Quality management in Australian emergency medicine: translation of theoryinto practice

Objectives. The primary objective was to describe the current level of impl ementation of quality management (QM) structures and practices with Austral ian emergency departments. The secondary objective was to describe the leve l of association between the presence of QM structures and processes and th e achievement of associated improvements. Design. Data were collected by mail-out of a structured survey instrument t o 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 d epartment. Main outcome measures. The presence of specific structure and process indic ators of QM and the achievement of QM linked improvements. Results. A respo nse rate of 63% was achieved. Designation of a hospital quality improvement (QT) physician was reported by 40% of institutions, an emergency departmen t (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 signi ficant 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) presen ce 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 signifi cant relationship between the presence of QM process indicators and the ach ievement of QM linked improvements P= 0.003). Conclusions. Demonstration of the links between QM structures, its indicato rs of activity (in structure and process), and the achievement of outcome i mprovement is fundamental to quality improvement methodology. These links a re demonstrated within the context of Australian emergency medicine, presid ing support for the effectiveness of this approach in promoting change and performance improvement.