Update 01: Directorate of Quality and Clinical Care

Directorate of Quality and Clinical Care

Barry White approved the programme’s aims and team on 21 st July 2010 and we had our first working group meeting on 18 th August.

National Clinical Programmes

The Emergency Medicine Programme (EMP) is one of 20 developed by the Directorate of Quality and Clinical Care (DQCC). Many of the other programmes are relevant to EM, particularly Acute Medicine, Critical Care, Surgery, Acute Coronary Syndrome, Stroke, Diagnostic Imaging, Trauma and Orthopaedics. There has been one meeting of the Programme Leads, with a second scheduled for Friday next. Many of the other programme groups have expressed interest in collaborating with Emergency Medicine (EM). The EMP sits within the RCSI group of programmes and RCSI has provided a programme manager (Kieran Tangney) to support our work.

The overarching aim of the EMP is to improve the safety and quality of care in EDs and reduce waiting times for patients. The programme isn’t about writing a huge report but rather that every ED should become involved in implementing change to improve the patient experience in EM. Of course, many factors with causes external to ED, particularly overcrowding, currently impede our ability to provide high quality care, but the DQCC is very much aware of the need to tackle the causes of overcrowding through the other programmes. There is also (perhaps belatedly) considerable focus on overcrowding within the HSE at present.

The current economic difficulties facing the country will inevitably be a major constraint on our work. Nonetheless, I think that significant improvement could be achieved if emergency care received due priority within hospitals. One of the programme’s tasks will be to disseminate existing good practice from EDs, so as not to try to re-invent the wheel. The Academic Committee of ACEMT has kindly agreed to lead on this work. This is a call therefore to every ED to share their ideas, guidelines, pathways and systems that have been proven to work, with the greater EM community.

Programme Methodology

In all national programmes the working group prepares plans, proposals and documents which go to the advisory group and then to Barry White (DQCC) for approval. The plans then go to the Regional Directors of Operations for Implementation. The ultimate aim of our programme is a plan which is implemented in every ED and which results in sustained improvement in patient care.

I’m sure many colleagues would have wanted to be members of the programme working group, but I was limited as to how many people could participate directly. Factors which influenced the composition of the working groups and advisory groups were:

1. The programme team composition had to comply with a generic DQCC team structure.
2. All programmes are collaborations between the HSE and the relevant training body. ACEMT was therefore required to provide the working group, which includes the regional leads.
3. Ensuring representation from all HSE regions and geographical areas.
4. Providing representation from subspecialty areas of Emergency Medicine – Paediatric Emergency Medicine (PEM), Pre-hospital and Academic EM.

The regional leads have a responsibility to ensure that there is good two-way communication between all Consultants in EM and the programme.

Working Group Members

Advisory Group

The working group agreed that the programme’s objectives should include increasing patient access to consultant provided care, implementing quality targets (such as the KPIs being developed by IAEM in collaboration with HIQA) and implementing the 6 hour target and other process measures.

We will also be developing models of care which will include:

• Defining the core activities of EM
• Describing an integrated system of emergency care incorporating pre-hospital care, EDs, other units and observation medicine/CDUs
• Making recommendations for consultant and NCHD staffing and staffing levels and skill mix for nursing and support staff
• Disseminating best practice EM guidelines and clinical guidelines developed by other programmes
• Developing clinical governance structures
• Working with other programmes to improve referral and admission processes.

We will have to develop standard definitions for ED processes and work with the HSE to ensure that future measures of the ED work and hospital performance are fair, reliable and reflect the true patient experience. The DQCC requires that each programme sets objectives in terms of quality, access and cost and we will have to develop measures for the programme’s work to reflect improvement in these areas.

I do not underestimate the breath and complexity of the programme’s work. We are a small specialty so we will need people who are not formal members of the working and advisory groups to contribute to aspects of the programme’s work. I hope that any who can help will do so, if called upon. I will keep you posted as the programme’s work progresses and you can expect more frequent updates now that the summer holiday season is over. Please feel free to contact me at any stage (contact details on email). I am aware of the understandable cynicism that may greet an initiative such as this. Unlike other past processes, the specialty now has an enormous opportunity to determine its own vision rather than having this provided by other groups or by a management consultancy. Criticism of our work is healthy provided it is constructive; this too can be fed back to me.

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