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FACEM > Admin & Legal > Flashcards

Admin & Legal Flashcards

1
Q

Steps in Quality Improvement

A

Plan: acknowledge issues, gather information, consult stakeholders

Do: formulate response, disseminate for comment

Study: monitor and adjust

Act: implement going forward

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2
Q

Examples of clinical indicators in quality improvement

A 
Hospital readmissions
ATS compliance
% access block
Time to PCI
Time to Abx
Time to analgesia
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3
Q

Designing protocol or guideline steps

A

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

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4
Q

What elements are required in a protocol or guideline

A 
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

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5
Q

Creating performance plan for intern doing poorly

A

Identify areas for improvement
Discuss reasons for poor performance
Provide specific examples of this
Create action plan, timeframe and review

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6
Q

Factors in deciding NFR

A 
Medical conditions
Functional status
Patients wishes
Medical decision (prognosis)
Advanced care directive
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7
Q

Legally who has say over family members wishes in decision making

A

Competent patient
MTDM
Court
Hospital executive

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8
Q

Steps in dealing with complaint

A 
Acknowledge & apologise
Investigate
Document 
Quality cycle 
Communicate with patient

If medical error above but add open disclosure, investigation and involve stakeholders

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9
Q

Informed consent

A 
Capacity 
Information given
Reasonable opportunity to ask questions
Given free of duress
Right to withdraw at any time
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10
Q

Capacity

A

Age >14 and deemed competent
Assimilate, retain info and paraphrase back to you
This includes indication, procedure, complications, alternative options

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11
Q

Disclosure to 3rd party

A

Request in writing
Specify exactly what required
Signed consent from patient with capacity

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12
Q

When is consent not required to release information regarding patient

A 
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
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13
Q

Reasons for poor patient experience / complaint

A

Access: timing
Communication: manner, where, how
Clinical care: food, drink, pressure care
Environment: lost belongings, unclean, dirty

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14
Q

What is clinical governance and what are the components of this (6)

A

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
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15
Q

How to create better cultural environment

A 
Interpreter 
Liaison
Take cultural history
Cultural training
Outdoor or private spaces
Education for staff on cultural awareness
Policies consider cultural differences
Self awareness
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16
Q

Time and acceptable % targets for triage categories

A

1: immediate 100%
2: 10 minutes 80%
3: 30 minutes 75%
4: 60 minutes 70%
5: 120 minutes 70%

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17
Q

Mandatory reporting events

A

Practicing intoxicated
Sexual misconduct
Impaired HCW (public harm)
Significant medical misconduct

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18
Q

Risk factors for DNW

A 
Long waits
Young male
Paediatrics
Indigenous 
Low acuity/triage
Social or behavioural issues
Low socioeconomic status
Afterhours attendance
WR overcrowding
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19
Q

How to reduced DNW

A

Systems (WR designs, access block, FT area)
Process (accurate triage, comfort needs met)
Individual (communication, analgesia in WR, early senior RAPID rv)

20
Q

Define access block

A

% patients awaiting admission in ED >8 hours

21
Q

How to address access block

A

Entry: GP access, rapid access clinics
During: early senior review, allied health, nurse practitioner
Disposition: transit lounge, SSU, early FU

22
Q

KPIs for SSU

A

<15% admission to inpatient
<10% over 24 hours
Reasons of SSU <1hr only
% time in ED & SSU combined <4hrs

23
Q

Define negligence and what is required to prove it

A

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)
24
Q

NEAT and ways to improve (ED and hospital)

A

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%

25
Q

Elder abuse definition

A

Act leading to harm of older person within informal relationship of trust (friends, family)

26
Q

Types of elder abuse

A 
Financial
Physical
Sexual
Neglect
Emotional
Social
27
Q

Steps to responding to elder abuse (6)

A 
Identify (hx and collateral)
Provide emotional support 
Assess risk
Plan safety
Refer to support agencies
Document
28
Q

Signs of order neglect

A 
Clothing
Injuries not cared to
Poor hygiene
Inadequate supervision
Abandoned for long periods
29
Q

Risk factors of elder abuse

A 
Addiction
Dependency
Cater stress
Language or cultural barriers
Social isolation
30
Q

High risk of DV

A 
Women
LGBTI
Disability
Older
Aboriginal
CALD Cultural & linguistically diverse
Rural

Others: separated, financial hardship, pregnancy, drugs

31
Q

ACEM core values (4)

A

Respect
Integrity
Collaboration
Equity

32
Q

Addressing bullying in hospital (4)

A

Organisation framework to identify
Ensure compliance to anti-bullying policies
Mandatory staff training
Mandatory manager training

33
Q

What is cultural competency

A

Multi-level efforts to create cross cultural working relationships

34
Q

What is cultural safety?

A

Patient experience of cultural treatment

35
Q

What is cultural responsiveness?

A

Healthcare systems adaptability for different cultures like prayer rooms

36
Q

Patient benefits of cultural competency

A 
Accurate diagnosis
Better trust
Better compliance
Shared decision making
Confidence in ED to return if complications
37
Q

Benefits to staff of cultural compentency

A

Diagnosis and tx compliance
Better patient experience
Reduced complaints
Reduces re-presentations

38
Q

5 feedback principles

A 
Overall performance
Active participation
Specific examples
Identify area for improvement
Establish plan for future and review
39
Q

5 stages of cultural adaptation

A 
Honeymoon (excited)
Disorientation
Rejection
Autonomy (recognising & adapting)
Independence (valuing)
40
Q

ACEM Quality Framework

A 
Clinical (audit, guidelines)
Research 
Administration
Professionalism
Education and Training
41
Q

Examples of clinical audits

A 
Hand hygiene
Time to ECG in chest pain
Time to analgesia
Time to thrombolysis
Time to antibiotics in sepsis
42
Q

Specificity

A

TN / TN & FP

43
Q

Sensitivity

A

TP / TP & FN

44
Q

PPV

A

TP / TP & FP

45
Q

Differences in sensitivity/specificity compared to PPV/NPV

A

Specificity and sensitivity completely independent of pre-test probability whereas other two percentage changes based on high vs low risk

FACEM (8 decks)

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