Using space technology approach to improve quality in emergency departments in India: a quality improvement program

Human errors are a leading cause of disability and death among hospitalized patients. Globally, various strategies have been employed to reduce errors and to improve the quality of patient care. One such novel effort never attempted before is the Health-QUEST (Quality Upgradation Enabled by Space Technology) initiative, which aims at translating the best quality and safety practices of the Indian Space Research Organization (ISRO) into the realm of emergency care. The objective of this quality improvement initiative was to understand the performance of emergency department (ED) across India using key performance indicators (KPIs) specified in HQ (Health-QUEST) document, adoptability of HQ-based practices in hospitals, and their effect on KPI.

A pre- and postintervention study design was used where each hospital served as its own control. Preintervention phase captured the time-based KPIs based on their existing practice, followed by implementation and training on QUEST recommendations and the postintervention phase assessed any improvement in the KPIs. Data were collected in real-time using REDCap mobile application by scanning the patient wrist bands. The time-based KPIs include door-to-triage time, door-to-doctor time, door-to-needle time, door-to-pain assessment time, door-to-ordering of investigation time, Time from ordering to first review of investigation, door-to-discharge/disposition time.

Seventeen hospitals were invited to participate in this quality improvement initiative, with 14 hospitals completing pilot training for real-time data collection. Among them, 10 hospitals participated in the pre- and post-intervention data collection contributing to 10 332 patients (5296 patients during the preintervention and 5036 during the postintervention phase). All the hospitals had a median triage time of <5 min. Nine out of the ten hospitals recorded a baseline median discharge time of around 2 h. The most significant reductions in time (mean difference between pre- and postintervention) were observed in triage time (11 min, P < .05), door-to-pain assessment time (23 min, P < .05), time from ordering to first review of investigation (26 h, P < .05), and disposition time (1 h and 30 min, P < .05).

This study evaluated real-time, time-based KPIs in patient management across emergency departments in India. The Health-QUEST program proved to be a straightforward and effective model, achieving significant improvements in multiple time-based KPIs across participating EDs.