2.  Patients in the ED setting who are critically ill (i.e. Trauma, Resuscitation) require detailed exam to delineate extent of illness, injury  Patients who are critically ill and not gowned present challenge to physician, nurses, etc. who are trying to delineate extent of injury, illness  Global aim: is to increase use of gowns for critically ill patients in the ED

3. What are we trying to accomplish? How will we know that a change is an improvement? Study Act What changes can we make that will result in improvement? The Improvement Model www.ihi.org Plan Do AIM Measurement Intervention

4. Increase gowning of critically ill patients Study Act The Improvement Model www.ihi.org Plan Do AIM

5. Over a 3 month period, the number of critically ill patients who are gowned will increase by 20%

6. Increase gowning of critically ill patients Study Act The Improvement Model www.ihi.org Plan Do AIM Measureme nt Review number of critically ill patients who were not gowned over the course of 3 shifts before intervention

7. Total number of patients over course of 3 ED shifts who are gowned before intervention Before Total number of patients over course of 3 ED shifts who are gowned after intervention Is there a 20% increase? After

8. Increase gowning of critically ill patients Study Act The Improvement Model www.ihi.org Plan Do AIM Measureme nt Intervention Review number of critically ill patients who were not gowned over the course of 3 shifts before intervention Identify patients requiring gowns for appropriate examination, address barriers to gowning of patients

9.  Created list of chief complaints that should necessitae gowning of patients  Distribute list to triage nurses  Communicate with housekeeping to ensure steady supply of gowns in ED at all times

10.  Chief Complaints That Need Gowns:  1. Fever  2. Rash  3. Child <2 years old  4. Abdominal pain  5. Cardiac Problems (i.e. chest pain, palpitations, syncope )  6. Respiratory problems (i.e. cough/wheeze/shortness of breath)  7. Back pain/flank pain  8. Female genital complaints (i.e.vaginal bleed/discharge)  9. Male genital complaints (i.e. trouble urinating, penile discharge, scrotal/groin pain)  10. Trauma (i.e. assault, auto vs. ped, fall injury)  11. Gluteal/genitourinary abscess  12. Suicidal ideations/attempt

12.  Patients in the ED setting who are critically ill (i.e. Trauma, Resuscitation) require detailed exam to delineate extent of illness, injury  Our global aim was accomplished › Increased gown usage for critical patients by 20% over 3-month period