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Dr. Joshua Tepper

Emergency Departments Drive for Higher Quality

“The publication of the first report on the Emergency Department (ED) Return Visit Quality Program is a proud moment for me personally – I’m proud of my colleagues and my discipline.

Emergency physicians were on the committee that developed the idea of looking at return visits to the emergency department which lead to hospital admissions as a means of improving quality care and we used a paper based on work done in an Ottawa ED by colleagues as the genesis of the concept. We socialized the approach with a group of ED Directors and leaders who were enthusiastic about the proposal and were honest enough to say that targeted funding was not required for them to participate.

Emergency physicians together with nurses and other members of our care teams have embraced the opportunity to use these audits as a means of improving the care provided in the ED; they have been creative in their implementation and generous in their sharing of ideas and experiences.

The result is a program that has already contributed to developing the culture of continuous quality improvement in our EDs and demonstrates the commitment to improved quality and safety we can find in all our Ontario emergency departments.”

These words from Dr. Howard Ovens, Co-Chair, ED Return Visit Quality Program Working Group, which provides advice to Health Quality Ontario, reflects the positive influence of this new program supported by Health Quality Ontario.

Today we are pleased to announce the inaugural report of this important project: The Emergency Department Return Visit Quality Program: Results from the First Year.

The Emergency Department Return Visit Quality Program helps clinicians and hospitals identify and study return visits to their emergency departments within 72 hours or within one week for key diagnoses. While some return visits are not only necessary but critically important, other return visits can be avoided.

This program looks to address these avoidable causes, thereby preventing future return visits. The idea for the program came from ED physicians as part of taskforce on quality improvement.

Eighty-six hospital EDs participated in the first year of this program, and these sites collectively receive 86% of all ED visits in Ontario. A partnership with the Access to Care programs at Cancer Care Ontario allowed data to be made available that enabled targeted auditing of cases where a return visit to the emergency department occurred.

The participating hospitals and Health Quality Ontario work together to foster a culture of continuous improvement and improved care by summarizing the results of their analysis, that not only informs their own improvement process, but also allows other hospitals to improve their own quality of care.

While in 2014/15 there were 5,571,948 emergency department visits in Ontario, return visits to the ED leading to an admission represented only 1% of these visits. However, experts feel these return visits are an important area of focus for improvement because research shows such visits can reflect quality issues at the initial visit. There are also costs for repeat visits, inconvenience for the patient and impact on the wait times for other patients.

We hope that EDs will learn from the experiences of others presented in this report and consider adapting promising ideas used by other EDs to improve their own over the coming year.

The participation and contributions of so many EDs and clinicians to the program in this pilot year is noteworthy. Many of the planned initiatives identified through this program align with provincial priorities for improvement – for example, supporting transitions in care for patients with complex needs and improving the linkages between hospital and community-based care.

The ED Return Visit program supports the establishment of a quality health system in Ontario which is safe, effective, efficient, patient-centred, timely and equitable through encouraging a culture of improvement across the province.

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