RESUMEN
As a primary access point for crisis psychiatric care, the emergency department (ED) is uniquely positioned to improve the quality of care and outcomes for patients with psychiatric emergencies. Quality measurement is the first key step in understanding the gaps and variations in emergency psychiatric care to guide quality improvement initiatives. Our objective was to develop a quality measurement framework informed by a comprehensive review and gap analysis of quality measures for ED psychiatric care. We conducted a systematic literature review and convened an expert panel in emergency medicine, psychiatry, and quality improvement to consider if and how existing quality measures evaluate the delivery of emergency psychiatric care in the ED setting. The expert panel reviewed 48 measures, of which 5 were standardized, and 3 had active National Quality Forum endorsement. Drawing from the measure appraisal, we developed a quality measurement framework with specific structural, process, and outcome measures across the ED care continuum. This framework can help shape an emergency medicine roadmap for future clinical quality improvement initiatives, research, and advocacy work designed to improve outcomes for patients presenting with psychiatric emergencies.
Asunto(s)
Servicios Médicos de Urgencia , Medicina de Emergencia , Humanos , Urgencias Médicas , Servicio de Urgencia en Hospital , Evaluación de Resultado en la Atención de SaludAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Servicios Médicos de Urgencia/organización & administración , Medicina de Emergencia/organización & administración , Innovación Organizacional , Atención Dirigida al Paciente/organización & administración , Eficiencia Organizacional , Humanos , Triaje/organización & administraciónRESUMEN
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Asunto(s)
Humanos , Medicina de Emergencia/organización & administración , Medicina de Desastres/organización & administración , Innovación Organizacional , Triaje/organización & administración , Pautas de la Práctica en Medicina , Modelos Organizacionales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/métodosRESUMEN
BACKGROUND: Most strategies used to help improve the patient experience of care and ease emergency department (ED) crowding and diversion require additional space and personnel resources, major process improvement interventions, or a combination of both. OBJECTIVES: To compare the impact of ED expansion vs. patient flow improvement and the establishment of a rapid assessment unit (RAU) on the patient experience of care in a medium-size safety net ED. METHODS: This paper describes a study of a single ED wherein the department first undertook a physical expansion (2006 Q2 to 2007 Q2) followed by a reorganization of patient flow and establishment of an RAU (2009 Q2) by the use of an interrupted time series analysis. RESULTS: In the time period after ED expansion, significant negative trends were observed: decreasing Press Ganey percentiles (-4.1 percentile per quarter), increasing door-to-provider time (+4.9 minutes per quarter), increasing duration of stay (+13.2 minutes per quarter), and increasing percent of patients leaving without being seen (+0.11 per quarter). After the RAU was established, significant immediate impacts were observed for door-to-provider time (-25.8 minutes) and total duration of stay (-66.8 minutes). The trends for these indicators further suggested the improvements continued to be significant over time. Furthermore, the negative trends for the Press Ganey outcomes observed after ED expansion were significantly reversed and in the positive direction after the RAU. CONCLUSIONS: Our results demonstrate that the impact of process improvement and rapid assessment implementation is far greater than the impact of renovation and facility expansion.
Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Arquitectura y Construcción de Instituciones de Salud , Satisfacción del Paciente , Triaje/organización & administración , Desvío de Ambulancias/tendencias , Aglomeración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Análisis de Series de Tiempo Interrumpido , Tiempo de Internación/tendencias , Evaluación de Procesos, Atención de Salud , Tiempo de Tratamiento/tendencias , Negativa del Paciente al Tratamiento/estadística & datos numéricos , Flujo de TrabajoRESUMEN
We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.