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An environmental scan of quality improvement and patient safety activities in emergency medicine in Canada

  • Edmund S.H. Kwok (a1) (a2), Jeffrey J. Perry (a1) (a2), Shawn Mondoux (a3) (a4) and Lucas B. Chartier (a5) (a6)

Abstract

Objective

We conducted an environmental scan of quality improvement and patient safety (QIPS) infrastructure and activities in academic emergency medicine (EM) programs and departments across Canada.

Methods

We developed 2 electronic surveys through expert panel consensus to assess important themes identified by the CAEP QIPS Committee. “Survey 1” was sent by email to all 17 Canadian medical school affiliated EM department Chairs and Academic Hospitals department Chiefs; “Survey 2” to 12 identified QIPS leads in these hospitals. This was followed by 2 monthly email reminders to participate in the survey.

Results

22/70 (31.4%) Department Chairs/Chiefs completed Survey 1. Most (81.8%) reported formal positions dedicated to QIPS activities within their groups, with a mixed funding model. Less than half of these positions have dedicated logistical support. 11/12 (91.7%) local QIPS leads completed Survey 2. Two-thirds (63.6%) reported explicit QIPS topics within residency curricula, but only 9.1% described QIPS training for staff physicians. Many described successful academic scholarship output, with the total number of peer-reviewed QIPS-related publications per centre ranging from 1–10 over the past 5 years. Few respondents reported access to academic supports: methodologists (27.3%), administrative personnel (27.3%), and statisticians (9.1%).

Conclusion

This environmental scan provides a snapshot of QIPS activities in EM across academic centres in Canada. We found significant local educational and academic efforts, although there is a discrepancy between the level of formal support/infrastructure and such activities. There remains opportunity to further advance QIPS efforts on a national level, as well as advocating and supporting local QIPS activities.

Objectif

L’étude visait à réaliser une analyse environnementale des activités d'amélioration de la qualité de la pratique clinique et de la sécurité des patients (AQSP) ainsi que de l'infrastructure afférente dans les programmes de médecine d'urgence (MU) et dans les services des urgences des hôpitaux d'enseignement partout au Canada.

Méthode

Deux questionnaires d'enquête électroniques ont été élaborés par un groupe d'experts après l'atteinte d'un consensus dans le but d’évaluer des thèmes jugés importants par le comité de l'AQSP de l'Association canadienne des médecins d'urgence. Le premier questionnaire a été envoyé par courriel aux directeurs de département de MU et aux chefs de service des hôpitaux d'enseignement rattachés aux 17 écoles de médecine au Canada; le deuxième, à 12 responsables des activités d'AQSP, désignés comme tels, dans ces hôpitaux. Ont suivi deux rappels envoyés par courriel, à un mois d'intervalle, aux participants concernés.

Résultats

Au total, 22 directeurs de département ou chefs de service sur 70 (31,4%) ont répondu au premier questionnaire. La grande majorité d'entre eux (81,8%) ont fait état de postes officiels réservés aux activités d'AQSP dans leur groupe, soutenus selon un modèle de financement mixte. Toutefois, moins de la moitié des postes en question disposent d'un soutien logistique particulier. Quant au deuxième questionnaire, 11 responsables locaux des activités d'AQSP sur 12 (91,7%) y ont répondu. Environ les deux tiers (63,6%) ont indiqué que des sujets explicites d'AQSP étaient inclus dans les programmes de résidence, mais seulement 9,1% des responsables ont décrit la formation en matière d'AQSP donnée aux médecins membres du personnel hospitalier. Par ailleurs, bon nombre de répondants ont fait état de travaux d’érudition couronnés de succès; ainsi, le nombre total de publications évaluées par les pairs en lien avec l'AQSP variait de 1 à 10 par centre, au cours des 5 dernières années. Enfin, peu de répondants ont indiqué bénéficier du soutien de ressources universitaires : spécialistes de la méthodologie (27,3%), personnel administratif (27,3%) et statisticiens (9,1%).

Conclusion

Cette analyse environnementale a dressé le portrait des activités d'AQSP menées dans les services de MU dans les hôpitaux d'enseignement au Canada. Les efforts fournis sur les plans de la formation et du soutien universitaire à l’échelle locale sont importants, mais il y a un déséquilibre entre le degré de soutien structuré ou d'infrastructure disponible et la réalisation de ces activités. Aussi y a-t-il lieu d'accroître les efforts d'AQSP à l’échelle nationale, en plus de soutenir ces activités à l’échelle locale et d'en faire la promotion.

Copyright

Corresponding author

Correspondence to: Dr. Edmund S.H. Kwok, Department of Emergency Medicine, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, K1Y 4E9; Email: ekwok@toh.ca

References

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An environmental scan of quality improvement and patient safety activities in emergency medicine in Canada

  • Edmund S.H. Kwok (a1) (a2), Jeffrey J. Perry (a1) (a2), Shawn Mondoux (a3) (a4) and Lucas B. Chartier (a5) (a6)

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