Peter Freeman

*Quality Framework in use in Rotorua ED

• Facilitate integration of quality activity into service delivery and to form the central hub for all quality activities within the Emergency Department.

• Provide communication about quality activities and initiatives for ED staff and provide integration with organisational quality improvement activities.

• Co-ordinate and drive quality activities within the Emergency Department.

• Work within the Quality framework domains of Clinical Profile, Education and Training, Administration, Professionalism and Research/Clinical Audit.

• Develop and maintain best practice initiatives and an evidence based culture for clinical practice.

• Monitor, report and evaluate professional and unit based quality activities.

• Maintain an overview of standards of practice, including clinical audit practice.

• Action outcomes and improvement initiatives from case reviews from critical incidents, complaints and mortality and morbidity meetings.

• Report to the Ambulatory Service Clinical Governance Group to enable and support strategic planning.

• Elevate any unresolved Quality issues to Service Clinical Governance Meeting.

*TOR of ED Quality Group (previously CQI)

• Clinical Profile

• Clinical Indicators, Procedures, Imaging, Pathology,

• M&M meeting summaries, ED QA Senior Case Review, Medication errors,

• Whole hospital initiatives.

• Education & Training Profile

• Education meetings, Courses attended, Academic achievements,

• Teaching schedule, CPD compliance, Credentialing, Competencies

• Research Profile

• Publications/Presentations, Clinical Audits

• Administration Profile

• Waiting times, Trauma calls, Complaints/Feedback, PAGI

• Risk management, Finances/CAPEX, Workforce, Statistics

• Professional Profile

• Participation in hospital committees, Public health, Liaison.

*Framework of meeting

*FormatClinical Reports Frequency Responsibility

of Core Clinical Indicators Defined by MOH in Suite of Quality Measure MonthlyProcedures Procedural sedation log MonthlyImaging Audit of nurse X-ray requests and clinician activity MonthlyPathology Haemolysis rate MonthlyM&M summaries Monthly report on learnings from cases discussed MonthlyED QA Senior Case Review Senior Doctor case reviews of near misses MonthlyMedication errors Report of medication errors identified MonthlyWhole of hospital initiatives Smoking cessation, Family Violence, Alcohol MonthlyEducation & Training    Education sessions Teaching sessions , medical and nursing MonthlyCourses attended Medical & Nursing MonthlyAcademic achievements Templates for both medical & nursing As and whenTeaching objectives Medical & Nursing AnnualCPD compliance As part of medical credentialing AnnualCompetencies Nursing AnnualResearch    Publications/Presentations Academic publications or presentations As and whenClinical Audits Medical audits MonthlyAdministration    Waiting times Arrival to Triage, Triage to seen, ED LOS MonthlyTrauma calls Number made with any delays or issues identified MonthlyComplaints/Feedback Report of numbers, types and trends MonthlyPAGI Report of numbers, types and learnings MonthlyRisk management Open discussion about current risks MonthlyFinances/CAPEX Standing report MonthlyWorkforce New appointments and vacancies MonthlyStatistics Open forum for discussion about trends MonthlyProfessional    Hospital committees List of hospital committee attended MonthlyPublic Health Current issues As and whenLiaison Medical and Nursing Portfolios Quarterly

• Allows Rotorua ED to respond to MOH Quality measures

• Formalises existing reports for Triage times and activity

• Provides a reference point for M&M meeting summaries, ED QA Senior Case Review and Medication error reports

• Profiles Whole of hospital initiatives.

• Education & Training activity is identified and recorded

• Education meetings, Courses attended, Academic achievements are recorded

• CPD compliance, Credentialing, Competencies are monitored

• Research is identified when active

• Publications/Presentations and Clinical Audits are shared and recorded

• Waiting times, Trauma calls, Complaints/Feedback, PAGI are discussed

• Risk management, Finances/CAPEX, Workforce, Statistics are discussed

• Participation in hospital committees, Public health activity and Liaison roles are acknowledged and recorded

*Benefits

• CQI is a process and the ED Quality Group has focussed on identifying activity and responding to issues and trends

• A repository of Quality activity is being created that can form the basis of Clinical Governance and annual reports

• Issues are taken up by sub groups to investigate – such as Triage 2 non compliance (data entry/integrity)

• More structured discussion

• Less ad hoc administrative reporting – standardised reports

• Inputs from all professional groups in ED

• Feedback to staff

*Benefits continued