Improving Quality Across the Globe: the IFEM Updated Quality Framework
1The Prince Charles Hospital, ACEM, Australia
The collaborative development, dissemination, use and enforcement of health policies by organisations involved in providing healthcare for emergency patients can and will improve the safety of our patients. A number of organisation play a key role in maintaining the quality of care provided in Emergency Medicine including pre-hospital providers, hospitals, governments, Colleges, medical and nursing associations and others. It is incumbent on these organisations to develop and promote relevant policies. IFEM has achieved this objective by releasing a Quality Framework, with an updated version recently released.
Quality of care and safety are paramount which can be measured by various means. Attention is now being paid to defining and assuring quality in emergency care, driven by metrics, financial drivers, accreditation standards, training status and medico-legal concerns. The rise in the use of EDs exceeds population growth and changes in population morbidity and presents particular system challenges of crowding, assessment and treatment delays. There is the potential for a reduction in both the quality and safety of care, especially if capacity cannot grow to match demand.
IFEM members have done extensive work within their own healthcare systems to identify quality in EDs applying various measures and promoting these measurements as important to the public and funding bodies. In some countries, there has been mandatory implementation of quality standards or requirements for quality improvement and patient safety training in speciality colleges. At the same time in countries where Emergency Medicine is developing, there may be immense pressures on the emergency care system, combined with limited resources to support that system. Under such conditions, tiers of quality measures appropriate to the particular circumstances can be implemented. The Updated Quality Framework took substantial collaborative, international effort from the IFEM Quality and Safety Special Interest Group.
The key areas of focus in the updated Quality Framework are:
1. What patients should expect from an Emergency Department
• Expertise in critical care in collaboration with colleagues from anaesthesia and intensive care.
• Early access to specialist inpatient and outpatient services to ensure appropriate ongoing evaluation and treatment of patients.
• Appropriate duration of stay in the ED to maximise patient care and comfort and to optimise clinical outcomes.
• Development of additional services alongside core ED activity
2. Enablers and barriers to quality care
• Physical structures
• ED Processes
• Co-ordinated emergency care throughout the patient pathway
• Monitoring of outcomes
Crowding (or overcrowding) is inconsistently defined and measured, but ideally should comprise a combination of non-flow items (such as ED occupancy) and flow items (such as length of stay)
4. Quality Indicators
• Quality Improvement resources and processes
• Incident Monitoring
• Morbidity and mortality review
• Integration and communication with ambulance, hospital specialities and primary care