We all strive to provide the best care for our patients, and it takes a lot of work, patience and motivation to create a culture where continuous quality improvement is expected, talked about and adhered to.
Such a culture can be found in Emergency Care with staff from a range of disciplines working together to ensure patients receive time critical treatments within the 6 hour target.
To achieve this, the team has developed a structured Quality Improvement plan using the acronym DAASHH to highlight its priority quality projects. Vanessa Thornton, Clinical Director of EC explains what DAASHH stand for.
- Documentation: We are currently looking at ways of improving documentation in EC. A monthly audit tool is currently being developed and piloted
- Airway: Improving 1st pass intubation (this means achieving an airway in an unwell patient on the first attempt). Since the introduction of an airway registry, where all EC acute intubations are logged and running teaching sessions for EC staff, rates have gone from 67.2% to 78.9%
- Analgesia: Improving time to Analgesia. Patients often present to EC with pain and we aim to provide pain relief to all patients within 30 minutes of arrival – sooner if they are in severe pain. We monitor the provision of pain relief in patients with renal colic (kidney stones) monthly as an indicator of how the department is doing as a whole and we aim to give 95% of patients presenting with renal colic analgesia within 30mins of their arrival. Our performance against this target continues to improve as staff become more engaged in this quality initiative.
- Sepsis: Our goal is that 80% of septic patients, who have an ICU review in EC will receive antibiotics within 60mins. 70% of patients presenting with signs of sepsis (who don’t have an ICU review) will receive antibiotics within 3 hours. As the graphs below show EC is improving its performance and beginning to reduce the variation in performance.
- H is for Heart: EC is monitoring the time it takes for patients, presenting with a severe heart attack to go to the Cardiac Cath Lab to have the clot removed. The goal is for 80% of patients, suffering from a severe heart attack to have a ‘door’ to ‘clot aspiration’ time of 90 mins. In 2011, 22% of patients had a ‘door’ to ‘clot aspiration’ time of 90mins. In 2015 this increased to 80%.
- H is also for Hand Hygiene with compliance rates going from 20% to 79% . That’s a remarkable achievement, considering the wide range of staff that come and go from EC
It’s clear that EC is very focused on quality improvement, and this is not going unnoticed by other Emergency Departments across the country. As the national leader EC has developed a reputation for its forward thinking and innovative ideas.
While all EC staff are committed to improve patient outcomes, a shift in culture wouldn’t have happened without the drive, passion, motivation and leadership from the top and people on the shop floor. This includes Debbie Hailstone, Quality Improvement Facilitator whose passion and drive keeps everyone engaged and involved and Vanessa Thornton who helps to spread the word that everyone has a role to play in keeping our patients safe and free from preventable harm. Anything else is unacceptable.
As a result EC has seen people take ownership of quality improvement in their day-to-day work and continuously strive to improve the care they provide.
For further information about EC’s quality projects contact Debbie Hailstone via email: Debbie.Hailstone@middlemore.co.nz.
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