Emergency physicians know well the realities of evidence-based guidelines in emergency departments throughout the country: either there is wide variability in their use and uptake, or there just aren’t any evidence-based guidelines.
Patients don’t often think about it when choosing emergency departments – they mostly think about the wait time – but it’s there. Two patients, each with the same complaints and same risk factors may get completely different treatments depending on which emergency department they walk into.
Hospital leaders also know about it. And, they are held increasingly accountable when a lack of evidence-based care in the emergency department leads to other problems, not just in the ED but throughout the hospital.
CMS has put in place metrics and guidelines for emergency departments, many of them focused around time – how quickly someone gets seen or receives a particular medication – but the CMS guidelines really don’t touch about 90 percent of what we emergency physicians see on a daily basis.
As the founding partners of US Acute Care Solutions (USACS) have come together to share best practices from our hospital campuses in every corner of the country, those disparities and differences are staring us right in the face. Enter the National Clinical Governance Board (NCGB).
The NCGB is tasked with all clinical governance issues facing USACS emergency departments throughout the country. One of the board’s committees, of which I am chair, is the Clinical Quality & Patient Safety Committee. Together with the board, the committee is tasked with establishing evidence-based clinical guidelines and then disseminating them throughout the company.
It’s actually an incredible undertaking: a national company, establishing national, evidence-based guidelines for emergency departments throughout the country.
The goal is to develop guidelines for clinical care based on certain chief complaints. If most USACS providers follow the evidence-based consensus guidelines, we will be able to track and measure the expected reduction in variability and utilization, and eventually the improved clinical outcomes.
Of course, this all sounds obvious: where there is evidence-based consensus, we should be demanding that it be used. At the same time, we know that physicians aren’t robots. We don’t want to tell clinicians what to do in every situation. These aren’t dictates – they are support tools to aid with clinical decision making.
And yet we anticipate the Hawthorne Effect will have a significant impact on our emergency departments. The mere act of observing and measuring will have a substantive impact on utilization in the emergency departments. Our founding partner physician groups have seen this in process and care improvement programs prior to joining US Acute Care Solutions. We expect the impact to be even greater on a national scale.
That is, after all, one of the points of getting big with like-minded partners: what previously we did to improve our companies on a regional basis, we can now do on a national basis. The National Clinical Governance Board is one of our largest, most significant steps toward improving emergency care nationwide.