#MEQAPI – Tweetchat July 6-2017 3:00ET: Fireworks & ETOH

Topic:  “Fireworks & ETOH”, QI perspective

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Besides the “normal” issues resulting from consumption of ETOH, and from playing with fire, many national holidays, religious days, and social events put the two together. As a result, primary care (PC) providers and Emergency Departments (ED) see a sudden spike in injuries. The injuries range from a blister on a little finger to profound burns and trauma.

With the July 4th celebrations fresh in memory, we discuss from a healthcare point of view and a quality improvement perspective what happens when ETOH and fireworks are brought together.

We will take a QI approach, and discuss the  topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.


Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: local, regional, or national policies regarding sale and use of fireworks, Hospital or clinic protocols on treating ETOH or firework injuries. Insurance coverage for them
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Fireworks design and manufacture, storage and transportation  systems, tools and usage systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Instructions for use of fireworks
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high,
      • Space: Cramped, uncomfortable work space etc.  Highly populated areas
      • Time: Too little time per patient or order, too little time in a day, too many demands. Pressure on using fireworks within a short period
      • Location: availability of spaces to use fireworks. Combustable matierials in the environment
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Architecture: location of work areas, gathering places, shared areas

Participants are invited to describe their experiences, and offer their insights and observations.


  1. What METHODS influence Fireworks and ETOH use
  2. What MACHINE factors influence Fireworks and ETOH use
  3. What PEOPLE issues and expectations influence Fireworks and ETOH use
  4. What MATERIALS influence Fireworks and ETOH use
  5. What MEASUREMENT factors influence Fireworks and ETOH use
  6. What ENVIRONMENTAL factors influence  Fireworks and ETOH use

MEQAPI Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.






Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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