11個基準應該重要的是eps

11評論

我們為什麼要關心基準?他們是一個積極主動評估和改善練習的方法,在獲得批評,解雇或減少賠償之前。

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Become a student of your ED’s stats and move from being a reactive to a proactive problem solver

我們為什麼要關心基準?他們是一個積極主動評估和改善練習的方法,在獲得批評,解雇或減少賠償之前。They can help you move beyond reactive evaluation related to a complaint, a poor patient satisfaction score or a suit, when you might not focus on the best things for improvement. Here are some of the top benchmarks that should matter to emergency physicians.

1.門到醫生的時間
患者到達醫生或中級提供者的幾分鍾數是對患者的第一名令人擔憂,並且可能是優秀患者護理的最佳駕駛員。我們需要找出誰在最少的時間內生病。滿足這一期望,您將滿足大多數患者,管理和提供高質量的護理。“優秀”閾值小於30分鍾,最佳EDS約10分鍾。也就是說,普通ed ed很難在一個小時內獲得這個數字。


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2.門到房間的時間
在患者到來和被置於患者護理區域之間的分鍾數是您的前端流程的最佳指標。平均執行ED將是大約25分鍾,在5分鍾內的最佳EDS時鍾。該參數主要受患者與床單的比率影響。如果您有很多患者競爭少床,則低醫生到室的時間將難以實現。但是如果您發現盡可能遠,使用並行流程而不是串行處理,您仍然可以使其工作。您可以使用虛擬床在患者獲得簡要考試的情況下,患者返回控股區域。這允許給予遵循患者而不是阻止患者。您必須遠離大多數EDS仍在使用的傳統前端處理。請記住,患者隻記得看到醫生需要多長時間。事實上,他在候診室等了一個小時,房間裏隻有5分鍾不會改變他對等待的印象。 This is a valuable tool in speaking to administrations about changing staffing, facilities, and other bottlenecks that are out of the control of the doctors.

3.承認決定到出發的時間
Once the decision is made to admit, how long does it take to actually leave the ED? Given the state of EDs around the country, the current “excellent threshold” is 100 minutes. The average of all EDs is a little over 2 hours, but the average ED with a census of over 70 thousand patients is over four hours. In most EDs, in fact, more time is spent on this end of the equation than all of the “value added” time being seen and evaluated by the staff. The question is whether your floors are pulling the patients up or is the ED having to push the patients. This is a question of hospital culture and must be handled with the full cooperation of administration and nursing. And there are lots of ways to improve this number, from streamlining the nurse reporting system to boarding patients in the hallways of the floors to which they are going instead of the ED. This is always a political question that cannot be fixed by the ED leadership alone.

4.留下而不被看見(LWBS)
當類似EPS和不是,這個數字是非常緊密地跟蹤的。EPS經常查看LWBS患者,因為這些疾病和傷害足以讓他們感受到他們需要等待或更糟糕的患者,這是我們寧願在ED中沒有在ED中擁有這樣的短熔絲。管理人員將這些患者視為收入損失和增加潛在責任。所以,如果你想在你的醫院工作,你必須注意這個號碼。“優異的閾值”為1%或更少,最好的EDS低得多。但事實是,看到超過70萬名患者的普通ED有3%或更多的患者離開而不被醫生看到。這個數字與門對地和門對手的時間密切相關。

5.滿意度調查百分位數
This falls in the camp of “if it’s important to the administration it must be important to us” despite the flaws in selection bias, small sample sizes and recall bias. To make matters worse, we all know that patient satisfaction is compared on a percentile ranking rather than raw numbers. So if all the physicians or hospitals being compared score very closely, just a few points difference in raw score could push an EP or hospital from the top percentile to the lowest. Nevertheless, these are going to continue to be important to administrators, particularly with the new pay-for-performance initiatives that tie hospital revenues to patient satisfaction.


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Realize that some hospital administrators’ pay is tied to patient satisfaction. Further, in the future there will also be more public reporting and hospital-to-hospital comparison of patient satisfaction. So, like it or not, these stats have to be important to us. Ways to improve patient satisfaction are myriad and relate to waiting times, communication, and the perception of care. There are also technical ways to improve scores, however, such as using telephone surveys of larger numbers of patients to dilute the impact of a few vocal unhappy campers.

6.急救醫師的工作滿意度視角
問題是“你的工作有多滿意?”這是主觀的 - 必須是匿名來獲得一個很好的樣本 - 但它與其他主觀調查相比。高員工滿意度通常反映效率和員工關係。普通的ED醫生是“滿意”。雖然具有較高卷的EDS,但在其他基準上的較高等待和一般較低的分數是最高的報告的ED工作滿意度(按小邊值),這是諸如補償,靈活的調度和訪問顧問等因素。高等醫師滿意度與長期等待或性能不佳無關。

7.埃米爾gency Nurse Perspective of Job Satisfaction
On average, emergency nurses are less satisfied with their jobs than emergency physicians and this is similarly true with higher volume EDs. This number correlates with nursing staff turnover rates, medical errors, and patient satisfaction.

8.護士/醫生關係與急診護士關係的EP視角
這些是兩個相關的調查。“優秀的門檻”是良好且優秀之間的平均分數。如果您的分數平均小於那個,或者單個分數得分低得多,則必須解決這些。有時,這與人員配置水平和/或勞動分工有關。如果領導層沒有意識到這些問題,直到它為時已晚,它將導致員工營業額,醫療錯誤,它會傷害患者滿意度。我們知道這意味著什麼。

9.PCI 90分鍾內
在ED的臨床能力中顯然有更好的基準,但目前的公眾意識是,這個數字與質量護理有關。我們都知道是無關緊要甚至有害質量護理的臨床基準。但這隻是強調EPS必須t
艾克費用是什麼臨床基準很重要。

10. Consultant Responsiveness
這是通過詢問EPS“您的專家隨叫隨到的麵板如何響應您的專家接通小組”來衡量,可能的響應為1 - 不響應,4 - 略響應,7-大多數響應,10-始終響應。由於大多數專家的回調性質,響應時間的實際數字很難捕獲。但是要處理感知是很重要的。平均ED分數略低於7,“大多數響應” - 普通社區醫院得分最低。雖然它可能不是原始分數,但在討論管理問題時,將自己的醫院對他人進行比較與他人的響應程度有助於。

11. Medical Staff Perspective of ED Performance
Whether it’s reality or perception, it is important to know how the medical staff views the ED. The “Excellent Threshold” is 9 out of 10. But the average 70k volume ED is only thought of as “good” by the medical staff. The average community hospital scores only slightly better on this survey. Scoring poorly on this survey can mean that your group is not likely to keep the contract. Scoring well can mean job security and a better place at the table when it comes to negotiating your group’s cut of the bundled payment pie.

Summary: The driving force of benchmarking must be improvement of performance. Benchmarks serve no purpose if they do not reflect the needs and perceptions of all the stakeholders. ED leadership must transition from reactive to proactive problem solving. A dedication to continuous performance improvement through ongoing benchmarked surveys that engage all the stakeholders recognizing and rewarding success will result in a culture of quality.

Mark Reiter,MD,MBA,是ED谘詢服務緊急卓越的聯合創始人和首席執行官。

11評論

  1. 達琳納爾遜

    國際這樣的指標來自CMS,以改善患者護理和滿足。他們已被合作醫療保健劫持以增加利潤。導致匆忙護理並增加反彈背部的主要指標是放電度量或保持壽命長度的門。在ER護士和提供商在巨大的壓力下,隨著門口到處置的九十分鍾時鍾開始勾選。當他們未能令人滿意的“數字”時,護士和醫生麵臨谘詢的谘詢。這是工作歪歪扭扭,燒壞,道德困境和最終可預防的醫療錯誤的主要原因。關心應始終患者需要聚焦,並不令人滿意的指標聚焦。指數與患者滿意度以及與合作貪婪有關的任何事情幾乎沒有任何關係。

  2. Hey Mark – I’m surprised I hadn’t seen this article until now. Thanks for doing it.

    我想看到更多關於這些指標對個人提供護理的每個指標的爭論。當然,我們可以製作儀表板,將這些指標放在工人麵前,以便他們仍然意識到他們是如何做的。但不是堆積額外和不必要的壓力嗎?就像達列琳尼爾森一樣暗示上麵,似乎我們需要一個不同的解決方案。

    我懷疑理想的實時度量捕獲整個部門的性能作為相互依存的團隊成員,而不是隔離任何特定個人的性能。

    我並不建議應該抑製其他數據。但我認為我們需要深思地了解個人性能指標如何激發,而不是抑製團隊成員。

    我對你的問題......
    If you could use ONLY ONE metric on a department performance dashboard, what would it be?

    我很樂意和你討論這個問題。很好,可以單獨造成這些措施的熱鬧討論。

  3. 這是偶然的。一個4個URI的家庭和膿毒症患者和有CHF的MI可能有一個AAA的MI被置於同一個“時間範圍”。

    The septic patient and the MI patient aren’t called for patient satisfaction because they’re admitted…… but the family of 4 is.

    他們很沮喪,因為他們不得不等待,醫生趕時間。

    哎呀,我想知道為什麼?

  4. Hello,
    我目前是1級創傷中心和急診部門的臨床護理主任,也是一個學術醫學教學中心。是否有任何數據可以查看該措施並與其他學術醫療中心進行ED吞吐量的基準?感謝您的回複。
    Thank you

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