Institute for Health Care Improvement Collaborative Trial to improve process times in an Australian emergency department

This study describes an Australian emergency department's (ED) experience with a quality improvement methodology from the USA. The Institute for Health Care Improvement (IHI) conducts collaboratives between clinical groups with similar interests, in this case ED. Their quality improvement model is described. Our involvement with the IHI showed the model to be transferable outside the USA. In applying the model to operational and clinical projects we were successful in meeting our goals to reduce clinical times: for time to analgesia (P = 0.34), time to thrombolysis (P = 0.30) and time to antibiotics in neutropenic patients (P = 0.015). We were unable to reach statistical significance in improvements due to the small sample sizes and sampling techniques. Changes in operational times were not clinically significant but almost reached statistical significance (e.g. median total length of stay in the ED fell 4 min (P = 0.06)). The near statistical significance of a small change was due to the large numbers of patients sampled.