Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: Review fundamental principles in high-value care Develop a list of opportunities to optimize value based care in the ED Introduce Value Process Mapping to explore barriers to high value care.

Introduction/Background: Quality Improvement (QI) is a key component of resident education and an ACGME requirement. Despite being on the front lines and witnessing low value care on a regular basis, many residents struggle to complete robust QI projects throughout residency. A key barrier to resident participation in QI projects is inexperience and poor understanding of the key components of QI. We developed a two-hour course that stresses individual thought and hands-on expert guided experience to empower residents to start their own meaningful QI projects.

Curricular Design: An expert in value based care led two 1-hour sessions to teach our residents components of QI and review key principles of our institutions transition to value based care: Care Variation, Waste in Care, Appropriate Setting of Care, Quality, Access and Advanced Analytics. For the first 1 hour session, key institution wide examples of each focus area were introduced to residents in chart form for 15 minutes. For 30 minutes residents were then separated into groups of 3 and they compiled their own ED specific examples for each focus area. For the final 15 minutes each small group shared their examples with the entire group. Several weeks later a second 1 hour session reviewed key principles in value process mapping. In preparation for the activity, residents were asked to process map some of their original ideas from the first session and send them to the instructor (senior VP and chief quality officer). Our expert reviewed each process map with the group and made suggestions for improvement. Results of both sessions were documented and reviewed with residents during PD led individual meetings regarding QI projects.

Impact/ Effectiveness: These two introductory activities have resulted in increased resident engagement in QI activities with a specific improvement in confidence to develop and implement meaningful QI projects in our department.