Care delivered in the emergency department is diverse and complex, impacting a wide range of patient populations and serving as an intermediary between the inpatient and outpatient care. Because of the nature of emergency care and range of potentially costly diagnostic and treatment options immediately available to emergency providers, there are many opportunities for evidence-based quality improvement efforts. The Michigan Emergency Department Improvement Collaborative (MEDIC) will create a first-of-its-kind registry to collect and analyze data on both adult and pediatric patients receiving common and costly procedures during emergency department visits. This work will fall into three broad categories, all with potential cost savings available:
- Diagnostic testing. For example, decision-making around advanced imaging such as computed tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.
- Treatment and processes of care. For example, ensuring prompt door-to-balloon time in ST-elevation myocardial infarction, timely initiation of appropriate antibiotics in septic shock, and provision of thrombolytics in acute ischemic stroke.
- Transitions of care. For example, choosing appropriate patients for hospitalization and ensuring quality transitions for those patients discharged for follow up with outpatient providers.
This is a new CQI. Due to the type of data collected, as well as factors such as length of treatment, timing rules, and tracking of patient outcomes, it takes time for the dataset to mature and become robust enough to allow analysis and produce results.