Audit and feedback for individual practitioners in the emergency department: an evidence-based and practical approach

Dowling, Shawn; Mondoux, Shawn; Bond, Christopher; Cheng, Amy; Kwok, Edmund; Lang, Eddy

doi:10.1017/cem.2020.28

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…There are no published studies on the introduction of a POCUS image archiving system in a community ED. The only other published plan-do-study-act study was with respect to POCUS documentation in an academic center in the UK where they were able to achieve 80% compliance with the demographic information they requested physicians to input [6]. In another study evaluating barriers to compliance POCUS documentation, recommendations were integration the current electronic medical record, better upkeep of US machines, and simplification of workflow [7].…”

Section: Discussionmentioning

confidence: 99%

Towards quality assurance: implementation of a POCUS image archiving system in a high-volume community emergency department

Aspler

Chiu

et al. 2021

Can J Emerg Med

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Background Quality assurance review is an integral part of point-of-care ultrasound (POCUS) programs but may not be routine practice in community hospitals. Lack of image acquisition and documentation can result in suboptimal patient care. In cases with an adverse outcome and no record of images, there is no mechanism for quality improvement. Objectives Our goal was to implement a system of POCUS image archiving in a community hospital. Our SMART (Specific, Measurable, Actionable, Realistic, Timely) aim was to have > 50% of emergency department (ED) POCUS users archiving scans, and > 80% of all billed POCUS scans archived, measuring improvements bi-weekly over a period of 9 months. Methods The study was conducted at a single-community ED between August 2020 and April 2021. The POCUS archiving workflow was developed and refined through multiple plan-do-study-act (PDSA) cycles. Surveys, stakeholder meetings, audits, and feedback were used to generate and re-evaluate the interventions. These included introduction of QPathE© software, streamlining of the workflow process, strategic machine placement, POCUS rounds, use of a website for POCUS workflow instructions, and dissemination of audit results. Scans were tracked biweekly, and indexed by the number of scans billed. The primary outcome measure was the number of POCUS scans archived per 100 scans billed. Results Over a 9-month period, spanning 72,986 ED visits, 550 scans were archived. The percentage of POCUS users who changed practice to consistently archiving scans was 51%. The rate of POCUS scans archived per 100 scans billed was > 80%, compared to no archiving at baseline. ConclusionWe were able to transition from a system with entirely unarchived POCUS scanning, to one with > 80% of scans archived over a period of 9 months. This is the first published paper documenting implementation of a POCUS image archiving system in a Canadian Community ED. KeywordsPoint-of-care ultrasound • Image archiving • Quality improvement • Quality assurance • Community emergency medicine Résumé Contexte L'examen de l'assurance qualité fait partie intégrante des programmes d'échographie au point d'intervention (POCUS), peut ne pas être une pratique courante dans les hôpitaux communautaires. L'absence d'acquisition et de * Anne Aspler

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Section: Discussionmentioning

confidence: 99%

Towards quality assurance: implementation of a POCUS image archiving system in a high-volume community emergency department

Aspler

Chiu

et al. 2021

Can J Emerg Med

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“…Therefore, another potential opportunity for future development could be around training physicians to be supportive and empathetic colleagues. Measures in this realm may include training individuals to adopt a coaching framework, 79 creating peer support networks, 80 or finding new ways to process errors in an educational systems‐based approach 66 . Because medicine is a field where professionals are continuously learning, it is important for support around medical errors to not only occur during official training periods such as medical school, residency, and fellowship, but throughout one's career trajectory.…”

Section: Discussionmentioning

confidence: 99%

“I made a mistake!”: A narrative analysis of experienced physicians' stories of preventable error

Kandasamy

Vanstone

Colvin

et al. 2021

Evaluation Clinical Practice

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Rationale, aims, and objectives The complexity of healthcare systems makes errors unavoidable. To strengthen the dialogue around how physicians experience and share medical errors, the objective of this study was to understand how generalist physicians make meaning of and grow from their medical errors. Methods This study used a narrative inquiry approach to conduct and analyse in‐depth interviews from 26 physicians from the generalist specialties of emergency, internal, and family medicine. We gathered stories via individual interview, analysed them for key components, and rewrote a “meta‐story” in a chronological sequence. We conceptualized the findings into a metaphor to draw similarities, learn from, and apply new principles from other fields of practice. Results Through analysis we interpreted the story of a physician who is required to make numerous decisions in a short period of time in different clinical environments among the patient's family and whilst abiding by existing rules and regulations. Through sharing stories of success and failure, the clinical supervisor can help optimize the physician's emotional growth and professional development. Similarly, through sharing and learning from stories, colleagues and trainees can also contribute to the growth of the protagonist's character and the development of clinic, hospital, and healthcare system. Conclusion We draw parallels between the clinical setting and a generalist physician's experiences of a medical error with the environment and practices within professional sports. Using this comparison, we discuss the potential for meaningful coaching in medical education.

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“…Ideally, clinicians would receive real time, clinically relevant, evidence-based data at the individual level that is contextualized with either peer comparators or achievable benchmarks. 29 There are several challenges with clinical dashboards. Firstly, encouraging physicians to engage meaningfully with them can be challenging.…”

Section: Clinical Dashboardsmentioning

confidence: 99%

Integrating training, practice, and reflection within a new model for Canadian medical licensure: a concept paper prepared for the Medical Council of Canada

Chan

Dowling²,

Tastad³

et al. 2022

Can. Med. Ed. J

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In 2020 the Medical Council of Canada created a task force to make recommendations on the modernization of its practices for granting licensure to medical trainees. This task force solicited papers on this topic from subject matter experts. As outlined within this Concept Paper, our proposal would shift licensure away from the traditional focus on high-stakes summative exams in a way that integrates training, clinical practice, and reflection. Specifically, we propose a model of graduated licensure that would have three stages including: a trainee license for trainees that have demonstrated adequate medical knowledge to begin training as a closely supervised resident, a transition to practice license for trainees that have compiled a reflective educational portfolio demonstrating the clinical competence required to begin independent practice with limitations and support, and a fully independent license for unsupervised practice for attendings that have demonstrated competence through a reflective portfolio of clinical analytics. This proposal was reviewed by a diverse group of 30 trainees, practitioners, and administrators in medical education. Their feedback was analyzed and summarized to provide an overview of the likely reception that this proposal would receive from the medical education community.

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Audit and feedback for individual practitioners in the emergency department: an evidence-based and practical approach

Cited by 4 publications

References 18 publications

Towards quality assurance: implementation of a POCUS image archiving system in a high-volume community emergency department

Towards quality assurance: implementation of a POCUS image archiving system in a high-volume community emergency department

“I made a mistake!”: A narrative analysis of experienced physicians' stories of preventable error

Integrating training, practice, and reflection within a new model for Canadian medical licensure: a concept paper prepared for the Medical Council of Canada

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