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ICES researchers develop Canada’s first quality index for emergency departments


For the first time, experts in emergency medicine led by a team of researchers at the Institute for Clinical Evaluative Sciences (ICES) have joined forces and developed a list of the most important evidence-based measures that can be used to evaluate and compare the quality of care in Canadian emergency departments.

"Many emergency departments already collect some quality of care data, but previously there has been no agreement on what are the important things to monitor, and very limited ability to compare different hospitals. Now we have that consensus on what to measure, so we can better assess and improve quality of care," says principal investigator and ICES scientist, Dr. Michael Schull.

A team of researchers at ICES working with experts from across Canada identified 170 indicators of quality and safety of emergency department care from existing scientific evidence, health quality organizations, and medical specialty associations in Canada and from around the world.

  • Through a well documented review process and national meeting of experts 48 measures were selected and prioritized across 9 clinical and operational categories.
  • The indicators cover many of the most serious health emergencies among adults and children seen in Canada's emergency departments, such as heart attack, stroke, asthma, and fever, as well as addressing important general care areas such as waiting times, the treatment of painful conditions and misdiagnosis.
  • The study identified gaps where new indicators should be developed, such as patient satisfaction, trauma and mental health and addiction.
  • In addition, current indicators will need to be regularly updated in light of advances in medical care and knowledge.
  • Examples of the highest priority measures include: how long people wait for pain relief, or to receive effective treatment when having a heart attack or a stroke.

"The use of data to evaluate and set goals is an important component of comprehensive processes to improve care. With the engagement of experts from across the country we are now able to identify priority measures with a goal to share transparently and identify opportunities for improving care within our own local settings," says Caroline Hatcher, Alberta Health Services.

Author affiliations: ICES (M. J. Schull, A. Guttmann, C. A. Leaver, M. Vermeulen, G. M. Anderson, M. Zwarenstein); Canadian Institutes of Health (M.J. Schull); Department of Medicine, U of T (M. J. Schull) Department of Health Policy, Management and Evaluation, U of T (M. J. Schull, G. M. Anderson, M. Zwarenstein); Cardiac Sciences, Critical Care and the Neonatal Intensive Care Unit, Foothills Medical Centre (C. M. Hatcher) Alberta Health Services, Calgary Alberta(C. M. Hatcher); Division of Pediatric Medicine, SickKids (A. Guttmann); Dept. of Pediatrics and Dept of Health Policy, Management and Evaluation, U of T (A. Guttmann); Emergency Airway Diseases, Government of Canada (B. H. Rowe); Dept. of Emergency Medicine, University of Alberta (B. H. Rowe); Sunnybrook Research Institute (M. Zwarenstein)

The ICES investigative report “Development of a Consensus on Evidence-Based Quality of Care Indicators for Canadian Emergency Departments” was published March 22, 2010 by ICES.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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