• Acceptable Types of Patient Care Practice Improvement Activities

    Additional examples can be found in the Primer on ABEM MOC APP PI Activities

    Cardiac-related Measures (also Resuscitation)

    Door-to-balloon times for acute myocardial infarction (AMI)

    o Fibrinolysis for AMI (median time and within 30 minutes; includes OP-1 and OP-2)

    Transfer time to another facility for AMI intervention (OP-3)

    Aspirin at arrival for AMI (OP-4b)

    o Aspirin at arrival for chest pain (OP-4c)

    o Median time to electrocardiogram (ECG) for AMI (5b) 

    o Median time to ECG for chest pain (5c)

    o Assessment for chest pain (including risk stratification, non-invasive testing and stress testing, diagnostic protocols for early rule-out, TIMI risk assessment)

    o Cardiac resuscitation and post-resuscitation care (including hypothermia)

    Stroke-related Measures (Thrombolytics, Imaging)

    Head CT within 45 minutes of arrival of stroke patient (OP-23)

    o Thrombolytic use in TPA eligible patients (STK-4)

    o Thrombolytic consideration for TPA eligible patients

    o Stroke activations and care pathways

    General Time Sensitive Measures, Throughput Times, and Analgesia Administration

    o Door-to-doctor times (door-to-provider and door-to-evaluation; includes OP-20)

    o Throughput time for discharged patients (OP-18)

    o Throughput time for admitted patients (includes ED-1a, ED-1b, ED-1c)

    o Time to decision to admit (includes ED-2a, ED-2b, ED-2c)

    o Time to pain management for all pain, including long-bone fractures (OP-21) 

    OPPE/FPPE (Joint Commission) [text box]

    Describe a single quality improvement activity

    Infectious Disease-related Measures (Pneumonia, Sepsis, Antibiotics, and Blood cultures)

    o Goal directed sepsis pathway and other sepsis-related measures

    o Antibiotics within a specific time (CAP and all other infections; includes OP-6)

    o Proper antibiotic choice (CAP and all other conditions; includes OP-7)

    o Blood culture before first dose of antibiotics (CAP and all other infections)

    Imaging Decision Making 

    o Appropriate CT use in minor and low-risk head trauma in adults

    o Appropriate CT use in minor and low-risk head trauma in children

    o Appropriate CT use in atraumatic headache

    o Appropriate CT for evaluation of suspected pulmonary embolus 

    o Appropriate imaging for renal and ureteral colic

    o Appropriate imaging for atraumatic lower back pain

    Additional Common Measures and Activities 

    o Left without being seen

    o Safe sign-outs and hand-offs

    o Asthma pathways (including medication use)

    o Patient call back program assessing care (not a patient satisfaction program or survey)

    o Unscheduled return visits (including 72 hour returns)

    o Use of restraints and seclusion

    o Suicide risk assessment (including SADD score)

    o Limiting coagulation studied in patients presenting with no coagulopathy or bleeding

    o Adequate anticoagulation for acute pulmonary embolism patients

    o Tobacco use screening and cessation (adults with asthma or COPD)

    Externally Developed Programs 

    o EMA Clinical Performance Improvement Program [127]

    o Sullivan RSQTM Clinical Assessment Emergency Medicine Risk Initiative Audit [106]

    o ACEP Simulation-based Immersive Medical Training Course

    Other types of patient care practice improvement activities are acceptable if they follow the four steps ABEM requires (see Patient Care Practice Improvement)

    For important high-acuity, low-volume clinical issues, diplomates may measure fewer than ten of their own patients.