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Emergency Medicine Quality Initiatives Outride the Pandemic

Written by: Jill Jansen, Ben Hunter, MD, Carl Pafford, MD, Matt Rutz, MD,MBA and Christian Strachan, MD 

Despite COVID-19 and a year that’s been anything but routine, efforts to improve quality in Emergency Medicine have continued. Under the leadership of Christian Strachan, MD, quality directors Ben Hunter, MD, (IU Health Methodist Hospital), Carl Pafford, MD, (IU Health Community EDs) and Matt Rutz, MD, MBA, (Eskenazi Health) are taking advantage of increasingly robust data to design quality programs and initiatives targeting two main areas—sepsis and patient experience.

“Sepsis is a big focus because it’s the number one cause of mortality in the hospital system,” Strachan said. “If we’re committed to addressing mortality, then we’ve got to be committed to addressing sepsis.”

With nearly 85 percent of IU Health hospital admissions coming through the ED, emergency medicine providers are on the frontline of sepsis prevention. That’s why both the academic and community EDs are focusing on recognition and early administration of antibiotics. At Methodist, ED huddles with nursing staff and other team-based strategies resulted in significant improvement with early administration of antibiotics jumping from 63 percent to 85 percent in just one month.

Pafford said the community EDs have been successful in building pathways to standardize work and expedite patient care. These include implementing order sets that address primary antibiotics for specific conditions. He added that teamwork also plays an important role in improving quality in the community Emergency Departments.

“We discovered early on in our sepsis work that it’s really a team effort,” he said. “It’s about educating team members who have the potential to recognize possible infection, and it’s also about getting the pharmacists involved so we’re intervening early with antibiotics.”

While sepsis and patient experience are important quality improvement priorities at Eskenazi, the ED is also working on best practices related to imaging and opiate utilization.

“As a coordinated initiative, quality improvement in the ED is fairly new at Eskenazi,” said Rutz. “We’re working on building a foundation, determining the best data sources and gaining a good understanding of our data.”

Quality teams statewide are also tackling patient experience in the ED. In addition to continual efforts to address wait times, boarding and “left without being seen” occurrences, recent initiatives are zeroing in on patient interactions with particular emphasis on frequency of contact and quality of communication. Training and education, including patient experience simulations and medical improv, are set to roll out in 2021 after being waylaid this year due to COVID-19.

There’s a big push in the Department of Emergency Medicine to incentivize quality metrics, and improving patient experience is a big one,” Strachan said. “We believe in, and we’re going to own some of these measures.”

Although patient experience and sepsis are the current priorities, Hunter said there’s value in every quality improvement effort—large or small.

Tracking things like how often a head CT is obtained for a patient who objectively could be proven not to need one—there’s great return in trying to diminish those,” he said. “They’re not overarching initiatives like sepsis or patient experience, but the more things we can improve the better overall care we’ll deliver.”