You are midway through a busy rapid response shift where you have noticed an increased response time of the hospital’s intubating teams to decompensating patients. Over the last few months, the COVID-19 pandemic has prompted a restructuring of the use of many spaces to accommodate the influx of patients. You understand that the system is overwhelmed but you are optimistic that you can optimize the interprofessional team’s response times. This sets off a …
Next Generation Improvement Part 2: QI Frameworks – Quality Improvement vs. Systems Thinking
You are the nurse manager of an emergency department at a small community hospital in rural Ontario. You recently helped facilitate the creation of a group of healthcare professionals to focus on improving patient flow within the emergency department, something that your hospital has noted to be a longstanding issue. The team is meeting for the first time tonight to discuss approaches to improving ED flow. You decide to take some time to …
Next Generation Improvement Part 1: A Call for the Strategic Deployment of Improvement Modalities
Quality Improvement (QI) is in the middle of a “market surge”. Over the last few years, we have seen QI move from being a fad to having an established presence in academia, hospital operations, and science. A plot of Pubmed articles with the search criteria “quality improvement” OR “QI” yield a very flat slope between 1948 and 2009 (Figure 1). Since then, there has been a notable increase, going from 3200 articles to …
HiQuiPs: Building Quality & Safety Infrastructure
You’ve completed a Quality Improvement (QI) project and you’re thinking about how you might align your efforts with those of your colleagues to build a community of practice that can prioritize, support, and deliver a comprehensive program of high-quality Q&S work. But where to start? What are the crucial steps and antecedents for success in building a robust Quality & Safety (Q&S) infrastructure? Welcome to this HiQuiPs post that offers a roadmap on …
HiQuiPs: Resource Issues in the Emergency Department
Emergency departments are busy and are getting busier1, 2. Emergency physicians are faced with issues of overcrowding, departmental closures, and insufficient staffing. These issues are exacerbated by both the Covid pandemic3 and pressures found in the post-Covid “return to normal”4. Physicians are still expected to provide safe medical care in the face of these challenges. But what does that look like when your emergency department lacks appropriate resources? And how can physicians minimize …
HiQuiPs: Optimizing your diagnostic reasoning – themes from CMPA medico-legal cases
A 49-year-old male presents to the emergency department with shortness of breath on exertion and left lower chest discomfort for the past 3 days. His past medical history is significant for hypertension and he has a family history of heart disease. At triage he is noted to have a pulse of 117 and normal blood pressure. His oxygenation is 94% on room air. His cardiac and respiratory exam are normal, and no other …