Emergency Department Collaborative
The Emergency Department (ED) quality improvement proposal was initiated in late 2011 by the Northern Ireland Trust Chief Executives Forum. The Health and Social Care Safety Forum was asked to
(i) Engage Trust ED teams to gain consensus on a number of internal professional standards that would act as regional quality indicators for emergency medicine.
(ii) Run a quality improvement collaborative in these chosen areas.
- A series of Trust visits were held with senior clinical leaders from each of the ED and a summary document was compiled and circulated
- Two regional workshops were facilitated by the HSC Safety Forum to seek consensus on a number of regional emergency department internal professional standards.
- Regular feedback has been provided to the CEO forum on progress.
- An ED Advisory Group has been established, to steer and support the collaborative. An ED consultant physician has been appointed as the Chair of this group with an ED nurse consultant as vice chair.
- The areas selected by the Trust clinical teams were as follows:
- Early management of severe sepsis and septic shock– baselining work has been completed in all Trusts linked to the College of Emergency Medicine (CEM) national audit
- Thrombolysis in acute stroke – Trusts are collecting data on the following measures:
- Assessed by Stroke team within 30 minutesCT scan within 45 minutes
- Door to needle time 60 minutes
- Onward transfer to acute stroke unit, or appropriate environment, within 90 minutes
- Patients who leave before treatment is complete – Trusts are collating monthly data on percentages with a target of less than 5%, aligned to the CEM standard. It was agreed that in addition to staff collecting the monthly percentages that they would also undertake a more in-depth analysis of the profile of these patients on a quarterly basis i.e. gender, age, post code, presenting complaint and to ascertain if they fall into what might be termed a “high risk” category such as mental health or children.
- Unscheduled re-attenders - Trusts are collating monthly data on percentages with a target of between 1 - 5%, aligned to the CEM standard.
- Patient/Client experience - agreement was reached with the regional patient-client experience group that they will use their audit period of April to July 2012 to focus on emergency departments, yielding data which will inform the collaborative on the most appropriate subject areas for work.
- The first Learning set for this collaborative was held on the 27th March 2012. Over forty Doctors, nurses and managers, from all Trusts (including Ambulance Service Trusts) participated in the event which included talks from Professor Fiona Lecky and Dr Susan Robinson from the College of Emergency Medicine and Dr Una Geary, who leads the National Clinical Programme in the Republic of Ireland. It is planned that the initiatives north and south of the border will share their learning and maintain links throughout the collaborative.
- Learning Session 2 (LS2) is scheduled for June 2012 at which participants will share their improvement work including feedback from an ED staff culture safety questionnaire. In advance of LS2, Trusts have been asked to use the Plan, Do, Study Act methodology to run small tests of change to drive improvement in the agreed areas.
- Continue links with the CEM quality improvement initiative and seek Northern Ireland and UK benchmarking data from the National Audit on severe sepsis