Purpose: Our goal is to apply disaster principles to education and quality improvement. This approach will allow individuals and facilities to prioritize training to achieve rapid significant improvement in treatment expertise.
Method: The Hazard and Vulnerability Analysis (HVA) makes hospitals continuously improve their preparedness by prioritized training for the greatest hazards to local health with poor current performance. The HVA score is based on 3 questions about each disaster. We substitute “Disease” for “Disaster”: 1) – How prevalent is this disease? (Score 1-3); 2) – How serious is the medical impact or outcome? (Score 1-3); and 3) – Current Skill – do we recognize and correctly manage it? (Score 1-5). Multiply the 3 scores to determine which diseases to address first. High scores reflect high disease prevalence, severe outcomes and identified management problems. As performance in the top priorities improves with training and process enhancements, another area becomes higher priority for addressing next. This fosters improvement over time based on patients treated, disease severity and current quality of care. HSEEP exercise concepts are applied next. The Universal Task List details specifics for achieving each Capability. We substitute Model Curriculums, textbooks, literature, national guidelines and educator opinion to develop lists detailing best treatment practices and required clinical skills. Each is ranked by importance to patient outcome, difficulty in accomplishment and current skills, based on the HVA. These are high priority capabilities for education and process enhancement. Educators can substitute national data detailing frequencies of diagnoses in EDs, hospitals, and clinics, along with outcomes such as how many did not receive recommended treatment, suffered complications, or died. EMR queries can provide data tailored for individual facilities. Assessment of current performance and adherence to guidelines can be augmented using pre-tests that trigger individualized training modules.
Result: We are completing SIMLABs and web-based applications using this method, including sepsis, infection control, thromboembolism and asthma. Outcomes are post-test scores and actual clinical performance improvements are measured using the EMR.
Conclusion: Individuals can selectively improve their skills or whole facilities can achieve and document improved quality of care over time based on actual patients treated and current performance lapses.
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