During your Emergency Medicine (EM) rotation, you’ve encountered numerous lacerations and have honed your suturing skills. Following the primary closure of your most recent laceration, your supervising physician has requested that you apply an appropriate dressing and provide wound care instructions, as the nursing staff are preoccupied with attending to other patients. You look at the Wound Product Information Sheet and are surprised by the variety of dressings available in the Emergency Department …
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 …
Quality Improvement in Nephrology Part 1 – Examining Patient Follow-up Practices
The Quality Improvement paradigm has been applied to a wide spectrum of settings and patient populations. There has been an exponential rise in QI publications over the recent decades.1 In this new HiQuiPs Series we explore the QI paradigm applied to different medical specialties and settings. We start with an example of an outpatient nephrology setting. Quality Improvement (QI) in nephrology for patients with kidney disease takes on many different forms depending on …
Initiation of Congestive Heart Failure Action Plan in the Emergency Department
A 72-year-old English-speaking male with a history of congestive heart failure (CHF) withreduced ejection fraction (EF) presented to the emergency department (ED) with acutedecompensated CHF. He had a two-year history of progressive dyspnea and exercise intolerance.Other comorbidities included coronary artery disease, hypertension, dyslipidemia, cardioembolicstroke, and gastroesophageal reflux disease. His medications included furosemide, apixaban,atorvastatin, carvedilol, and fosinopril. His furosemide was reduced from 40 mg to 20 mg daily by hisfamily physician five months prior …