“You don’t know what you don’t know.”

Our department’s ED Quality Assurance (EDQA) committee celebrated its 3rd  anniversary this September. In that time over 700 cases were reviewed by the roughly 10 individuals who make up the committee. Many of the charts come from automatic screens (ED mortalities, <72 hour bounce backs who are then admitted) but many come from referrals. Anyone in the department can refer to EDQA by providing the relevant information to Sharon Pineda. Cases are also identified from complaints\concerns expressed from those outside our department.

The review centers around a structure questionnaire involving our opinions on potential adverse outcomes, physician\nurse documentation, the care the patient received. A great deal of time is spent  identifying system issues that lead to less-than-optimal care and outcomes. 

What follows is a look at some of the myths surrounding the EDQA process and my take on its benefits and limitations.

EDQA MYTHS:

  • Certain individuals are targeted for review (most cases come from automatic screens or from those working in the department. Very few come from ED Exec team).
  • Certain individuals are exempt from review (see me personally for my personal experience with the review of my cases 🙂 .
  • Fault is always found in the care given (2\3 of cases are found without concern. Most issues identified are system not individual issues).
  • It is overly focused on the doc or nurse or …. (the physicians carry a larger share of the attention given their larger role in critical decision making. However, attention is paid to all aspects of  care).
  • You must not have reviewed the case I sent you because I never heard anything (given the number of cases reviewed you may not hear the outcome of a case you referred).
  • People have been fired over EDQA decisions (while EDQA does make specific recommendations on system related improvements it does not regarding individuals. It is focused on the care).
  • The reviewers do not work in the real world of medicine (the composition of the reviewers can change weekly and includes a number of physicians and nurses who spend large portions of time providing clinical care).

BENEFITS:

  • It is an internal process that is recognized by the hospital as well constructed and effective. Because of that many issues are handled and controlled internally.
  • Gives us a vehicle to bring well defined concerns to other departments.
  • Is a major source of information for the decision makers in our department
  • While at-risk employees have been identified in this process the overwhelming percentage of the attention is paid to system problems and how to solve them.
  • The information and discussion is very educational and CME\contact hours are available.
  • It is democratic in that anyone care refer a case and be sure it will be evaluated.
  • I would rather learn from others’ mistakes than duplicate them.
  • I feel very strongly that care is safer and more effective due to this process!

LIMITATIONS:

  • At times too much emphasis is placed on the final score (zero through six) than on the lessons that can be learned.
  • The make up of the group is not as diverse as it could be in terms of clinical employees.
  • People feel it is a negative (punitive) process rather than a proactive (let’s fix things) one.
  • The valuable information obtained is not gotten out to the entire department.
  • People may be hesitant to refer cases they are involved in.

Stay tuned for regular EDQA updates under “Lessons Learned”.

As always the opinions expressed here are mine and do not represent those of my employers or any groups I am associated with.