A comprehensive approach to achieving near 100% compliance with The Joint Commission Core Measures for pneumonia antibiotic timing

The Relationship Between Accurate Triage and Core Measures Compliance for Acute Myocardial Infarction and Heart Failure in Older Adults Presenting to the Emergency Department

BACKGROUND

Accurate emergency department (ED) triage in the geriatric population is an important nurse-sensitive quality indicator; however, few quality indicators are verified for impact.

PURPOSE

To examine the relationship between triage accuracy in adults older than 65 years and Core Measures for acute myocardial infarction (AMI) and heart failure (HF).

METHODS

A correlational approach was used to determine strength and direction of the relationship between variables.

RESULTS

Strong positive correlations were found between triage accuracy and mortality for AMI and HF, as well as with 30-day hospital readmissions for AMI. A weak negative correlation was found between triage accuracy and 30-day hospital readmissions for HF.

CONCLUSIONS

Accurate triage can lead to a more effective care trajectory for patients, better adherence to Core Measures, and better outcomes. Accuracy in triage for AMI and HF is a valid indicator of ED quality care.

Improving emergency physician performance using audit and feedback: a systematic review

BACKGROUND

Audit and feedback can decrease variation and improve the quality of care in a variety of health care settings. There is a growing literature on audit and feedback in the emergency department (ED) setting. Because most studies have been small and not focused on a single clinical process, systematic assessment could determine the effectiveness of audit and feedback interventions in the ED and which specific characteristics improve the quality of emergency care.

OBJECTIVE

The objective of the study is to assess the effect of audit and feedback on emergency physician performance and identify features critical to success.

METHODS

We adhered to the PRISMA statement to conduct a systematic review of the literature from January 1994 to January 2014 related to audit and feedback of physicians in the ED. We searched Medline, EMBASE, PsycINFO, and PubMed databases. We included studies that were conducted in the ED and reported quantitative outcomes with interventions using both audit and feedback. For included studies, 2 reviewers independently assessed methodological quality using the validated Downs and Black checklist for nonrandomized studies. Treatment effect and heterogeneity were to be reported via meta-analysis and the I2 inconsistency index.

RESULTS

The search yielded 4332 articles, all of which underwent title review; 780 abstracts and 131 full-text articles were reviewed. Of these, 24 studies met inclusion criteria with an average Downs and Black score of 15.6 of 30 (range, 6-22). Improved performance was reported in 23 of the 24 studies. Six studies reported sufficient outcome data to conduct summary analysis. Pooled data from studies that included 41,124 patients yielded an average treatment effect among physicians of 36% (SD, 16%) with high heterogeneity (I2=83%).

CONCLUSION

The literature on audit and feedback in the ED reports positive results for interventions across numerous clinical conditions but without standardized reporting sufficient for meta-analysis. Characteristics of audit and feedback interventions that were used in a majority of studies were feedback that targeted errors of omission and that was explicit with measurable instruction and a plan for change delivered in the clinical setting greater than 1 week after the audited performance using a combination of media and types at both the individual and group levels. Future work should use standardized reporting to identify the specific aspects of audit or feedback that drive effectiveness in the ED.

Recent Publications on Medications and Pharmacy

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.