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The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

ABSTRACT: Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec.We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013.Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators.Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.

SUBMITTER: Layani G

PROVIDER: S-EPMC5047798 | biostudies-other | 2016 Jul-Sep

REPOSITORIES: biostudies-other

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The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

Layani Géraldine G Fleet Richard R Dallaire Renée R Tounkara Fatoumata K FK Poitras Julien J Archambault Patrick P Chauny Jean-Marc JM Ouimet Mathieu M Gauthier Josée J Dupuis Gilles G Tanguay Alain A Lévesque Jean-Frédéric JF Simard-Racine Geneviève G Haggerty Jeannie J Légaré France F

CMAJ open 20160701 3

<h4>Background</h4>Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec.<h4>Methods</h4>We previously identified rural emergency departments in Quebec that offered medical coverage with ho ...[more]

PMID: 27730103

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Project description:BackgroundHome dialysis offers many advantages to patients, but they require support to manage a home-based therapy such as peritoneal dialysis (PD). A rural emergency department provides an important safety net for patients requiring medical care, including managing complications of PD, such as peritonitis. Patients living in northern Alberta are spread out geographically and can be far from a PD training center, yet anecdotally, many rural sites do not provide care for these patients.ObjectiveOur aim was to identify the facilitators and barriers to nursing care in rural emergency departments in northern Alberta for patients receiving PD.DesignA qualitative interpretive descriptive approach was used.SettingRural emergency departments across northern Alberta.ParticipantsPurposeful sampling was used to seek participants from 1 of 4 rural acute care hospital emergency departments in northern Alberta. Six registered nurses and 1 licensed practical nurse agreed to participate in the study. They ranged in experience from 2 to 18 years. Two of the participants were unit managers, 2 were clinical nurse educators (CNEs), and the other 3 were staff nurses with 1 of them in a leadership position.MethodsIndividual semistructured interview were conducted over the telephone. The interview guide was developed based on a review of the literature. Interviews continued until no new information was obtained, that is, data were saturated. Interviews were audio recorded and transcribed verbatim. Field notes were recorded. A constant comparative approach was used for analysis. The coding process was both deductive (drawing from the literature) and inductive.ResultsSeven participants were interviewed, and there were 4 main themes and 1 subtheme that emerged from the analysis: education (along with the subtheme of resources) was seen as both facilitators and barriers; patient/family ability to perform PD; infrequent exposure; and physician supports. Continuing education about PD was a facilitator, and the lack of education was a barrier to provision of PD care. Similarly, availability of resource materials about PD and access to a CNE were facilitators, while lack of these resources was a barrier to offering PD care. As PD was not always seen regularly, infrequent exposure was a barrier to offering PD care. Lack of physician supports, both from the locum physicians who were sometimes reluctant to care for these patients and the delays in reaching nephrologists were barriers.LimitationsThe findings represent the perceptions of the emergency department nurses who participated. These perceptions may differ from those of nurses who work in other regions of the country. Furthermore, most participants were in a leadership role, and it may be that their perspectives differ from those of front-line nurses.ConclusionsThe findings from our study highlight the need for availability of education and resource materials/persons to care for these patients. There is also a need for greater physician support from both local physicians as well as nephrologists to offer high-quality PD care.Trial registrationNot applicable. This study is not a clinical trial. It did not involve prospective assignment of participants to a treatment group.

Dataset Information

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

Publications

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study.

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