Tuscany program focuses on quality and risk management in emergency medicine

As part of continued efforts to enhance emergency medical services in Italy, HMI faculty led a two-day program on health care quality and risk management. Held at the Azienda Ospedaliero-Universitaria in Pisa, the workshop was designed for clinicians in the region working to apply the core principles of health care quality and patient safety to the context of emergency medicine.

Faculty from the risk management program

Twenty-seven people from the university hospital in Pisa participated, including physicians and nurses as well as members of the Tuscany Region. The program was conducted by Sharon Kleefield, PhD, HMI director of health care quality, and John Helfrick, DDS, MS, FACD, FICD, HMI senior consultant. Dr. Kevin Ban and Dr. Paolo di Martino helped to organize the program, in collaboration with Dr. Enrico Desideri, director general of Azienda Ospedaliero-Universitaria Pisana and Dr. Riccardo Tartaglia, regional director of the clinical risk management team.

“Although the principles of health care quality can be understood broadly across all departments of a hospital, emergency medicine presents some very specific challenges with regards to risk management, patient safety, and overall quality of care,” said Kleefield. “The objectives of this program were to review the fundamentals of clinical quality management, discuss specific issues in the emergency department context, and provide the program’s participants with best practices associated with improving quality and outcomes.”

Desideri added that the program helped give the clinicians “a common language for quality improvement and clinical risk management, and ensure collaborative communication among team members.”

Dr. Sharon Kleefield: “Although the principles of health care quality can be understood broadly across all departments of a hospital, emergency medicine presents some very specific challenges with regards to risk management, patient safety, and overall quality of care.”

Lectures and interactive discussions during the program focused on increasing awareness of clinical risk, and understanding the emergency department as a system that must be monitored, evaluated, and improved through information-gathering, training, and process and protocol development. Kleefield and Helfrick presented strategies for maintaining safety and reducing risk, including but not limited to improving medication safety, incident reporting, and record-keeping.

“A number of factors contribute to increased clinical risk in the emergency department, including the wide variety of clinical conditions encountered, minimal clinical information from patients, and the challenge of attending to several patients and tasks simultaneously,” said Kleefield.

Helfrick explained that a common misperception in health care quality is that individuals are responsible for most medical errors, when in fact problems are usually the fault of the system in which they work. “A critical first step to improving health care quality and patient safety, not only in the emergency department but throughout the hospital, is to remove the ‘blame culture.’ Only then can hospitals provide an honest account of what is occurring on a day to day basis. This enables them to improve their ability to gather information about incidents and near misses, determine where the problems are, and implement changes to prevent incidents from happening,” he said.

Kleefield said the next step in the program will be the identification of a quality management project in Pisa which will be undertaken by members of this group. Kleefield and Helfrick will also deliver workshops on quality and risk management for clinicians in Siena and Florence.

“The ultimate goal of this collaboration is to develop a center of excellence for quality improvement for all of Italy to follow,” said di Martino.

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