Acceptable Types of IMP Activities

Physicians may complete Improvement in Medical Practice efforts related to any of the measures or activities below. Others that are not listed, may be acceptable if they follow the four steps ABEM requires.

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

    • Sepsis guidelines, including use of DART toolkit 
    • Septic shock: repeat lactate level measurement      
    • Antibiotic stewardship (includes selection, administration time, local resistance pattern identification, etc.)     
    • Septic shock: lactate clearance rate of greater than or equal to 10%
    • Appropriate testing for children with pharyngitis
    • Appropriate treatment for children with upper respiratory infection  
    • Antibiotic treatment for adults with acute bronchitis: avoidance of inappropriate use           
    • Antibiotics within a specific time (CAP and all other infections)       
    • Blood culture before antibiotics         
    • Immunization status - Pneumococcal, Influenza, Pediatric  
    • COVID-19 Patient Management         
  • 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)
    • Transfer time to another facility for AMI intervention [OP-3]
    • Aspirin at arrival for AMI or chest pain [includes OP-4b, OP-4c]
    • Assessment for chest pain (including risk stratification, non-invasive testing and stress testing, diagnostic protocols for early rule-out, TIMI risk assessment) [PQRS #54]
    • Median time to electrocardiogram (ECG) for AMI or chest pain
    • Improving care for patients with chest pain
    • Cardiac resuscitation and post-resuscitation care
    • Screening for high blood pressure and follow-up documented
  • 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
    • Avoid head CT for patients with uncomplicated syncope
  • 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.)
    • Reduction of Healthcare Disparities/Implicit Bias
  • 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.)
  • Patient Safety, Error Reduction, and Complication Avoidance

    • 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
    • Management of the intoxicated or alcohol withdrawal patient           
    • 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
    • Safe ventilator management
    • Adherence to indications for blood transfusions
     
  • 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
    • Asthma pathways
    • EMA Clinical Performance Improvement Program
    • Pregnancy test for female abdominal pain patients
    • Appropriate use of urine culture
  • Addiction and Mental Health

    • Initiate medication for addiction treatment (MAT) in the ED (e.g., buprenorphine)  
    • Assure follow-up for MAT as outpatient
    • Evaluation for risk of opiate misuse
    • Use of statewide electronic pain medication prescribing system
    • Opioid overdose management (treatment, referral, safe discharge, etc.)
    • Adherence to opioid prescribing recommendations for chronic pain (includes CDC recommendations) 
    • Implement an alcohol withdrawal management guideline
    • Tobacco use screening and cessation
    • Referral to outpatient community mental health
    • Depression screening
    • Integration of behavioral health into ED         
  • Palliative Care

    • Use of Palliative Care consultation    
    • Discuss end-of-life care goals           
    • Integration of hospice into emergency care  
    • Adherence to POLST registry according to state standards