Emergency department admission decision-making: an opportunity for quality improvement in medical education and practice.

摘要

Healthcare providers are currently involved in a transformation around quality as profound as the changes that occurred 100 years ago after the Flexner report. The ability to define quality as the gap between care that is being delivered and care that could be delivered, based on best evidence and the development of quality measures, has led to documentation of significant unexplained variation in care even in the best of healthcare organizations. Identifying causes of variation is an important step in finding leverage points for improvement. However, developing quality measures, assessing gaps in quality, and identifying causes of unnecessary variation do not automatically lead to improvement. Knowledge of how to systematically redesign and improve care-quality improvement science-is also necessary. In 2000, the Accreditation Council for Graduate Medical Education (ACGME) and the 24 ABMS certifying boards simultaneously endorsed six core physician competencies necessary to deliver quality care. Two ofthese competencies require residents completing training and practicing physicians maintaining board certification to demonstrate competency in quality improvement and system-based practice as important steps to ensure that physicians can take action to systematically close gaps in quality in their practices. Integrating assessment and improvement of quality of care into clinical practice during residency training and afterward is a major challenge.