For a significant number of patients, their most frequent interaction with clinicians occurs in the emergency room. In many communities, emergency departments serve as a critical health care safety net—making the quality of care in the ER a high priority for health care policy makers and hospital administrators.
At a recent meeting of the Emergency Department Safety Committee coordinated by Hospitals Insurance Company (HIC), patient safety representatives from some of New York City’s leading teaching hospitals engaged in a spirited discussion about their efforts to enhance the quality of care in the ER.
A key part of the program is centered on simulation training, which enables clinicians to get hands-on experience and measure skill retention in a controlled environment. Simulation training has focused on procedures such as video-assisted laryngoscopy, tube thoracostomy, and chest tube insertion. Data on each module are collected and analyzed by HIC, which works through the simulation subcommittee to report back to the hospitals.
“Simulation training is invaluable for ED physicians. The opportunity to work alongside peers and to receive real-time feedback is critical in developing technical skills,” said Dr. Chris Strother of Mount Sinai Hospital.
Training with technical simulations will be followed by the use of simulated environments to strengthen teamwork skills. This effort coincides with the conclusion of formal teamwork training using TeamSTEPPS at each of the hospital ERs. As in similar safety initiatives in other departments, the TeamSTEPPS system plays an important role in the ER.
“TeamSTEPPS is improving the quality of care in emergency departments because the system empowers every member of the team to speak up. Every member of the team takes responsibility for a patient’s safety,” said HIC Chief Medical Officer David L. Feldman, MD.
In a series of presentations about ongoing initiatives, a consensus developed on the critical role that organizational culture plays in enhancing patient safety. At Maimonides Medical Center, the ED incorporates feedback and findings from post-shift, multidisciplinary huddles into their learning.
“Changing culture requires frequent reinforcement. We employ huddles, a multidisciplinary action committee, team simulation, debriefing, and ‘save the game’ e-mails in which individuals are recognized for actions that have a positive impact on the team and patients,” said Dr. John Marshall, Chair of Emergency Medicine at Maimonides Medical Center.
A recurring theme in the culture-of-safety discussion was the crucial role of nurses in patient safety, and the importance of rewarding those who speak up.
“It can be intimidating for young nurses to feel empowered as part of the team, which makes it so important for hospital leadership to set the tone and demonstrate a strong commitment to communication and teamwork,” said HIC Chief Nursing Officer Pat Kischak.
The ED Safety Committee embodies this commitment, with the active engagement of nurses and physicians from Bronx-Lebanon Hospital Center, Maimonides Medical Center, Montefiore Medical Center, and Mount Sinai Health System (including Mount Sinai Beth Israel, Mount Sinai Hospital, Mount Sinai Roosevelt, and Mount Sinai St. Luke’s). The committee holds monthly meetings in which members report on the progress of safety initiatives and share lessons learned from adverse events.
About Hospitals Insurance Company
Hospitals Insurance Company (HIC) is a premier provider of medical professional liability insurance to physicians and hospitals in New York. HIC works closely with member hospitals to lead initiatives to improve patient safety and quality of care. The HIC program grew out of a partnership established in the mid-1970s when four large New York hospitals created a shared professional liability program, HIC, with their own risk management advisors, FOJP Service Corporation. The central mission of HIC and FOJP—unlike those of most private insurers—is to improve patient safety and quality of care within member hospitals. HIC does not have traditional shareholders and is not driven to recruit members or build profit margins. Instead, HIC and FOJP focus resources to reduce patient injury and improve clinical outcomes.