DAY 1:
MON, APRIL 20

CONCEPTS IN CONTINUOUS QUALITY IMPROVEMENT IN EMERGENCY MEDICINE

8:15-9:00 Course Registration Machievelli Room, Grand Hotel Baglioni

9:00-9:15 Welcome
Jonathan Edlow, MD & Barbara Masser, MD

9:15-10:30 Keynote Lecture: Why Quality Assurance is Essential to Every Emergency Department
Richard Wolfe, MD & David Brown, MD
After this keynote presentation by two ED chiefs, participants will have an understanding on the necessity of having a well-run quality program in their EDs and the importance of using quality metrics to measure ED performance, drive intended clinical behaviors, ensure high-quality care delivery to patients in emergency medicine clinical practice and creation of a blame-free culture. The intention of the presentation is to create common understanding of, and a shared passion for ED quality amongst international colleagues.

10:30-10:45 Break

10:45-11:30 Ice-Breaker: Team Building and Communication: Foundations of an Effective QA System

11:30-11:55 Too Err is Human: What is an Error?
After this presentation, participants will: 1) better understand how to define an error (versus “judgment”); 2) be able to differentiate errors in planning (mistakes) from errors in execution (slips and lapses); and 3) distinguish between errors and adverse events. Participants will also be able to rate an error using the AHRQ Adverse Event Severity Scale, discuss factors contributing to errors, and understand the relationship between error and standard of care.

11:55-12:55 Workshop: Adverse Event & Error
During this session, participants will use clinical case examples to illustrate and discuss concepts of adverse event and error, including application of standardized scoring systems such as the AHRQ scale.

12:55-13:45 Lunch: Hotel Baglioni Rooftop Restaurant

13:45-15:45 Workshop: Introduction to a Rule-Based System of Medical Error
After this session, participants will be able to: 1) understand the use of new and more informative ED-based quality assurance markers for clinical error, 2) understand the benefit of standardizing a set of ED rules to differentiate standard of care from acceptable practice variability, and 3) identify common themes when looking at error; themes that can subsequently be used to develop education and risk reduction strategies.

15:45-16:00 Break

16:00-17:00 Principles of Emergency Department Quality Metrics
After this session, participants will be able to: 1) understand best practices for choosing metrics that ensure high-quality emergency care, such as metrics for: patient throughput, diagnostic accuracy, production of errors and adverse events, times from arrival to therapeutic interventions, and resource utilization (admission rates, use of expensive diagnostics, etc.).

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18:00-19:00 NETWORKING EVENT
Join us on the Rooftop Bar of the Hotel Baglioni for a welcome drink and network with fellow emergency medicine clinicians.


DAY 2
TUESDAY, APRIL 21

IMPLEMENTING PRINCIPLES OF CONTINUOUS QUALITY IMPROVEMENT IN YOUR ED

9:00-10:05 Root Cause Analysis Workshop
After this session, participants will be able to: 1) Utilize RCA (root cause analysis) as a tool to identify and analyze factors that result in errors and adverse outcomes, 2) Understand how to investigate the relationships between contributing factors and problems or adverse events, 3) Learn the methodology of RCA describing problems or delineating facts of an event utilizing timelines to sequence events leading to behaviors, conditions, actions, and inactions, and 4) Identify and pinpoint corrective actions that will prevent recurrence of untoward outcomes while assessing cost, simplicity, and ease of implementation.

10:05-10:20 Break

10:20-12:05 Workshop: Quality Assurance Committee Function and Hospital System Interaction
During this workshop, participants will learn about standard quality assurance processes at the departmental and hospital levels. The presentation will be followed by an interactive mock QA committee workshop exercise.

12:05-13:05 Lunch: Hotel Baglioni Rooftop Restaurant

13:05-14:05 Using Clinical Pathways to Improve Patient Safety & Clinical Quality: Discussion
During this session, participants will review important concepts regarding the use of clinical pathways to improve patient safety. Faculty from BIDMC and other institutions will conduct an in-depth review of their clinical pathway development process. The group will discuss the practical considerations necessary in the creation of specific pathways, as well as the measurable results from pathway implementation. In addition, participants will be given access to clinical pathways from BIDMC and will have time to discuss implementation challenges due to varying hospital settings, patient needs, and healthcare system realities.

14:05-15:05 Using Clinical Pathways to Improve Patient Safety & Clinical Quality: Workshop
During this workshop, participants will have the opportunity to create a clinical pathway to address specific QA issues raised in a presented clinical case.

15:05-15:20 Break

15:20-15:40 Case Study: Using Triggers to Improve Patient Safety & Clinical Quality
In this session, participants will use a clinical case as a basis to discuss the development of a trigger program which quickly and effectively identifies patients who need immediate assistance, thereby improving clinical quality and patient satisfaction. Participants will learn about the ED-specific “triggers” protocols for heart rate, systolic blood pressure, respiratory rate, and SaO2. Participants will also learn concepts such as defining a trigger team, designating a trigger room, outlining the triggers processes, and training staff.

15:40-16:20 Group Discussion: Using Triggers to Improve Patient Safety & Clinical Quality
Faculty will lead participants in a discussion of their experiences with trigger protocols and how these protocols have either contributed to or detracted from the ED clinical quality.


DAY 3
WEDNESDAY, APRIL 22

METHODS FOR STANDARDIZING CLINICAL CARE TO IMPROVE QUALITY

9:00-9:40 Physician Assessment and Remediation
Physician performance failures pose a significant threat to patient safety and welfare. During this session and through use of case-based examples, participants will learn how to effectively perform physician assessment and remediation as a part of a robust QA system.

9:40-10:40 Roundtable: ED Crowding

During this session, participants will be asked to share examples of their own ED crowding challenges for discussion and problem solving with faculty and other participants. This will be a facilitated group discussion on the issue of ED crowding and its significant impact on the real time provision of quality care, from a variety of international perspectives.

10:40-10:55 Break

10:55-12:55 Leadership and Change Management for Quality Assurance
Through this interactive workshop, participants will learn the leadership and change management skills necessary to implement QA changes in their departments. Participants will gain an understanding of “the change curve” and how people go through change. By the end of this session, participants will discover their own preferred approach to change, other preferred approaches, and how these approaches may interact in navigating change. In the session, participants will gain a deeper understanding of the learning curve, comfort zones, and what is needed for leaders and departments to grow and develop.

12:55-13:30 Lunch

13:30-14:40 Certification Exam (Optional).
Participants who do not take the certification exam still qualify to receive a certificate of attendance and CME credit.

14:40 Distribution of certificates