You are working in the Emergency Department on a day when it is busy and bed blocked. You assess a patient presenting with chest pain in the EMS offload area. Standing next to the stretcher, stopping to move every time a porter comes by with another patient stretcher, you sense that your patient is frustrated. After the initial workup is complete, you go to reassess your patient and review the results. As you …
HiQuiPs: Patient Safety in the ED Part 4 – Patient Handovers and Transitions of Care
You are beginning a morning shift in the Emergency Department when the overnight physician comes up to you and asks “Hey, can I give you a few handovers?” Your colleague provides a brief verbal handover for three patients and then says “this fourth one is a slam dunk admit, I’ve called the hospitalist and they’ll come to see the patient sometime this morning. Don’t even worry about it.” A few hours later, a …
HiQuiPs: Patient Safety in the ED Part 3 – The Role of Safety Culture in a Patient Safety Program
You are attending a departmental event when you walk over to a group of your colleagues, and the conversation goes silent. You wonder if you had that effect on the conversation, but the awkward silence is reluctantly broken by the person who was speaking when they quietly continue their story. This veteran physician discusses a recent incident where they placed a wrong-sized lumen chest tube in a patient, only to have to replace …
HiQuiPs: Patient Safety in the ED Part 2 – Key Concepts in the Systems-Based Patient Safety Paradigm
You are working a busy shift in your local ED, which has a paper-based system for documentation and orders. You have seen two patients with the first name ‘Ben’, and two patients with the last name ‘Chen’. As you are reflecting on this, you realize that the last order you placed for one of the ‘Bens’ was placed on the wrong patient chart. You quickly grab the chart, put a line through the …
HiQuiPs: Patient Safety in the ED Part 1 – Introduction to the Systems Approach
So far in our series we’ve explored several approaches, frameworks and tools that will help guide you through the process of quality improvement. You are probably eager to get started at this point (or you may have already!), but you may be wondering which areas to target first in your emergency department (ED). In a previous post we listed some high-yield priorities to choose from. Among these, one of the most recognized and accessible …
HiQuiPs: Implementation Part 2 – Which Strategy to Choose: PDSA, Lean, or Six Sigma?
PDSA, Lean, and Six Sigma are three different frameworks that can be part of your quality improvement armamentarium. Each of them can often be applied to the same quality issue. Deciding on which one to use requires an understanding of their inherent strengths and weaknesses. In our last post, we briefly introduced the theory behind Lean, Six Sigma, and PDSA cycles. Here, we will practically apply each methodology to one quality problem to …