ok existing guidelines, reviewed literature to update the guidelines with new knowledge, and consulted with pulmonologists to incorporate their needs in the final guidelines.

The guidelines and summary of the literature review were then presented during a monthly, evidence-based meeting in the UC emergency medicine department for input from faculty, residents and nurses.

Since the first one was developed, guidelines for more than 20 other conditions, such as pneumonia, ischemic stroke, diabetes and gallbladder disease, have been added. Nearly 40 instructional discharge sheets for patients are on the site, as well as common medical forms and procedure guidelines.

Guidelines can be very helpful for all physiciansfrom new residents to those with years of experience, says Wright. Anyone can overlook a step in treating a condition at the end of a long shift because theyre tired.

Physicians in the emergency departments at University, Christ and Jewish are not required to use the CPQE tools but are encouraged to do so, and even receive a scorecard based on their performance.The scorecards include core measures from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and CPQE guidelines.

The goal is to make physicians better, because if they find themselves below the mean for procedural complications, such as with inserting a chest tube, it will provide motivation for them to improve, says Wright.

Wright says the scorecards also track which physicians may need more education on a particular therapy or procedure.In addition, if there are physicians who are doing an excellent job, we want to try to emulate their practice, Wright says.

Wright admits that although nursing staff have embraced the new focus on quality care and the use of guidelines, physicians compliance with using CPQE tools is low. But hes hoping that will change as th
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