Using space technology approach to improve quality in emergency departments in India: a quality improvement program.

Abstract

Introduction Human errors are a leading cause of disability and death among hospitalized patients. Globally, various strategies have been employed to reduce errors and to improve the quality of patient care. One such novel effort never attempted before is the Health-QUEST (Quality Upgradation Enabled by Space Technology) initiative which aims at translating the best quality and safety practices of the Indian Space Research Organization (ISRO) into the realm of emergency care. The objective of this quality improvement initiative was to understand the performance of ED across India using key performance indicators (KPI) specified in HQ (Health Quest) document, adoptability of HQ based practices in hospitals and their effect on KPI. Methods A pre- and post-intervention study design was used where each hospital served as its own control. Preintervention phase captured the time-based key performance indicators based on their existing practice, followed by implementation and training on QUEST recommendations and the post intervention phase assessed any improvement in the KPIs. Data was collected in real-time using REDCap mobile application by scanning the patient wrist bands. The time based KPIs include Door to triage time, Door to doctor time, Door to needle time, Door to pain assessment time, Door to ordering of investigation time, Time from ordering to first review of investigation, Door to discharge/disposition time. Results Seventeen hospitals were invited to participate in this quality improvement initiative, with 14 hospitals completing pilot training for real time data collection. Among them, 10 hospitals participated in the pre and post intervention data collection contributing to 10,332 patients (5296 patients during the pre-intervention and 5036 during the post intervention phase). All the hospitals had a median triage time of less than 5 minutes. Nine out of the ten hospitals recorded a baseline median discharge time of around 2 hours. The most significant reductions in time (mean difference between pre- and post-intervention) were observed in triage time (11 minutes, p < 0.05), door-to-pain assessment time (23 minutes, p < 0.05), time from ordering to first review of investigation (26 hours, p < 0.05), and disposition time (1 hour and 30 minutes, p < 0.05) Conclusion This study evaluated real-time, time-based KPIs in patient management across emergency departments in India. The Health-QUEST program proved to be a straightforward and effective model, achieving significant improvements in multiple time-based KPIs across participating EDs.