Measuring Quality and Implementing Change in Emergency Departments (Text Version)

On September 14, 2009, Megan McHugh made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (805 KB). 

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Slide 1

Measuring Quality and Implementing Change in Emergency Departments

The Urgent Matters Learning Network (UMLN) II

AHRQ Annual Meeting
September 14, 2009

Megan McHugh, PhD

Transforming Health Care Through Research and Education
HRET Health Research & Education Trust
In Partnership with AHA 

Slide 2

UMLN II Hospitals

Map of the United States with the following UMLN II hospital locations marked:

• St. Francis Hospital in Indiana
• Stony Brook University Medical Center in New York
• Good Samaritan Hospital in New York
• Thomas Jefferson University in Pennsylvania
• Hahnemann University Hospital in Pennsylvania
• Westmoreland Hospital in Pennsylvania 

Slide 3

UMLN II Hospital Requirements

• Form a multi-disciplinary, hospital-wide team
• Select and implement improvement strategies
• Complete an implementation plan and monthly progress reports
• Participate in UMLN II meetings
• Field-test standard performance measures
• Participate in the evaluation of the strategies 

Slide 4

UMLN II Framework

Graphic showing:

• The hospitals linked to Urgent Matters Team and HRET
• Urgent Matters Team linked to the hospitals, HRET, AHRQ and RWJF
• HRET linked to the hospitals, Urgent Matters Team and AHRQ
• AHRQ linked to Urgent Matters Team, HRET and RWJF
• RWJF linked to Urgent Matters Team and AHRQ 

Slide 5

Percent of Patients that Leave Before Being Seen

Graph showing:

• Hospital A at 2%
• Hospital B at 2%
• Hospital C at 12%
• Hospital D at 8%
• Hospital E at 6%
• Hospital F at 3% 

Slide 6

UMLN II Strategies (Examples)

• Open Bed Policy (Hahnemann)
• Consultation Process (Stony Brook)
• "Revitalizing" Fast Track (Thomas Jefferson)
• ESI III "Mid-Track" (Good Samaritan)
• Standardize Triage Process (St. Francis)
• ED/Inpatient Report Tool (Westmoreland) 

Slide 7

UMLN II - Goals

1. Evaluate the implementation of strategies to improve patient flow.
2. Advance the development of performance measurement in the ED.
3. Promote the spread of promising practices to a wider audience. 

Slide 8

UM LN II Evaluation Questions

• What factors motivated, supported, or impeded the implementation of the strategies?
• What changes in patient flow occurred after the implementation of the strategies?
• What resources were used for the implementation of the strategies, and what were the associated costs? 

Slide 9

UMLN II - Goals

1. Evaluate the implementation of strategies to improve patient flow.
2. Advance the development of performance measurement in the ED.
3. Promote the spread of promising practices to a wider audience. 

Slide 10

UMLN II Performance Measures

• Time from ED arrival to ED departure (admitted/discharged)
• Time to pain management for long bone fracture (admitted/discharged)
• Time to chest X-ray (admitted/discharged)
• Admit decision time to ED departure time (admitted) 

Slide 11

UMLN II Performance Measures

• Time from ED arrival to ED departure (admitted/discharged)
• Time to pain management for long bone fracture (admitted/discharged)
• Time to chest X-ray (admitted/discharged)
• Admit decision time to ED departure time (admitted) 

Slide 12

UMLN II - Goals

1. Evaluate the implementation of strategies to improve patient flow.
2. Advance the development of performance measurement in the ED.
3. Promote the spread of promising practices to a wider audience. 

Slide 13

Preliminary Thoughts

• Hospitals frequently encounter challenges during implementation.
• Our ability to attribute improvement to specific interventions is limited.
• Implementation is time intensive.