Improvement in Medical Practice
How to Meet This Requirement
The Improvement in Medical Practice (IMP) requirement focuses on practice-based learning and improvement in areas such as patient care and communication. Many qualifying programs and options meet this requirement, some of which you may already be participating in!
To fulfill this requirement you must attest to the completion of one Patient Care Practice Improvement (PI) Activity during each 5-year certification cycle.
To get credit for your PI activity
- Sign in to your ABEM Portal to attest that your PI activity is complete. Make sure you follow the Practice Improvement Guide and choose an activity that is approved.
- Identify an independent verifier. They must have oversight or knowledge of the practice performance for your PI activity.
- If ABEM randomly selects you for verification, the individual you specified will be asked to confirm that you have met the IMP requirement.
If you are “clinically inactive”
The Improvement in Medical Practice requirement is waived for clinically inactive physicians. If you see less than 20 patients in a five-year span, you can declare yourself “clinically inactive” by contacting staycertified@abem.org
Approved Types of PI Activities
ABEM has a list of pre-approved PI activities for you to choose from including some that have been externally developed and are available to all current and former ABEM-certified physicians. Other activities that are not listed may be acceptable if they follow the four steps ABEM requires.
Approved PI Activities
Time Related
- Door-to-doctor times (door-to-provider, door-to-evaluation) [includes OP-20]
- ED length of stay for discharged psychiatric and transferred patients [includes OP-18, CEDR]
- Throughput time improvement [includes ED1-a, ED 1-b, ED-1c]
- Time to disposition decision (admit, discharge, etc.) [includes ED-2a, ED-2b, ED-2c]
Infectious Disease Related
- Sepsis guidelines, including the use of the DART toolkit
- Septic shock: repeat lactate level measurement
- Antibiotic stewardship (includes selection, administration time, local resistance pattern identification, etc.)
- Septic shock: lactate clearance rate greater than or equal to 10%
- Appropriate testing for children with pharyngitis
- Appropriate treatment for children with upper respiratory infection
- Antibiotic treatment for adults with acute bronchitis: avoidance of inappropriate use
- Antibiotics within a specific time (CAP and all other infections)
- Blood culture before antibiotics
- Immunization status – Pneumococcal, Influenza, Pediatric
- COVID-19 Patient Management
Stroke Related
- Head CT within 45 minutes of the arrival of stroke patient [OP-23]
- Thrombolytic consideration or use in eligible patients [STK-4, PQRS #187, CEDR]
- Door-to-puncture time for endovascular stroke treatment [PQRS #413]
- Stroke activations and care pathways
Cardiac Related
- Door-to-balloon times for acute myocardial infarction (AMI)
- Transfer time to another facility for AMI intervention [OP-3]
- Aspirin at arrival for AMI or chest pain [includes OP-4b, OP-4c]
- Assessment for chest pain (including risk stratification, non-invasive testing and stress testing, diagnostic protocols for early rule-out, TIMI risk assessment) [PQRS #54]
- Median time to electrocardiogram (ECG) for AMI or chest pain
- Improving care for patients with chest pain
- Cardiac resuscitation and post-resuscitation care
- Screening for high blood pressure and follow-up documented
Appropriate Imaging
- Appropriate CT use in minor blunt head trauma – patients aged 18+ [including PQRS #415, CEDR]
- Appropriate CT use in minor blunt head trauma – patients 2-17 years [PQRS #416, CEDR]
- Appropriate CT for evaluation of suspected pulmonary embolus
- Appropriate CT use for abdominal pain in adults
- Appropriate imaging for renal and ureteral colic
- Appropriate imaging for trauma patients (includes Nexus criteria and Ottawa rules)
- Use of imaging for low back pain [PQRS #312]
- Use of ultrasound for diagnosis for abdominal pain, pediatric
- Ultrasound determination of pregnancy location for pregnant patients with abdominal pain [PQRS #254]
- Appropriate use of neuroimaging for patients with primary headache, a normal neurological examination, and no trauma
- Avoid head CT for patients with uncomplicated syncope
Advancing Health Equity
- Increasing the collection and data integrity of race, ethnicity, language preference and health-related social needs
- Use data to identify a health equity focus (e.g., throughput, LWBS, patient experience, STEMI and stroke metrics, pain management) Example Health Equity
- Access to linguistically and culturally appropriate care
- Secure pregnancy-related care for Black and/or American Indian/Alaskan Native women
- Consultation with case manager/social worker to improve health insurance or prescription access
- Consultation with mental health and substance use disorder specialists for at-risk populations (e.g., low-income, inner city, rural, racial, and ethnic minorities, LGBTQ+, etc.)
- Auxiliary aids for patients with communication disabilities (e.g., deaf, blind, hearing or vision loss)
Communication – Patient Care
- Patient call back system
- Improving patient understanding of discharge instructions
- Improvements in response to Patient Experience of Care Survey results
- Safe sign-out between Emergency Physicians
- Transfer of care to another care provider (consultant, admitting physician, etc.)
- Reduction of Healthcare Disparities/Implicit Bias
Pain Management and Sedation
- Time to pain management for all pain, including long-bone fractures [OP-21]
- Reassessment of pain after administration of analgesia
- Procedural sedation safety (includes appropriate medication selection, checklists, etc.)
Patient Safety, Error Reduction, and Complication Avoidance
- Prevention of central venous catheter-related blood stream infections [PQRS #76]
- Ultrasound use for central line insertion
- Appropriate Foley catheter use in the ED [CEDR]
- Medication error reduction, including ACEP module, “Preventing Medication Errors”
- Appropriate use of restraints and seclusion
- Management of the intoxicated or alcohol withdrawal patient
- Reassessment of vital signs at discharge
- Planning safer and more effective aftercare, including ACEP Module
- Reducing discrepancies between emergency physician and radiologist X-ray interpretation
- Notification of Regional Poison Control Center for poisoned patient
- Safe ventilator management
- Adherence to indications for blood transfusions
Substance Use Disorder and Mental Health
- Initiate medication for opioid use disorder (MOUD) in the ED (e.g., buprenorphine)
- Assure outpatient follow-up for MOUD treatment
- Evaluation for risk of opioid use disorder
- Use of statewide electronic pain medication prescribing system
- Opioid overdose management (e.g., treatment, referral, harm reduction)
- Adherence to opioid prescribing recommendations for chronic pain (includes CDC recommendations)
- Implement an alcohol withdrawal management guideline
- Screening for substance use disorder (e.g., alcohol, cannabinoid, opioid, stimulant, tobacco)
- Referral to outpatient community mental health
- Depression screening
- Integration of behavioral health into ED
Palliative Care
- Use of Palliative Care consultation
- Discuss end-of-life care goals
- Integration of hospice into emergency care
- Adherence to POLST registry according to state standards
Additional Common Measures and Activities
- Left without being seen
- Unscheduled return visits to ED (Including 72-hour returns)
- OPPE/FPPE
- Improvement of difficult airway management
- Asthma pathways
- EMA Clinical Performance Improvement Program
- Pregnancy test for female abdominal pain patients
- Appropriate use of urine culture
Approved Externally Developed PI Activities
If an organization wishes to add to the approved externally developed PI list, an application is available year-round. Learn more
ACEP Clinical Emergency Data Registry (CEDR)
- Provider: American College of Emergency Physicians
- Credit: One ABEM PI Activity
- Description: Participate in the clinical data registry, CEDR, and review your measures at least once.
- How to get credit:
- Even if you are not an ACEP member, log in to the ACEP website and ‘opt-in’ to share your CEDR participation activity with ABEM.
- Allow six months to ensure any substantive changes in clinical practice have been accounted for in CEDR reporting and re-review your performance on the CEDR dashboard a second time to compare your performance.
- ABEM will receive a notification each time you review your data but will not have access to any performance data on any CEDR measure.
ACEP E-QUAL Initiative Options
- ACEP E-QUAL Initiatives: Substance Use Disorder
- Effective 7/1/2022 – 6/30/2025
- ACEP E-Qual Initiatives: Acute Infections
- Effective 7/1/2022 – 7/30/2027
- ACEP E-QUAL Initiatives: Acute Stroke and VTE
- Effective 7/1/2022 – 7/30/2027
- Provider: American College of Emergency Physicians
- Credit:
- One ABEM PI Activity
- 1 AMA PRA Category 1 Credit™ for participation in each monthly webinar/post-test
- Description: Topic-based online activity to improve the early identification and treatment of patients by implementing standardized early recognition and treatment.
- How to get credit:
- Even if you are not an ACEP member, log in to the ACEP website and ‘opt-in’ to share your E-QUAL participation activity with ABEM.
- ABEM will receive a notification each time you review your data but will not have access to any performance data on any E-QUAL measure.
AAP Revise II: Reducing Excessive Variability in Infant Sepsis Evaluation
- Provider: American Academy of Pediatrics
- Effective Date: 9/1/2021 – 8/30/2024
- Credit:
- One ABEM PI Activity
- 20 AMA PRA Category 1 CreditsTM
- Description: Online activity to improve the efficiency, effectiveness, and value of reducing excessive variability in infant sepsis evaluation.
- How to get credit: Attest to the conclusion of your project through the AAP
AAP Improving Mental Health Processes, Workflows, and Responses (IMPWR)
- Provider: American Academy of Pediatrics
- Effective Date: November 30, 2023 – July 30, 2025
- Credit:
- One ABEM PI Activity
- 20 AMA PRA Category 1 CreditsTM
- Description: Online activity that will utilize quality improvement science to implement evidence-based clinical practices for management of patients presenting with acute mental health concerns across the patient care continuum.
- How to get credit: Attest to the conclusion of your project through the AAP
Multi-Specialty Portfolio Approval Program (MSPP)
- Provider: Sponsor institution/organizations approved by the American Board of Medical Specialties.
- Who can participate: Physicians whose practice is associated with an MSPP sponsor institution/organization.
- Effective Date: Each project has its own
- Credit: One ABEM PI Activity
- Description: Through the MSPP, organizations such as health systems, physician groups, and others are authorized to sponsor practice improvement efforts in which board-certified physicians can participate and receive practice improvement credit.
- How to get credit: ABEM will automatically record your completion of an MSPP activity. Note that the timeframe of ABEM receiving the completion notice varies between institutions. Check your ABEM portal for the completion information, it should be available by the end of the calendar year at the latest.
- If your organization appears on the list of approved sponsor organizations, use the “Contact Us” feature on the MSPP website to request information about the contact person(s) within your organization. If your organization is not a sponsor, you can contact MSPP to find out if your organization has applied to be a sponsor.
