Quality management in Australian emergency medicine: translation of theory into practice.

OBJECTIVES: The primary objective was to describe the current level of implementation of quality management (QM) structures and practices with Australian emergency departments. The secondary objective was to describe the level of association between the presence of QM structures and processes and the achievement of associated improvements.

DESIGN: Data were collected by mail-out of a structured survey instrument to all Australian emergency departments accredited for postgraduate training by the Australasian College for Emergency Medicine.

PARTICIPANTS: Director of Emergency Medicine or delegate in each surveyed department.

MAIN OUTCOME MEASURES: The presence of specific structure and process indicators of QM and the achievement of QM linked improvements.

RESULTS: A response rate of 63% was achieved. Designation of a hospital quality improvement (QI) physician was reported by 40% of institutions, an emergency department (ED) QI physician by 40%, and an ED QI nurse by 67%. A structured system for QM indicator analysis was present in 67% of the departments; in 45% of the departments public reporting of performance occurred. There was a significant association between QM process indicators and the presence of (i) a hospital QI physician (P=0.02), (ii) an ED QI nurse (P=0.02), (iii) presence of a system for data analysis and reporting (P=0.01), and (iv) presence of a QM component to postgraduate education (P= 0.05). There was a significant relationship between the presence of QM process indicators and the achievement of QM linked improvements (P= 0.003).

CONCLUSIONS: Demonstration of the links between QM structures, its indicators of activity (in structure and process), and the achievement of outcome improvement is fundamental to quality improvement methodology. These links are demonstrated within the context of Australian emergency medicine, providing support for the effectiveness of this approach in promoting change and performance improvement.