Admin & Legal Flashcards
Steps in Quality Improvement
Plan: acknowledge issues, gather information, consult stakeholders
Do: formulate response, disseminate for comment
Study: monitor and adjust
Act: implement going forward
Examples of clinical indicators in quality improvement
Hospital readmissions ATS compliance % access block Time to PCI Time to Abx Time to analgesia
Designing protocol or guideline steps
1: identify area for improvement
2: gather information
3: involve stakeholders
4: set objective and timeframe
5: draft guidelines & circulate for comment
6: implement
7: study/audit response
8: adjust as indicated
9: ensure regular review
Same as plan, do, study, act but fleshed out
What elements are required in a protocol or guideline
Title Who must comply Setting Precautions and contraindications Equipment Procedure Tools abs resources Document manager
Think of any protocol you have read and what is on that sheet
Creating performance plan for intern doing poorly
Identify areas for improvement
Discuss reasons for poor performance
Provide specific examples of this
Create action plan, timeframe and review
Factors in deciding NFR
Medical conditions Functional status Patients wishes Medical decision (prognosis) Advanced care directive
Legally who has say over family members wishes in decision making
Competent patient
MTDM
Court
Hospital executive
Steps in dealing with complaint
Acknowledge & apologise Investigate Document Quality cycle Communicate with patient
If medical error above but add open disclosure, investigation and involve stakeholders
Informed consent
Capacity Information given Reasonable opportunity to ask questions Given free of duress Right to withdraw at any time
Capacity
Age >14 and deemed competent
Assimilate, retain info and paraphrase back to you
This includes indication, procedure, complications, alternative options
Disclosure to 3rd party
Request in writing
Specify exactly what required
Signed consent from patient with capacity
When is consent not required to release information regarding patient
Notifiable disease NAI Impaired HCW Life threatening assault Court disclosure Firearm legislation Significant risk to public Registration of death/birth Coroners case Domestic Violence in NT
Reasons for poor patient experience / complaint
Access: timing
Communication: manner, where, how
Clinical care: food, drink, pressure care
Environment: lost belongings, unclean, dirty
What is clinical governance and what are the components of this (6)
Systematic and integrative approach to ensuring services accountable for delivering high quality care
Clinical effectiveness Risk management Professional development Patient & Public involvement Audit Training and education Resource access and IT
How to create better cultural environment
Interpreter Liaison Take cultural history Cultural training Outdoor or private spaces Education for staff on cultural awareness Policies consider cultural differences Self awareness
Time and acceptable % targets for triage categories
1: immediate 100%
2: 10 minutes 80%
3: 30 minutes 75%
4: 60 minutes 70%
5: 120 minutes 70%
Mandatory reporting events
Practicing intoxicated
Sexual misconduct
Impaired HCW (public harm)
Significant medical misconduct
Risk factors for DNW
Long waits Young male Paediatrics Indigenous Low acuity/triage Social or behavioural issues Low socioeconomic status Afterhours attendance WR overcrowding
How to reduced DNW
Systems (WR designs, access block, FT area)
Process (accurate triage, comfort needs met)
Individual (communication, analgesia in WR, early senior RAPID rv)
Define access block
% patients awaiting admission in ED >8 hours
How to address access block
Entry: GP access, rapid access clinics
During: early senior review, allied health, nurse practitioner
Disposition: transit lounge, SSU, early FU
KPIs for SSU
<15% admission to inpatient
<10% over 24 hours
Reasons of SSU <1hr only
% time in ED & SSU combined <4hrs
Define negligence and what is required to prove it
Failure to take REASONABLE care to avoid causing injury or loss to another person
Need to establish:
- Duty of care exists
- breach of duty
- damage sustained & foreseeable
- causation (damage result of breach)
NEAT and ways to improve (ED and hospital)
From presentation to ED to disposition (DC, admit, or refer) within 4 hours 90% target
ED: early senior RV, early referral, WR initiate tx/ix
Hosp: allied health, prompt IP review, interim orders, bed occupancy 85%
Elder abuse definition
Act leading to harm of older person within informal relationship of trust (friends, family)
Types of elder abuse
Financial Physical Sexual Neglect Emotional Social
Steps to responding to elder abuse (6)
Identify (hx and collateral) Provide emotional support Assess risk Plan safety Refer to support agencies Document
Signs of order neglect
Clothing Injuries not cared to Poor hygiene Inadequate supervision Abandoned for long periods
Risk factors of elder abuse
Addiction Dependency Cater stress Language or cultural barriers Social isolation
High risk of DV
Women LGBTI Disability Older Aboriginal CALD Cultural & linguistically diverse Rural
Others: separated, financial hardship, pregnancy, drugs
ACEM core values (4)
Respect
Integrity
Collaboration
Equity
Addressing bullying in hospital (4)
Organisation framework to identify
Ensure compliance to anti-bullying policies
Mandatory staff training
Mandatory manager training
What is cultural competency
Multi-level efforts to create cross cultural working relationships
What is cultural safety?
Patient experience of cultural treatment
What is cultural responsiveness?
Healthcare systems adaptability for different cultures like prayer rooms
Patient benefits of cultural competency
Accurate diagnosis Better trust Better compliance Shared decision making Confidence in ED to return if complications
Benefits to staff of cultural compentency
Diagnosis and tx compliance
Better patient experience
Reduced complaints
Reduces re-presentations
5 feedback principles
Overall performance Active participation Specific examples Identify area for improvement Establish plan for future and review
5 stages of cultural adaptation
Honeymoon (excited) Disorientation Rejection Autonomy (recognising & adapting) Independence (valuing)
ACEM Quality Framework
Clinical (audit, guidelines) Research Administration Professionalism Education and Training
Examples of clinical audits
Hand hygiene Time to ECG in chest pain Time to analgesia Time to thrombolysis Time to antibiotics in sepsis
Specificity
TN / TN & FP
Sensitivity
TP / TP & FN
PPV
TP / TP & FP
Differences in sensitivity/specificity compared to PPV/NPV
Specificity and sensitivity completely independent of pre-test probability whereas other two percentage changes based on high vs low risk
