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

OBJECTIVE: The 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. DESIGN: We 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. SETTING: In 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. PARTICIPANTS: Between June and August 2018, we interviewed 32 participants (local programme leads and non-lead physicians) from 23 out of the 86 participating centres. RESULTS: Participants' 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. CONCLUSIONS: This 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.

Quality Assurance Processes Ensuring Appropriate Follow-up of Test Results Pending at Discharge in Emergency Departments: A Systematic Review.

STUDY OBJECTIVE: In many cases, emergency department (ED) care leads to investigations for which there are not final results at patient disposition. The follow-up for these test results pending at discharge, most commonly final diagnostic imaging reports and microbiology cultures, is a significant safety concern for patients and a medicolegal risk for ED practitioners. Our objective is to perform a systematic review of the literature and report on the structure and outcomes of existing ED quality assurance processes to address these test results pending at discharge. METHODS: We searched for studies that reported processes to ensure follow-up of test results pending at discharge for patients discharged from ED settings in 6 relevant databases, from inception to June 11, 2019. We appraised the quality of each study and extracted characteristics of the quality assurance process being discussed, as well as its influence and outcomes, cost, and feasibility. RESULTS: We identified 17,862 studies, and 17 met our criteria for inclusion. Four major processes were identified to improve the follow-up of test results pending at discharge: only nurses or clerks involved, physician-driven process, direct patient contact, and pharmacist-led process. The 5 recommendations generated by our literature review included dedicating staff to the quality assurance process, protecting their quality assurance time from clinical duties, ensuring electronic medical record integration, encouraging collaboration among health care disciplines, and engaging patients. CONCLUSION: A variety of quality assurance processes have been described to follow up on ED test results pending at discharge, and we provided recommendations to improve patient care. All ED leaders should consider implementing these according to their local context.