Benchmarking and quality improvement in Emergency Departments in Belgium.

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Benchmarking and quality improvement in Emergency
Departments in Belgium.

• On behalf of the Belgian Board for Quality
  Improvement,
• J.B. Gillet.
• Eusem, Portoroz 2002.

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Federal Ministry of Public Health, Ministerial
Decree , june10, 1999 Buylaert Walter, Colson
Paul, De Soir Ria (vice-présidente), D'Orio
Vincent (exp.), Gillet Jean Bernard (Président),
Hachimi Idrissi Said, Lheureux Philippe
(secrétaire), Marion Eric (exp.), Meulemans
Agnes (exp.), Stroobants Jan (exp.), Vergnion
Michel, Vroonen Marie Christine
(secrétaire-adjointe).
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Partners in Belgium

• Belgian College of Emergency Physician (BeCEP)
• Belgian Society for Emergency and Disaster
  Medicine (BeSEDiM)

• Federal Ministry of Public Health

Belgian Board of Emergency Physicians for
Quality Improvement
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Mission statement

• To define indicators of quality
• To propose a national registry on specific topics
  selected by the peers.
• To promote continuous quality improvement by
  continuous feed back
• To edit a yearly national report

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Quality of care ?Potential components of quality.

• Accessibility
• Appropriateness
• Continuity
• Effectiveness
• Efficacy
• Efficiency
• Patient perception issues
• Safety of the care environment
• Timeliness of care

By the Joint Commission on Accreditation of
Health Care Organizations, 1990.
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Quality Assurance vs Quality Improvement
Quality assurance focus
Quality improvement shift curve to the right.
Good outcome
Bad outcome
Okay outcome
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Continuous Quality Improvement

• Error free can not be guaranteed, but quality of
  care can always be improved
• CQI focuses on system first and individuals
  second.
• CQI requires leadership commitment and
  performance measurement.
• CQI is organised around patient care

DS MR O Leary, Emerg Med Clinics of North
America, 1992.
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Benchmarking
 The continuous process of measuring products,
services, and practices against the compagnys
toughest competitors or those companies renowned
as industry leaders. 
Camp RC Milwaukee, Wis, 1989, American Society
for Quality Control, Quality Press.
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Benchmarking model

• Phase 1 Planning
• Phase 2 Analysis
• Phase 3 Integration
• Phase 4 Action

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• Aim of the study
• Evaluate
• activity,
• architecture,
• organization
• finances
• Benchmarking

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• Indirect indicators of quality ?
• Do you have regular staff meetings ?
• Do you have access  round the clock  to the
  medical records of the patients ?
• Is the chief of the ED an emergency physician ?
• Do you use guideliness ?
• Do you have a annual disaster plan review, and
  exercice ?

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• Benchmarking ?
• A written rapport of the survey (1997)
• An oral presentation to the general assembly of
  the BeCEP
• Publication in the medical and non medical press
  (1998)

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• Aim of the study
• Evaluate
• activity,
• architecture,
• organization
• Compare with 1996
• Benchmarking

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Comparison 1996-2000

• Number of participating ED 52/143
• Average size of participating hospitals 416
  beds
• Average passages / ED 19.000

• Number of participating ED 89/143
• Average size of participating hospitals 252
  beds
• Average passages / ED 19.808

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BeCEP 96 vs College 2000 Hospital size of the
participating ED.
1996
2000
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Do you organize regular ED staff meetings ?

• In 1996
• No 12/52 (23)
• Yes, monthly 21/52 (40)

• In 2000
• No 21/89 (23 )
• Yes, monthly 78/89 (87 )

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ED staff meetings ? Analysis restricted to the
participants at both studies
1996 87 vs 2000 83, Binomial, NS.
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Do you have an ED committee with reprentative of
other services of the hospital ?

• In 1996
• No 39/52 (75)
• Yes 13/52 ( 25)

• In 2000
• No 64/89 (72)
• Yes 25/89 ( 28)

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ED committee Analysis restricted to the
participants at both studies
Mac Neuman, p0.035
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Are medical records available  round the clock ?

• In 1996
• Yes 36 ( 69 )
• No 16 ( 31)

• In 2000
• Yes 64/89 (72)
• No 25/89 (28)

21
Medical record available ? Analysis restricted
to the participants at both studies
1996 74 vs 2000 82, Binomial, NS.
22
Do you use guidelines ?

• In 1996
• No 16/52 (31)
• Yes 36/52 (69)
• Medical 31/52
• Ethical 18/52

• In 2000
• No 19/89 (23 )
• Yes, 70/89 (87 )
• Medical 70/89
• Ethical 39/89

23
Guidelines ? Analysis restricted to the
participants at both studies
1996 71 vs 2000 84, Binomial, NS.
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Do you send systematicaly a medical letter to the
GP ?

• In 1996
• No 11/52 (21)
• Yes 41/52 (78)
• Yes, typed 8/41 (19)

• In 2000
• No 20/89 (22 )
• Yes 69/89 (78 )
• yes, typed 28/69 (40)

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Letter to the GP ? Analysis restricted to the
participants at both studies
Binomial, NS.
26
Letter typed to the GP ? Analysis restricted to
the participants at both studies
Binomial, p 0.016.
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Disaster prepardness ?

• In 1996
• EP involvement in disaster planning
• Yes 42/52 (80)
• Annual exercice
• Yes 22/52 (42)
• Annual review
• Yes 31/52 (60)

• In 2000
• EP involvement in disaster planning
• Yes 69/89 (77)
• Annual exercice
• Yes 36/89 (40)
• Annual review
• Yes 60/89 (67)

28
Disaster planning review ? Analysis restricted
to the participants at both studies
1996 69 vs 2000 91, Binomial p0.0039
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Is the ED under the responsability of an EP ?

• In 1996
• No /52 (31)
• Yes /52 (69)

• In 2000
• No 20/89 (22 )
• Yes, 69/89 (78 )

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Is the ED under the responsability of an EP?
Analysis restricted to the participants at both
studies
1996 83 vs 2000 100, Binomial p0.0031
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Conclusions (1)

• We observed that the participation at such
  surveys is increasing with smaller hospitals
  participating
• Between 1996 and 2000, some improvements in
  quality indicators are observed.

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Conclusions (2)

• Benchmarking is one of the possible explanation.
• Other factors of influence are non excluded
• Federal decree with dedicated regulation on EM in
  1998
• inclusion bias due to participation on voluntary
  base.

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Conclusions (3)

• Since our results discloses that some ED do not
  satisfy to the legal requirements, we conclude
  that the answers given by the participating ED
  are very honest and reflects the reality of the
  emergency medicine in Belgium.
• This seems to be due to the strict independence
  and the guaranty of anonymity given by the
  Belgian Board.