Acceptable Types of PI Activities

Acceptable Types of Patient Care Practice Improvement Activities

• Time-related (Throughput Time, ED length of stay, and other process time measures)

  • Door-to-doctor times (door-to-provider, door-to-evaluation)  [includes OP-20]
  • ED length of stay for discharged psychiatric and transferred patients [includes OP-18, CEDR]
  • Throughput time improvement [includes ED1-a, ED 1-b, ED-1c]
  • Time to disposition decision (admit, discharge, etc.) [includes ED-2a, ED-2b, ED-2c]

• Infectious Disease-related

  • Goal-directed sepsis pathway, use of DART toolkit, other sepsis guidelines [CEDR]
  • Appropriate testing for children with pharyngitis [PQRS #66, CEDR]
  • Appropriate treatment for children with upper respiratory infection [PQRS #65]
  • Antibiotic treatment for adults with acute bronchitis: avoidance of inappropriate use [PQRS #116]
  • Antibiotic stewardship (includes selection, administration time, local resistance pattern identification, etc.)  [includes OP-6, OP-7, PQRS #331]
  • Blood culture before antibiotics

• Stroke-related

  • Head CT within 45 minutes of arrival of stroke patient [OP-23]
  • Thrombolytic consideration or use in eligible patients [STK-4, PQRS #187, CEDR]
  • Door to puncture time for endovascular stroke treatment [PQRS #413]
  • Stroke activations and care pathways

• Cardiac-related

  • Door-to-balloon times for acute myocardial infarction (AMI)
  • 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 or chest pain [includes OP-4b, OP-4c]
  • Median time to electrocardiogram (ECG) for AMI or chest pain [5b, 5c]
  • Assessment for chest pain (including risk stratification, non-invasive testing and stress testing, diagnostic protocols for early rule-out, TIMI risk assessment) [PQRS #54]
  • Improving care for patients with chest pain
  • Cardiac resuscitation and post-resuscitation care
  • Screening for high blood pressure and follow-up documented [CEDR]
  • Coagulation studies in patients presenting with chest pain with no coagulopathy or bleeding [CEDR]

• Appropriate Imaging

  • Appropriate CT use in minor blunt head trauma – patients aged 18+ [including PQRS #415, CEDR]  
  • Appropriate CT use in minor blunt head trauma – patients 2-17 years [PQRS #416, CEDR]
  • Appropriate CT for evaluation of suspected pulmonary embolus
  • Appropriate CT use for abdominal pain in adults
  • Appropriate imaging for renal and ureteral colic
  • Appropriate imaging for trauma patients (includes Nexus criteria and Ottawa rules)
  • Use of imaging for low back pain [PQRS #312]
  • Use of ultrasound for diagnosis for abdominal pain, pediatric
  • Ultrasound determination of pregnancy location for pregnant patients with abdominal pain [PQRS #254]
  • Appropriate use of neuroimaging for patients with primary headache, a normal neurological examination, and no trauma [includes CEDR]

• Communication – Patient Care

  • Patient call back system
  • Improving patient understanding of discharge instructions
  • Improvements in response to Patient Experience of Care Survey results
  • Safe sign-out between Emergency Physicians
  • Transfer of care to other care provider (consultant, admitting physician, etc.)

• Pain Management and Sedation

  • Time to pain management for all pain, including long-bone fractures [OP-21]
  • Reassessment of pain after administration of analgesia
  • Procedural sedation safety (includes appropriate medication selection, checklists, etc.)
  • Adherence to opioid prescribing recommendations for chronic pain
  • Completion of “Prescribing Opioids in the Emergency Department” from EMPainline
  • Use of statewide electronic pain medication prescribing system
  • Evaluation for risk of opiate misuse

• Patient Safety, Error Reduction, and Complication Avoidance

  • Adherence to indications for central line insertion
  • Prevention of central venous catheter-related blood stream infections [PQRS #76]
  • Ultrasound use for central line insertion
  • Appropriate Foley catheter use in the ED [CEDR]
  • Medication error reduction, including ACEP module, “Preventing Medication Errors”
  • Appropriate use of restraints and seclusion
  • Reassessment of vital signs at discharge
  • Planning safer and more effective aftercare, including ACEP Module
  • Reducing discrepancies between emergency physician and radiologist x-ray interpretation
  • Notification of Regional Poison Control Center for poisoned patient

• Additional Common Measures and Activities

  • Left without being seen
  • Unscheduled return visits to ED (Including 72 hour returns)
  • OPPE/FPPE
  • Improvement of difficult airway management
  • Management of the intoxicated or alcohol withdrawal patient
  • Tobacco use screening and cessation
  • Asthma pathways
  • EMA Clinical Performance Improvement Program
  • Unhealthy alcohol use: screening and brief counseling [PQRS #431]