Emergency Quality Improvement

Agus Barmawi Department of Surgery Sardjito General Hospital/GMU Yogyakarta

Introduction
Emergency Departments (EDs) are a crucible of the healthcare system, where quality, accuracy and efficiency are tested to the extreme. The current economic climate, coupled with a cultural mentality of instant gratification, contributes to further strain on EDs. High rates of unemployment mean more people without insurance and with less access to routine preventive care from primary care doctors end up in EDs. And everyone expects immediate attention.

Basic achievement of quality improvement

Hospital vision Hospital mission

Dasar Strategik/Strategic Foundation

Terdapat Pelayanan Gawat Darurat Masayarakat Dukungan Klinis

Strategi dalam pencapaian tujuan

Kualitas (quality) Akses (Access) Pemeliharaan Pencapaian (Sustainability)

Arah Strategik (Strategic Direction)

Fokus dalam pelayanan pasien/Patient centered care Kualitas Pelayanan Rumah Sakit/Quality Hospital Care Kepemimpinan/Leadership Persekutuan/perkongsian/Kebersamaan/Partn ership. Integrasi/integration

Instalasi Gawat Darurat adalah pintunya rumah sakit

Keberhasilan IGD tergantung pada setiap orang. Berusaha terus menerus memperbaiki hasil pelayanan Gawat Darurat (Quality). Fokus dalam rangka mengurangi waktu tunggu di Gawat Darurat (Access). Berusaha mengintegrasikan pelayanan pada tingakatan yang paling memadai (Sustainability)

 Quality Improvement Plan (QIP) was tailored to fit plan already underway across organization and in ED.

Perencanaan Peningkatan Mutu

Pengukuran kepuasan pelanggan Perencanaan: Memepercepat waktu Penilaian Awal Dokter (initial Assessmen Meningkatkan mutu Penanganan Nyeri Meningkatkat komunikasi mengapa pasien harus menunggu Memperkuat Proses Hubungan dengan Pasien Menerapkan Seluruh Janji Program untuk meningkatkan Kepemimpinan dan ketrampilan pelayanan pelanggan untuk tiap dan setiap anggota dan dokter

Perencanaan Peningkatan Mutu

Indikator Instalasi Gawat Darurat Presentasi Kenyamanan Untuk Seluruh Pelayanan yang diterima Presentasi Tahun ke 1 80 % Presentasi Tahun ke 2 ? Presentasi Tahun ke 3 ? Presentasi Tahun ke 4 ?

Hal-hal yang menjadi perhatian utama

Ukuran yang Strategik
Kenyamanan Pelayanan Gawat Darurat Waktu tunggu

Kepemimpinan yang Strategik

Tunjukkan bahwa setiap program adalah berhubungan, mempunyai peranan dan tanggung jawab dalam setiap masalah di Gawat Darurat

Hal-hal yang menjadi perhatian utama

Keterukuran yang Strategik
Termasuk dalam Perencanaan Peningkatan Kualitas adalah Kompensasi Eksekutif Dimungkin untuk ditingkatkan setiap hal yang dianggap penting Mamajemen IGD harus fokus untuk membuat ukuran/peraturan untuk seluruh eksekutif.

 Emergency Services have been working to reduce cycle times for ED discharge patients and admit times for ED-to-hospital admissions. Brockmeyer and her team began reviewing data related to ED wait times, measured in the hours to discharge or admission after the decision to admit is made. The benchmark in 2003 was to have the patient to a hospital bed within four hours after decision to admit.

Indonesia Concept of Emergency Services

Strategy
Increase the quality of triage Increase the availability of drugs Improve and automate patient registry system Reduce time interval between decision and operation for trauma surgery Optimize output of new training center Improve compliance with Emergency guidelines Improve response time for lab and x-ray results

 Discovered and addressed several issues across the system where improvements could be made, notes, and steps, such as better central census of all hospital discharges and potentially available beds.

 In 2004 2005, Roper St. Francis invested in a TeleTracking board that electronically monitors the status of every bed in the hospital from one centralized screen. This addition resulted in more efficient hospital discharge communication, which created greater inpatient bed capacity, thus ED patients to be admitted are moved out of the ED more efficiently, and ED beds are opened up more quickly for those waiting.

Dispatchers and other personnel at Life EMS Ambulance had to become accustomed to trusting the Predictive Deployment Software technology over years of gut instincts. Shown here covering the city of Kalamazoo at about 2:02 p.m. Wednesday, the darkest colors on the system's computerized graphic are the areas with the greatest likelihood for an emergency call

Together GPS (global positioning system) technology with CAD (computer-aided dispatching to help manage scheduling of work crews, vehicle fleet maintenance, human resources and quality assurance.