Quincy Medical Center's ED Embraces Technology to Improve Quality Quincy Medical Center (Quincy, MA) has made dramatic improvements in addressing quality initiatives through the innovative use of technology and the ability to incorporate hospital process changes. The site has most recently tackled issues such as meeting JCAHO standards, following Blue Cross and Blue Shield requirements, ensuring quality assurance, managing patient flow, and adhering to best practices. These quality improvements start right in the Emergency Department, where more than half of the hospital's admissions occur, and where the cornerstones of Quincy Medical's technology solution are MEDITECH's Emergency Department Management, Patient Tracker, and Electronic Medical Record products. "We rely heavily on the ability to collect and analyze data using the Tracker and the Electronic Medical Record," says Robert Dart, M.D., chief of emergency services at Quincy Medical. "These tools enable us to gain a realistic view of what we can do to positively impact care, and give us the data we need in order to follow up and see whether we are doing those things correctly." Here are highlights of a few of Quincy Medical Center's latest quality improvements: Enhancing "Tracer Methodology" for JCAHO Reviews Hospitals undergoing a JCAHO review must now be able to "trace" the entire care process of a given patient, on the spot. MEDITECH's system helps them to do just that, explains Dr. Dart. "Our electronic records enable us to show a patient's care process, starting from the Emergency Department all the way through to discharge. It is really wonderful to be able to go up to any PC in the Emergency Department and view the ED chart, which gives you the whole scope of care and practice in a way that is easy to access, legible, and comprehensive," he says. Adhering to New Performance Measures Quincy Medical has improved the way they manage cases of pneumonia and acute coronary syndrome, according to performance measures established by health care organizations including Blue Cross and Blue Shield. Hospitals that adhere to these measures ultimately receive higher reimbursement from payors. For instance, the hospital has improved their timing on antibiotics and blood cultures given to patients with pneumonia. Also, Quincy Medical is ensuring appropriate use of aspirin and beta blockers for patients with symptoms of acute coronary syndrome, as well as improving the timing on providing critical patients the next level of care. "We have found that beta blockers are a lower-risk treatment for those patients who only show a moderate risk of the disease," says Dr. Dart. "We are also better now at more quickly determining when these patients need higher levels of care, such as angioplasty. The information contained in the Electronic Medical Record assists us in collecting the necessary information in a timely manner in order to provide appropriate care."   Improving Internal Quality Assurance The health care organization has made great strides in risk stratification, by quickly determining what level of care patients require, and moving them to that level. "We have improved our ability to get at the scope of the problem more quickly. By accessing data from our MEDITECH system, we can look for common themes in patients, and then make appropriate changes to our Admissions guidelines," says Dr. Dart. "For instance, we have learned that it's best not to start at too low a level of care for patients with high alcohol withdrawal levels. We now start with intermediate care, and then move them down if they're doing okay. Our approach maximizes our use of limited hospital resources, and leads to better outcomes and resource utilization."   Increasing Patient Flow Quincy Medical has been striving to improve patient flow within the hospital. Its goal is for all patients entering the Emergency Department to see a physician within 30 minutes. "We have been reviewing data from the Tracker to identify system delays within hospital processes. Then, when we change a process, we are able to determine whether it leads to an improvement," says Dr. Dart. "For example, we learned that many patients visit the ED around 10 or 11 a.m., and so we doubled our staff covering that time period." Improving Best Practices The MEDITECH system is also helping Quincy Medical to track and improve upon best practices. One of their efforts involves lowering inpatient mortality rates. "We have been monitoring practice, measuring the impact, and then developing new practice guidelines," says Dr. Dart. The hospital has significantly improved its ability to manage patients who have been diagnosed with a massive GI bleed. "We have been able to study very detailed information about these patients and their treatment, including the adequacy of resuscitation efforts, appropriate airway management, admission to the appropriate care level, and ultimately, the outcomes. Because we have been able to review these processes through our MEDITECH system, we have identified ways in which we can improve care," says Dr. Dart. Engaging in Quality Initiatives More Imperative Now than Ever Health care organizations are now facing more external pressures than ever to engage in quality initiatives. Dr. Dart explains that hospitals must meet pay-for-performance requirements from payors, and also adopt outcomes measures as required by regulators. "We need to focus on improving outcomes, rather than just measuring processes," says Dr. Dart. "Health care organizations must include IS as part of the overall solution if they are to improve the quality of care."