Overview of the E-Quality Group Christchurch Hospital Emergency Department Anne Esson – Nurse Manager anne.esson@cdhb.health.nz Polly Grainger – Nurse Coordinator Clinical Projects polly.grainger@cdhb.health.nz History In 2012 discussion at the national REDS conference about the creation of a national quality framework and suite of quality measures via the MOH sparked a review of our current quality focussed forums . At the time some of the most active were the Floor Group which was established in 2004 as a forum for discussing ED matters among all professional groups working in the ED and Project RED . Project RED (rejuvenating ED) was set up n 2007 as a response to overcrowding in CHCH ED and a great number of improvements were made over a period of 3 years. As time went by Project Red become less active and the floor group was trundling on . The development of the quality framework seemed a good time to farewell the above groups and create something else that would be proactive in setting the direction for the department and bring to life the new the quality framework. So the Christchurch ED E- Quality group was born .This group has a strong leadership role-helping to direct us to where we need to be and ensuring we get there .It is still in its infancy stage and I don’t think we’re there yet but we’re on the journey.

Purpose Embed the New Zealand Triple Aim Principles for quality improvement for: The individual – improved, quality safety and clinical care The population – improved health and equity for all populations The system – best value for public health system resources Facilitate the monitoring and compliance to the Shorter Stays in ED Health Target, the Quality Framework and Suite of Quality Measures

Scope and objectives Scope: Provide overview, support and direction towards clinical governance in the ED context through: Open and transparent communication and decision-making Implementing best practice Adherence to policies, procedures and protocols Robust measurement, accountability and responsibility  Objectives: Patient safety; clinical effectiveness; patient experience

Participants Clinical Director Nurse Manager Clerical Manager Quality Facilitator Service Manager Visiting subject matter experts as required Representatives of all ED multidisciplinary professional groups Note: Consumer and/or community representation to be set up

Collaborative functional relationships Senior Nursing Team (SNT) Group Senior Medical Officer (SMO) Group ED Business Meeting Combined SNT /SMO Group ED Nurses Rep Group Hospital Aides Group Mortality and Morbidity Meetings Infection Prevention and Control Process Improvement Groups (PIGs) Health and Safety Committee Audit Planning Team Nursing Roster Governance Group Evaluation and Audit Working Group Acquisitions Group Quality Action Plan Development Team

In practice Quarterly reporting: New business: audit prioritisation, new policies, and invited speakers Ongoing business: existing projects Patient H&S and OSH topics and initiatives – staff (patient H&S in all other meetings) Month 1 – Jan, April, July, Oct Audits & pathways in progress Month 2 – Feb, May, Aug, Nov Patient journey time stamps Month 3 – March, June, Sept, Dec Quality processes and patient experiences: Incidents, complaints, compliments, M&M outcomes, SAC outcomes

Tools Decision Reporting Suite Signals from Noise (SfN) Quality Framework and Suite of Quality Measures for ED HAC key improvements reports Audit prioritisation template – Hawkes Bay DHB Individual audit tools CDHB Audit Reporting Suite Open-access electronic file of resources from the Quality Office

Audits Integrating SMO requirements for FACEM and RN needs for PDRP Altering the focus: – from what the auditor needs to comply – to what the department needs Providing existing tools for repeat audits Providing similar tools to base new audits on Raising awareness of audits – enabling collegial assistance Collating all tools and reports in one open-access electronic file