• 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.