Assessing the suitability of intervention sites for quality improvement studies in emergency departments

Objectives: As an initial step in disseminating an emergency department (ED)-based quality improvement program (QIP) to improve antibiotic prescribing for patients with acute respiratory infections, the authors conducted a nationwide survey to assess the value and feasibility of the QIP. Methods: Directors of EDs at 119 Veterans Administration hospitals and 160 non-Veterans Administration hospitals (identified based on the existence of accredited emergency medicine training programs and/or participation in an existing ED-based research network) were surveyed. The survey included questions on the current existence of an antibiotic QIP in the ED, enthusiasm for an antibiotic QIP program, and the existence of physical features in the ED that would support the QIP intervention. Results: Overall, 77% of ED directors reported they did not have an existing antibiotic QIP and 84% reported they would benefit from having such a program (either new or in addition to their current program). In addition, 63% of respondents indicated that improving antibiotic prescribing was an intermediate to high priority in the ED. Forty-five percent reported that they did not have a suitable location for a key component of the intervention (an interactive computer kiosk), and 26% reported that they could not display educational posters on the walls of the examination room. Conclusions: Many EDs identify barriers to implementing an antibiotic QIP. Perceived and real barriers are important factors to consider in translating successful QIPs into routine clinical practice.