Emergency Medical Evaluation of Dangerousness

eMed International Inc®

Suicidal and Homicidal Assessments

     In emergency department (ED) assessment of youth suicidality, maintaining optimal standards may be difficult because of (1) critical nature of cases seen in the emergency departments; (2) large numbers of patients seeking emergency evaluation; (3) too few providers; (4) imbalance in workload; (5) overutilization of scarce ED resources as primary care; (6) limited experience of junior health professionals; (7) lack of sufficient time for emergency room physicians to participate in educational activities; and (8) delay in or unavailability of consultation collaboration.
     However, quality assurance (QA) programs may help to resolve some of these problems faced in the ED by addressing the structural and process aspects of emergency assessment.  eMed Colorado™ QA programs measure, analyze, control, and improve acceptable standards of clinical care in psychiatric emergencies.  The programs strive to achieve stable and predictable assessment results that reduce variation in psychiatric emergency assessment, management, outcome, and technical support.  
     eMed Colorado™ QA focuses on four aspects of emergency care delivery: (1) structure, which refers to primary care, school district, and emergency department (ED) standardized training,  competency, and certification of clinicians; (2) evaluation of outcome, indicated by death rates,  incidence of complications, patient waiting period, time to consultation, and follow-up care; (3) documentation of the processes of health care delivery, specified by reliability and validity of medical assessments, procedures for documentation, enhanced monitoring, patient satisfaction, and clinician approval; and (4) technical support detailed by timely detection of major design errors, percent of problems identified in the field, and errors in reports.
     eMed Colorado™ utilizes assessment psychometric statistical methods and organizational healthcare Six Sigma strategies to improve and maintain efficient and effective youth suicidality design and implementation.  Quality indicator measures follow the recommendations of the Colorado Department of Public Health and the Environment, Office of Suicide Prevention. Performance Improvement Programs are conducted annually.  Quality improvement initiatives include best practice forums consistent with applicable professional standards of care of NIMH, JCAHO, the American Foundation for Suicide Prevention, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Academy of Child and Adolescent Psychiatry, the American Academy of Emergency Physicians, the American Medical Association’s Guidelines for Adolescent and Preventive Services, the US Department of Health and Human Services Center for Substance Treatment, the U.S. Mental Health and Psychiatric Congress, and the National Association of School Psychologists.

The following table itemizes examples of required eMed Colorado™ QA components

Assessments must comply with state and federal confidentiality rules
Assessment guidelines

-  Assessments must adopt practice guidelines that are based on valid and reliable evidence or a consensus of health care professionals in the field; consider the needs of the population, are adopted in consultation with health care professionals, and are reviewed and updated periodically.

-  Guidelines must disseminate by county, state, region, national, and world-wide with standardized training in core competencies.

Quality assessment and performance improvement

-  Plan must have an ongoing improvement program.
-  Plan conducts performance measurement, have in effect mechanisms to detect both underutilization and overutilization, have in effect a mechanism to assess the quality and appropriateness of assessments administered in emergency departments, school districts, primary care offices, and mobile crisis units to individuals from diverse populations, and those with special health care needs.
-  Achieve improvement in quality, evaluation of the effectiveness of the intervention, planning, initiation, and delivery of assessments.

Plan demonstrates ongoing development
Plan demonstrates ongoing program of performance improvement projects that focus on clinical and nonclinical areas.  Projects should be designed to achieve, through ongoing evidence-based research, measurements and intervention, significant improvement and development, sustained over time, in areas that are expected to have a favorable effect on outcomes and patient, family, and practitioner satisfaction.  Projects should include: measurement of performance, and training and implementation of specific assessment interventions.
Health information systems

-  Plan must have a system in place that collects, analyzes, integrates, and reports data and supports the plan’s compliance with the quality requirements.
-  Collect data on individual and provider characteristics and on assessments administered through an encounter data system platform and device options.

-  The plan should ensure that data from providers is accurate and complete by verifying the accuracy and timeliness of reported data, screening the data for completeness, logic and consistency, collecting service information is standardized.

-  Timely detection of design errors, problems and errors identified.

Quality Assurance Program