ED Transfer Communication Quality Improvement Study

Data shows there is room for improvement among MT CAHs in ED Transfer Communication. Participation in this Quality Improvement Study (QIS) and demonstrated improvement in EDTC measures meets MT Flex/PIN Quality Award Criteria #1 РPerformance Improvement.  Data from 4Q 16 is used for baseline and hospitals will be remeasured using 2Q 17 EDTC data (due Aug 1).

Improvement Tools and Resources

EDTC QIS Performance Improvement Webinar Recording
EDTC QIS Performance Improvement Webinar Presentation
EDTC Specification Manual
EMTALA Presentation (St. Joseph Health System, Kentucky)
CCD Screen Shot
Sample EMTALA Policy
Complete Transfer Form

Study Goals:

  • determine why specific elements are frequently missed
  • identify why some facilities are successful in meeting all elements
  • share best practices of those with the best scores with those who need improvement
  • provide education (if needed) about EMTALA and how ED Transfer Communication Measures confirm that all requirements are met for transferred patients
  • create simple tools to help facilities meet all elements¬† and reduce the number of locations where information might be hiding

There is a lot of room for improvement across Montana!

  • The state average for the percent of patients with ALL COMMUNICATIONS documented was only 59%, while the national average is much greater at 74%
  • Only 2 MT CAHs had 100% on all measures during Q4
  • Only 7 MT CAHs scored over 90% on all measures-¬† National Goal is >90%
  • Of those 7 MT CAHs, only 3 scored over 90% on the ALL COMMUNICATIONS measure