No abstract

Emergency medicine faces unique challenges in the effort to improve efficiency and effectiveness. Increased patient volumes, decreased emergency department (ED) supply, and an increased emphasis on the ED as a diagnostic center have contributed to poor customer satisfaction and process failures such as diversion/bypass. Statistical process control (SPC) techniques developed in industry offer an empirically based means to understand our work processes and manage by fact. Emphasizing that meaningful quality improvement can occur only when it is exercised by "front-line" providers, this primer presents robust yet accessible SPC concepts and techniques for use in today's ED.

From 7/2014 through 6/2015, 10 emergency department (ED) medication dosing errors were reported through the electronic incident reporting system of an urban academic medical center. Analysis of these medication errors identified inaccurate estimated weight on patients as the root cause. The goal of this project was to reduce weight-based dosing medication errors due to inaccurate estimated weights on patients presenting to the ED. Chart review revealed that 13.8% of estimated weights documented on admitted ED patients varied more than 10% from subsequent actual admission weights recorded. A random sample of 100 charts containing estimated weights revealed 2 previously unreported significant medication dosage errors (.02 significant error rate). Key improvements included removing barriers to weighing ED patients, storytelling to engage staff and change culture, and removal of the estimated weight documentation field from the ED electronic health record (EHR) forms. With these improvements estimated weights on ED patients, and the resulting medication errors, were eliminated.

Background Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase. Objective To reduce unnecessary diagnostic testing in acute pancreatitis. Methods The pre-checked amylase test within the Emergency Department's Computerised Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state but kept as an option to order with a single click. Amylase testing, lipase testing and cost were measured for one year pre-and post-intervention. Results Simple de-selection intervention reduced redundant amylase testing from 71% to 9%, resulting in a percent of decrease of 87% and an annualised saving of approximately $719,000 in charges. Conclusion CPOE de-selection is an effective tool to reduce non-value added activity and reduce cost while maintaining quality patient care and physician choice.