluation across different hospitals and groups has been lacking. We describe the development of the Michigan Emergency Department Improvement Collaborative (MEDIC), an integrated pediatric and adult, emergency physician-led quality improvement project advancing emergency care throughout Michigan. Methods: MEDIC is supported by Blue Cross Blue Shield of Michigan and Blue Care Network as part of their Value Partnerships program. MEDIC measures, evaluates, and enhances the quality of emergency care and outcomes for adults and children treated in 15 Michigan EDs by leveraging shared knowledge and experience of site participants. A committee-based governance structure provides vision and direction for the collaborative. Cooperation between sites is supported by triannual collaborative-wide in-person meetings. General and children’s hospital EDs are recruited annually. Each participating ED selects an emergency physician clinical champion who serves as the liaison between the coordinating center and their site. Sites contribute operational data for all visits to their EDs. Data abstractors from each site conduct chart review on specific cases eligible for quality improvement initiatives that have been selected by the collaborative. Data are submitted to a central clinical data registry via a Web-based portal. Inter-institutional performance on each quality initiative is measured and shared. Performance is reported in blinded fashion at both the site and individual physician level relative to peers via an on-demand Web-based reporting platform. Results: Since inception in 2015, MEDIC has: (1) built infrastructure (staff, clinical registry); (2) collected data (novel system of automated data flow from electronic medical records supplemented by strategic chart abstraction); (3) recruited 8 inaugural sites representing diverse settings (academic/community, rural/urban, pediatric/adult/general) with 7 new sites on-boarding in 2017; (4) specified measures and reported performance for 4 quality initiatives (minor head injury CT appropriateness for children and adults; chest x-ray [CXR] use for common pediatric respiratory conditions [asthma, bronchiolitis, croup]; diagnostic yield of pulmonary embolism [PE] CTs; and creation of clinical care pathways to provide alternatives to admission from the ED). After the first year of data collection, the MEDIC registry contains operational data on more than 550,000 ED visits, including 138,000 pediatric (<18 years old) visits. Specific to the quality initiatives, there were 20,000 minor head injury visits screened with 4,100 head CTs performed on eligible cases, 10,000 pediatric respiratory visits with 4,400 CXRs performed, and 7,000 PE CT cases. Three additional initiatives are in development. When fully operational, these 15 sites will contribute data from roughly 1.2 million annual ED visits, 25% of which are for children. The total ED volume of participating sites represents about 30% of all ED visits in Michigan.
S132 Annals of Emergency Medicine
Conclusions: MEDIC provides a robust platform for emergency physician engagement across a variety of practice settings working together to improve patient care and serves as a model for other states.
334
Patient Satisfaction: It’s Just a Matter of Time
Salehpoor A, Soudachanh T, Howse B, Sinaloa F, Segura A, Bussmann S, Fullerton L, Femling J/University of New Mexico, Albuquerque, NM; University of New Mexico, Albuquerque, NM
Study Objectives: We examined the effect of a Patient Liaison in the University of New Mexico Hospital (UNMH) emergency department (ED) waiting room on patient satisfaction. Methods: From June 2015 to June 2016, an interventionist known as the “patient liaison” was present in the UNMH ED waiting room during the time when new patient registration volume peaked on alternating Mondays and Wednesdays. The liaison was trained to provide patients and visitors with general information about the patient care process in the UNMH ED. The liaison wore a uniform to distinguish them from clinical staff and made attempts to approach patients or visitors in the waiting room to solicit questions and offer assistance and information. After the peak on both days, a cross-section of patients assigned a room was surveyed about their understanding and satisfaction with their ED visit and waiting room experience. Results: Patients who spent time in the waiting room (n¼292) reported a mean satisfaction with time being taken to receive care of 6.7 out of 10. Patients who did not go to the waiting room reported an average satisfaction of 7.8 (n¼201). Among patients who were present in the waiting room on a liaison day, 41.7% (63/151) reported they were aware of the liaison and 21.2% (32/151) reported that they spoke to the liaison. Among patients who had gone through the waiting room, those who spoke to the liaison did not report a significant difference in their satisfaction. We found a negative relationship between time spent in the waiting room and patient satisfaction (p < 0.001). A linear regression analysis indicated that for every hour spent in the waiting room, patient satisfaction decreased by 0.28 points on a 10-point scale. The data shows a strong positive relationship between patient understanding and patient satisfaction (p < 0.001). Conclusions: Our results are consistent with previous findings of the impact of ED wait times on patient satisfaction. An unexpectedly low proportion of patients who went through the waiting room were aware of or spoke to the liaison. While our intervention did not impact patient satisfaction, information about the scale and rate of decline in patient satisfaction and its strong association with patient understanding of the steps being taken to provide them with care are informative for design of future interventions. Aspects of future waiting room interventions that may be more effective in improving patient satisfaction include targeting patients with the longest wait times and adopting a more personalized, proactive intervention method designed to improve each individual patient’s understanding of the steps being taken to provide them with care.
Volume 70, no. 4s : October 2017