Improving Quality of Care Through a Mandatory Provincial Audit Program: Ontario’s Emergency Department Return Visit Quality Program

Chartier, Lucas B.; Ovens, Howard; Hayes, Emily; Davis, Brittany; Calder, Lisa A.; Schull, Michael J.; Dreyer, Jonathan; Ostrow, Olivia

doi:10.1016/j.annemergmed.2020.09.449

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…This allows for cross-country comparisons, which have previously been completed using the QIs for nursing homes [ 61 ]. Using the existing interRAI data is an efficient and cost-effective use of this information and avoids the additional effort that would be required if quality was assessed by using detailed chart reviews [ 37 ] or additional surveying of staff, individuals receiving PC, and families.…”

Section: Discussionmentioning

confidence: 99%

“…Utilizing the existing, routinely-collected, and population-based interRAI data to generate QIs is a very efficient use of this information and avoids the tremendous time and energy required using traditional approaches to quality improvement, such as using detailed chart reviews [ 37 ]. In fact, the interRAI data represents one of the only databases in Canada with a sufficient number of assessments and unique individuals to allow for the creation and testing of QIs.…”

Section: Introductionmentioning

confidence: 99%

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A multi-stage process to develop quality indicators for community-based palliative care using interRAI data

et al. 2022

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Background Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments—an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families. Methods The development efforts took part in multiple stages, between 2017–2021, including a workshop with clinicians and decision-makers working in PC, qualitative interviews with individuals receiving PC, families and decision makers and a modified Delphi panel, based on the RAND/ULCA appropriateness method. Results Based on the workshop results, and qualitative interviews, a set of 27 candidate QIs were defined. They capture issues such as caregiver burden, pain, breathlessness, falls, constipation, nausea/vomiting and loneliness. These QIs were further evaluated by clinicians/decision makers working in PC, through the modified Delphi panel, and five were removed from further consideration, resulting in 22 QIs. Conclusions Through in-depth and multiple-stakeholder consultations we developed a set of QIs generated with data already collected with interRAI assessments. These indicators provide a feasible basis for quality benchmarking and improvement systems for care providers aiming to optimize PC to individuals and their families.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A multi-stage process to develop quality indicators for community-based palliative care using interRAI data

et al. 2022

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“…However, our default should always be to not imply providers' sole responsibility or wrongdoing unless proven otherwise. In a 3‐year study involving 13.6 million ED patient visits in Ontario, approximately one percent (0.93%) of patients discharged from the ED returned and were admitted to hospital within 72 h of their initial visit 5 . Eliminating return visits is impossible and it should not be our goal; if anything, we should celebrate return visits—it means the providers gave clear and action‐oriented return instructions to their patients, who understood them and implemented them 6,7 .…”

Section: Figurementioning

confidence: 99%

What's in a name? “Return visits” in the emergency department

Chartier

2022

Academic Emergency Medicine

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“…17 The ED Return Visit Quality Programme (RVQP) was launched in 2016 in Ontario, Canada, as a large-scale programme meant to promote continuous QI through the routine auditing of RVA cases in EDs. 18 Participating hospitals must conduct a set number of audits each year to identify the underlying cause(s) of these RVAs, which may lead to the identification of system-level quality gaps that can be addressed with QI initiatives. All EDs with >30 000 patient visits per year are mandated to participate as part of a provincial funding programme, and lower-volume EDs can participate on a voluntary basis.…”

Section: Introductionmentioning

confidence: 99%

“…The programme is intended to provide a focused mechanism through which ED clinicians can receive data on their patients who returned to the ED and reflect on their individual practices, and it gives ED leaders a systematic approach for discovering quality issues that are amenable to local improvement opportunities. 18 Evaluating healthcare quality programmes to identify QI barriers and enablers is recommended as a valuable source of learning and a strategy to improve programme results. 19 Without formal evaluation, the opportunities for system and programme learnings applicable to others may be lost, and the likelihood of programme sustainability may be diminished.…”

Section: Introductionmentioning

confidence: 99%

Qualitative evaluation of a mandatory provincial programme auditing emergency department return visits

et al. 2021

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ObjectiveThe objective of this qualitative study was to evaluate the perceived impact and value of the Return Visit Quality Programme (RVQP), a mandatory province-wide emergency department audit programme.DesignWe employed an interpretive descriptive qualitative approach with maximum variation sampling to ensure diverse representation across several geographical and institutional factors. RVQP programme leads were invited to participate in semistructured interviews and snowball sampling was used to reach non-lead physicians to capture the perspectives of those working within the programme.SettingIn Ontario’s RVQP, participating emergency departments must audit their return visits resulting in admission to identify issues that can be addressed through quality improvement initiatives.ParticipantsBetween June and August 2018, we interviewed 32 participants (local programme leads and non-lead physicians) from 23 out of the 86 participating centres.ResultsParticipants’ perceived impact and value of the programme was associated with the existence (or absence) and nature of the local quality improvement culture, the implementation approach of the programme within their emergency departments, and key aspects of the programme pertaining to medicolegal concerns and resource availability.ConclusionsThis study of an innovative, large-scale programme aimed at promoting continuous quality improvement in emergency departments showed that while its perceived impact has been meaningful, there are key structural and operational elements that support and hinder this aim. Healthcare leaders should consider these findings when looking to implement large-scale audit or quality improvement programmes.

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Improving Quality of Care Through a Mandatory Provincial Audit Program: Ontario’s Emergency Department Return Visit Quality Program

Cited by 12 publications

References 30 publications

A multi-stage process to develop quality indicators for community-based palliative care using interRAI data

A multi-stage process to develop quality indicators for community-based palliative care using interRAI data

What's in a name? “Return visits” in the emergency department

Qualitative evaluation of a mandatory provincial programme auditing emergency department return visits

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