Quality Assurance in Emergency Medicine - A Caribbean Perspective

Purpose – Emergency medicine is a new specialty in the Caribbean. With the development of specialist training over the past 20 years, the issues of quality assurance and governance have become more prominent. The purpose of this paper is to explore the successes and challenges of implementing systems of quality assurance in this unique environment, highlighting issues peculiar to the Caribbean setting.

Design/methodology/approach – This paper is a review of current practice in the emergency departments (ED) of the four major teaching hospitals of the University of the West Indies. Information was gathered through interviews with key stakeholders (including the respective ED residency directors, senior residents and senior nursing and administrative staff), review of departmental protocols and guidelines and reviews of current published and unpublished literature.

Findings – Examples of good practice were identified in all six components of the clinical governance framework (clinical audit, clinical effectiveness, research and development, openness, risk management and education and training). Challenges to implementation of quality management included an underdeveloped quality culture, inadequate data collection, poor incentives for improvement and high external pressures, including staff shortages, departmental crowding and lack of public empowerment.

Originality/value – This is the first published work on clinical governance and quality assurance in emergency medicine in the Caribbean. This paper gives an insight into the unique opportunities and challenges in the area of quality management and clinical governance in the developing world, and suggests ways forward with regard to more effective implementation of quality initiatives in under-resourced jurisdictions.