Integrating Quality indicators into Research Strategy Third QPEM - - PowerPoint PPT Presentation

Dr Ashok Aralihond Attending Physician

Third QPEM Conference 11-13th of January 2019

Integrating Quality indicators into Research Strategy

I do not have any relevant financial relationship with commercial interest to disclose.

DISCLOSURE

Learning Objectives

Explain with examples how quality indicators can be integrated into research strategies

Aims of Quality Indicators

• Effective
• Safe
• Efficient
• Timely
• Equitable
• Patient-centered

Khan NS, Jain S. Quality initiatives in the emergency

• department. Curr Opin Pediatr 2010;22:262-7.

What are the methods used to improve quality?

Quality assurance versus quality improvement

Quality Indicators and Research

Quality Indicators Education Research

De Vos et all Using quality indicators to improve hospital care: a review of the literature International Journal for Quality in Health Care, 2009

Quality Parameters In Emergency Department

• Length of stay
• Patient and family satisfaction data
• Care alignment with multiple

clinical guidelines

• 72-hour return visits
• Morbidity and mortality
• Data interpretation errors
• Transfers out
• Appropriate use of consultants
• Procedural sedation

Alessandrini Et Al. • Academic Emergency Medicine 2011

Quality Framework and LEAN principles

Structure: Process Outcomes

DONABEDIAN Model (Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, 2006)

LEAN and ED

• Redesign processes
• Improve patient access and flow
• Reduce wait times
• ED overcrowding and errors

Rutman et al; Improving Patient Flow Using Lean Methodology: an Emergency Medicine Experience Curr Treat Options Peds (2015)

The 4-hour standard is a meaningful quality indicator: correlation of performance with emergency department European Journal of Emergency Medicine 2017

Improving patient handovers from the ED to inpatient units

Mahajan et al. Quality In Pediatric Emergency Medicine / • Vol. 12, No. 2 87

Clinical Quality Indicators In The Children's Emergency Department - Why Do Children Re-attend? Hacking et al. Archives of Disease in Childhood, May 2012 Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department Doyle et al Journal of Emergency Nursing, January 2012 Other examples of Quality Indicators which help in Research

Other examples of Quality Indicators which help in Research

Prioritizing performance measurement for emergency department care: consensus on evidence-based quality of care indicators. Schull et al CJEM. 2011 Sep;13(5):300-9, E28-43. Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions Davies et al Health Services Research, October 2017

Other examples of Quality Indicators which help in Research

Evaluation of emergency department performance – a systematic review on recommended performance and quality-in-care Measures Sørup et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013. Patients who leave emergency departments without being seen: literature review and English data analysis. Clarey AJ, Cooke MW. Emerg Med J 2012

Improving Adherence to PALS Septic Shock Guidelines- Enhances the patient care

Paul et all, Pediatrics 2014;133:e1–e9

Process focused QI methodology Reduced mortality 4.8% to 1.7% Care bundles simplify & streamline the process thus speeding it up

Robert M Califf et al. JACC 2002;40:1895-1901

Integrating Quality in Development of Research

Take home messages How quality integrates in research ?

• Alignment with existing pathways for busy clinician
• Improving accuracy of medical data interpretation in practice
• Morbidity and mortality review
• Utilization and timeliness of consultations
• Transfers of care
• Regulatory compliance

Knazik And De Baker Clinical Pediatric Emergency Medicine 2011

Questions?