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Editorial
. 2020 Jul;37(7):437-442.
doi: 10.1136/emermed-2019-209290. Epub 2020 May 13.

Updated framework on quality and safety in emergency medicine

Kim Hansen  1   2 , Adrian Boyle  3 , Brian Holroyd  4   5 , Georgina Phillips  6   7 , Jonathan Benger  8 , Lucas B Chartier  9   10 , Fiona Lecky  11   12 , Samuel Vaillancourt  13 , Peter Cameron  7   14 , Grzegorz Waligora  15 , Lisa Kurland  16 , Melinda Truesdale  17   18 ; IFEM Quality and Safety Special Interest Group
Collaborators, Affiliations
Editorial

Updated framework on quality and safety in emergency medicine

Kim Hansen et al. Emerg Med J. 2020 Jul.

Abstract

Objectives: Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a 'safety-net' function. Demand is increasing, creating resource challenges in all settings. Where EM is well established, this is recognised through the implementation of quality standards and staff training for patient safety. In settings where EM is developing, immense system and patient pressures exist, thereby necessitating the availability of tiered standards appropriate to the local context.

Methods: The original quality framework arose from expert consensus at the International Federation of Emergency Medicine (IFEM) Symposium for Quality and Safety in Emergency Care (UK, 2011). The IFEM Quality and Safety Special Interest Group members have subsequently refined it to achieve a consensus in 2018.

Results: Patients should expect EDs to provide effective acute care. To do this, trained emergency personnel should make patient-centred, timely and expert decisions to provide care, supported by systems, processes, diagnostics, appropriate equipment and facilities. Enablers to high-quality care include appropriate staff, access to care (including financial), coordinated emergency care through the whole patient journey and monitoring of outcomes. Crowding directly impacts on patient quality of care, morbidity and mortality. Quality indicators should be pragmatic, measurable and prioritised as components of an improvement strategy which should be developed, tailored and implemented in each setting.

Conclusion: EDs globally have a remit to deliver the best care possible. IFEM has defined and updated an international consensus framework for quality and safety.

Keywords: emergency care systems; emergency department; quality improvement; risk management; safety.

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Conflict of interest statement

Competing interests: Professor Jonathan Benger is an Emergency Physician in the UK and is the acting Chief Medical Officer for NHS Digital, the national information and technology partner to the health and care system in England. Dr Kim Hansen is Chair of the Board of the Emergency Medicine Foundation in Australia.

Figures

Figure 1
Figure 1
Emergency Care Systems Framework.
Figure 2
Figure 2
Hospital crowding states. Boarders, patients waiting for an inpatient bed. Outliers, patients unable to be admitted to the ‘correct’ ward (eg, medical patients on surgical wards). (Permission to reproduce granted by authors.)
Figure 3
Figure 3
Institute of Medicine domains of ‘high quality care’.
See this image and copyright information in PMC

References

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