Quality management in

Emergency Care Department

W.A .Keerthirathne(RN,BScN,PGDDE,Dip Teaching

& Sup,Dip in Edu,Mgt & Leadership,Dip in Psy) Special Grade Nursing Tutor PBCN

 is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury.

  Emergency Nursing is a specialty in which nurses care for patients in the emergency or critical phase of their illness or injury and are adept at discerning life-threatening problems, prioritizing the urgency of care, rapidly and effectively carrying out resuscitative measures and other treatment, acting with a high degree of autonomy and ability to initiate needed measures without outside direction, educating the patient and his family with the information and emotional support needed to preserve themselves as they cope with a new reality. These activities may be carried out in a variety of settings and not necessarily in an "Emergency Room."

Every other specialty of nursing, a patient arrives with a diagnosis  by a physician and the

nurse must manage patient's care according to that diagnosis,

Emergency nurses work with patients diagnosis has not yet been made and the cause of the problem is not known.

Emergency nurses frequently contact patients in the emergency department before the patient sees a physician.

In this situation, the nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening illness or injury, the use of advanced monitoring and treatment equipment, and in some cases, the ordering of testing and medication according to "advance treatment guidelines" or "standing orders" set out by the hospital's emergency physician staff.

. How is "Emergency Nursing" different from other nursing?  

An Emergency Nurse is hold high degrees of knowledge and skills, with diagnostic and decision-making power to effectuate urgently needed activities in autonomous or in the closely-collaborative with other health professionals. An Emergency Nurse is capable of providing a broad spectrum of skills that in other settings would be delegated to other health care workers. Without disregarding the critical activities, Emergency Nurses commonly triage and treat less urgent problems, providing care and treatment of those injuries or illnesses, and providing the educational and psychosocial evaluations and support to return the patient successfully

High level of value or excellence How good or bad some thing

The combine and unceasing effort of everyone

The combine and continuous effort of every one ,health care professionals, patients and their families, payers ,researchers, educators and planners

to make changes that will leads to better patient outcome(health),

better system performance(care) and better professional

development(learning)

Concept is complex Main goal is to change performance not to

discover new knowledge. To do their work, improve it. Change in care process and routine work in

health care All improvement require changers but not

every change is improvement. Do more carefully. Faster ,better, more effective and safer

Patients in emergency care not always satisfied with the care

Nursing care describe as instrumental and non-holistic.

Information Respect and empathy Pain relief Nutrition Waiting time General atmosphere Patent safety Cost effectiveness Evidenced based practice

2. Determine solution

5. Monitor and analyse

7. Document and educate 3. Implement solution

6. review accordingly 4. Communicate the process

I Identify a problem

Safety Timely Access Equitable Efficacy Efficient Patient Centered

How can you improve a system to achieve better results in the 6 pillars of quality?

You need a good understanding of the system

You need to understand where it is failing - Identify what is wrong Make sure it is the step that needs

fixingThen you can implement a change to

the “system”

System = any assembly of procedures, resources and routines to carry out a specific activity

To understand a system and identify what is wrong with it Map it out!

Use a flow chart/diagram

Use different perspectives (a doctor’s perspective is different to a nurse’s or a porter’s to a patient’s perspective)

1. The Aim: What are we trying to accomplish? (How good do we want to get and by when?)

2. The Measures: How will we know a change is an improvement?

3. The Changes: What change can we make that will result in improvement?

What are we trying to accomplish?

How will we know that a change is an improvement?

What change can we make that will result in improvement?

MODEL FOR IMPROVEMENT

STUDY

ACT PLAN

DO

Plan a change Do the change Study the results Act on the results

STUDY

ACT PLAN

DO

Eight fundamental priority rights to improve quality of emergency department

Health care staff who are appropriately trained and qualified to deliver emergency care, with the early involvement of senior doctors with specific expertise in E M where life-threatening/changing illness (physical or mental) or injury is suspected.

1. Properly equipped (for example with monitoring equipment and supplies)

2. Appropriate compliance with hygiene3. Infection control measures reduce the incidence of

hospital acquired infection for the anticipated number of patients and all commonly presenting conditions, as well as less common but predictable emergencies.

3.Adequate space to provide the necessary patient care in an environment that is secure and promotes patient privacy and dignity;

4. Acutely ill and injured patients should not be routinely cared for in hallways or non-equipped overflow spaces.

At all levels of ED function, from managerial/administrative levels to the frontline, the importance of critical thinking in decision making should be recognized and emphasized.

To ensure early recognition of those patients requiring immediate attention and prompt time critical interventions, and the timely assessment, investigation and management of those with emergency conditions

Patient-centred care with an emphasis on relieving suffering, good communication and the overall experience of patients and those accompanying and/or caring for them.

Optimal outcomes from treatment within the ED for all patients presenting with emergency healthcare needs.

Which enables the patient to access timely and appropriate emergency care, and which continues to support them after they have left the ED. There should be strong links to the community including education and prevention, alongside the promotion of public health.

From community and hospital-based healthcare teams, and managers of the ED, who should ensure that the above arrangements are sustainable. There should be established and agreed mechanisms to monitor standards and compliance, with action taken if an ED falls short.

Appropriate access and utilization of, diagnostic support services (e.g. plain radiography, ultrasound, CT scanning and laboratory services) by EM doctors when needed for the immediate diagnosis of life threatening conditions

Expertise in critical care in collaboration with colleagues from anaesthesia and intensive care

Early access to specialist inpatient and outpatient services to assure appropriate on-going evaluation and treatment of patients with emergency care needs

Appropriate duration of stay in the ED to maximise patient care and comfort, and to optimise clinical outcomes

Additional services to enhance the quality and safety of emergency care. Such as short-stay/observation facilities, alternative patient pathways, social and mental health services or associated outpatient activity.

However excellent ED care is the constant development of innovative and enhanced services to support the delivery of quality and safety.

Safe - Avoiding harm to patients . Effective -Providing services based on

scientific knowledge to all who could benefit, and refraining from providing services/care to those not likely to benefit.

Patient-centred -Providing care that is respectful of and responsive to individual patient preferences, needs, and values .

Timely -Reducing waits and sometimes harmful delays .

Efficient -Avoid waste (personnel, ressources, finance).

Equitable -Providing care that does not vary in quality because of personal characteristics .