Quality improvement has been described as the activities prepared via the use acquired date to facilitate the direct enhancement in specific aspects of the delivery of health services. Some of the activities included in quality improvement include nursing sensitive indicators, performance measures and compliance checks. Performance measures refer to the frequency of occurrence of the process of care, usually aimed at improving patient care while keeping the cost as low as possible. There are many areas in the Academic Medical Center that need quality improvement. This paper shall focus on quality improvement of the emergency department. The emergency unit is a vital part of any hospital, since many people can lose their lives due to delayed treatment, as a result of poor prioritization by the nurses, when it comes to the people who need medical care urgently.
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Development of emergency medical services
The implementation of quality improvement in the emergency medical services is a three stage process. The first stage involves leaders taking the initiative to learn about the procedures, theory and advantages of quality improvement. This stage is meant to encourage the leaders to engage in quality improvement, and strategize on a suitable plan for action. The second stage involves informing and ensuring the participation of the entire workforce in development of the QI plan strategies. The workforce requires knowledge on the techniques involved in quality improvement process, such that they can be able to identify measures of progress as well as problems in their work, and solve them. This stage ensures openness among involved parties, leaders and staff, with accurate measures of progress in place.
Methodologies for integrating QI strategies into performance measurements
The third and final stage involves integration and commitment of the QI strategies. At this stage, the activities of QI are observed to change management practices as well as production methods. Characteristics at this stage include benchmarking, self-directed work teams, continuous improvement and increased communication, among others.
One of the methodologies for integrating QI strategies into performance measurements is the provision of a structure that supports and strengthens the infrastructure of public health. This has been achieved through the Environmental Public Health Performance Standards Program (AnvPHPS). Its role is to evaluate the environmental health programs in their ability to perform the essential services, identify the necessary modifications to increase the capacity as well as measure the progress of public health. The EnvPHPS is advantageous as it candidly illustrates the performance level that should be the target for all environmental health programs. This reduces the instances of emergency services, as prevention is better than treatment (Hunt, Haynes, & Hanna, 1998).
The implementation of the standards and quality improvement processes also increases accountability and consistency in the nation’s environmental public health system. The disadvantage of this methodology is that it does little to monitor the emergency medical services, in the hospital. It may refer to statistics of admissions to monitor the progress of the program, though it brings little change to those admitted in emergency situations (Hunt, Haynes, & Hanna, 1998).
Another methodology to assist in emergency medical services is supporting and improving laboratories. The laboratory system is involved in testing and reporting public health, conducting tests that have implications on public health as well as study of data in public health. The operations of laboratories are enhanced via improvement programs. This is beneficial to emergency medical services as weaknesses within the laboratory systems can be identified and rectified (Shojania, McDonald, Wachter, & Owens, 2007).
The fast delivery of laboratory information is beneficial in administering the correct treatment, therefore reducing the time assigned to monitoring patients, and focusing more on emergency cases. Test results are also useful in identifying regular patterns, so that preventive measures can be taken. The problem with improving the laboratory systems in cases of emergency services is that the fast arrival of treatment may not lead to a fast response by medical personnel, due to either many clients or reluctance in administering treatment (Shojania, McDonald, Wachter, & Owens, 2007).
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Increased funding for public health emergency preparedness (PHEP)
Funds are an integral part in the provision of emergency medical services. The amount of money available affects the preparations and response rate of the health departments when it comes to emergency situations. The role of performance management and quality improvement is enhanced by the requirement for performance measures, which are the basis for funding. These performance measures are based on science. The increased funds to deal with emergency situations are beneficial, as it improves the capacity for handling more patients. The funding is monitored so that it improves the preparedness and response operations, in terms of capacity and capabilities. The capacity is measured in terms of staff and infrastructure, while operational capabilities are dependent on the delivery of countermeasures and management of incidences (Shojania, McDonald, Wachter, & Owens, 2007).
One of the advantages of this methodology is that the funding is monitored to ensure efficiency. This way, it is easy to identify gaps in the infrastructure and other requirements for high efficiency. The process also requires continuous improvement, which is possible through testing and assessment. The funds may be well directed towards increasing the capability of public health systems in protecting the health of the public, though there is the challenge of developing an approach that strengthens the public health system.
Information technology applications (clinical decision support systems) as components of QI management
Clinical decision making is improved by use of clinical decision support system. Computerized clinical support systems have improved the quality of care by improving physician’s guideline compliance. One of the popular computer based decision support systems is the clinical reminder system (CRS). It uses evidence based medicine in specific procedures for applications of preventive care and chronic disease treatment strategies. This allows physicians to monitor better, the treatment of patients. It comprises a knowledge base that has algorithms that use disease treatment protocols. This is very useful in emergency treatment since in some cases, close monitoring is necessary especially for fatal cases. The CSR prompts the operator to take the history of a patient. This information is then used to provide screening information, including referral to a physician, laboratory investigations, advice on prevention and simple treatment (Hunt, Haynes, & Hanna, 1998).
Another kind of CDS system is the knowledge based CDS. Their name is due to the compiled knowledge regarding clinical matters. The main aim of the knowledge based CDS was to provide expert consultation for diagnosing and the selection of the right medication. These systems take into consideration the clinical data f a particular patient before producing a result. These guidelines are provided for national consultation as well as individual concerns. These systems are beneficial in the provision of emergency medical services due to the fast and accurate diagnosing, based on former individual clinical data. The medication administered is also more likely to be accurate. Problems with the knowledge based CDS systems include the lack of accurate maintenance of patient records and the obsolete knowledge embedded In the CDS. These two issues can lead to misdiagnosis due to omission of some patient information, causing the system to override the treatment administered. The systems need to be fed wit new drugs and treatments, that are discovered progressively (Hunt, Haynes, & Hanna, 1998).
The third kind of CDS system is the automation of guideline based management systems. This strategy has been observed to be quite effective in improving the quality of health care as well as saving on the expenses of medical care. one of the problems with availing the guidelines online and in electronic format is that the health workers will seldom take their time to select the most appropriate guideline for a particular patient. These drawbacks have been countered by the dissemination of guidelines using automated computations.
The automation of guideline-based care implies that clinical guidelines are maintained and retrieved according to particular patients, and the quality of treatment accessed. There is interaction between the automated support system and the medical personnel who delivers the care. The systems are fast and accurate in the provision of decisions for patient management. This is beneficial in emergency situations due to the accuracy and speed of treatment, which allows for faster monitoring, and fast treatment, as opposed to delayed medication due to uncertainty of illnesses, or the condition (Hunt, Haynes, & Hanna, 1998).
Involvement of benchmarks and milestones in managing QI
One of the benchmarks in the use of CDS in EMS is the provision of rapid access to relevant medical data. The automation of medical services has helped to eradicate delays associated with paper work. Another benchmark is the administration of correct medical procedures, owed to following the right guidelines in diagnosing patients. The final milestone is the acceptability of the EPR systems by both the patients and personnel. This is made possible by the systems being made user friendly, which reduces the time required to activate. The benchmarks or milestones for the provision of emergency medical services reach a climax with the achievement of results from the efforts of quality improvement. Such results include high rate of patient satisfaction and health status due to improved quality of care, as well as emergency medical services. Other positive results include reduced medical costs, more efficient use of resources and more profits (W., 2003).
Hunt, D. L., Haynes, R. B., & Hanna, S. E. (1998). Effect of computer-based clinical decision support systems on physical performance and patient outcomes: a systematic review. J Am Med , 280:1339- 46.
Shojania, K. G., McDonald, K. M., Wachter, R. M., & Owens, D. K. (2007). Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Prevention of Healthcare-Associated Infections , 4(7), 3-123.
W., J. R. (2003). Benchmarking for prevention: the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) system experience. Infection , 2:44-8.