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A Quality Disconnect

Maureen Larkin, for HealthLeaders Media, June 12, 2008

When it's your job to monitor the quality of a healthcare organization, there's a long list of items that you think about on a daily—if not hourly—basis. You're always looking for new ways to prevent the spread of infection, or how to keep patients who are susceptible to falls from getting out of bed without assistance. You're up to date on your organization's readmission and mortality rates, and you're on top of your hospital's latest HCAHPS scores.

But in the minds of our consumers, a quality healthcare experience is something completely different. A cardiac patient may be given an aspirin immediately after being admitted to your hospital. He may be shielded from a hospital acquired infection by your new infection control protocol, but if he must wait for hours in a crowded waiting room to receive care, he'll remember that experience as anything but "quality."

I know this because last week I was one of those patients. After taking ill at work, my doctor recommended that I get myself to the closest emergency department for evaluation. Five hours later, when I finally got to see a physician, they couldn't find anything wrong with me.

"I don't know what may have caused you to pass out, Ms. Larkin," the doctor said after monitoring my vitals for a couple of hours. "Granted, that was almost eight hours ago now, so there could have been something going on that we can't see now."

Gee, thanks.

I had a great nurse tending to me in the ED. He made sure that I was fed, hydrated, and comfortable. He came in often to check on me and kept me informed about when the doctor would be in to chat with me about my test results, and finally, when I'd be able to go home. But when anyone asks me about my ED experience, the first thing I tell them is how long I had to wait-and how my waiting didn't even produce a diagnosis.

I'm not telling you this because I need a place to vent about my ED experience. Nor do I want you to think that I expected to receive care immediately after walking in the door. I understand that a person with nausea and lightheadedness isn't going to be seen before the woman who comes in bleeding with a large cut on her forehead, or the man experiencing chest pains. But as more people in America seek care at emergency departments, we must figure out a way to provide better experiences for patients in our EDs. Delivering a "quality" experience in our EDs may be rare, but it's possible.

Earlier this year, my colleague Molly Rowe wrote about the challenges that EDs pose to hospitals in HealthLeaders magazine. She profiled several hospitals that recognize the importance of the ED to the rest of the hospital's operations. They've changed their processes and staffing levels to allow smooth patient throughput regardless of how many patients are waiting to be seen. They recognize that patients coming through the doors of the ED—60% of hospital admissions come from the ED—are important to the hospital's success. A "quality" experience in the ED can bring you a patient for life.

When it comes to providing high quality care, there's a lot that leaders must think about—infections, falls, and the timeliness of procedures—but we also need to keep in mind what quality means to patients. There may come a day when we've eliminated MRSA and we no longer worry about pressure ulcers, but if we can't give timely treatment to a patient in our emergency department, will we really be able to say that we offer a quality healthcare experience?


Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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