The Use of Audit and Feedback in Implementing a Clinical Decision Support Tool Identifying Patients with Life-Limiting Illness in the Emergency Department (QI132)

• Published in: Journal of pain and symptom management 2023-05, Vol.65 (5), p.e638-e638
• Main Authors: Zhao, Nicole, Cuthel, Allison, Lawrence, Katharine, Yamarik, Rebecca L., Grudzen, Corita
• Format: Article
• Language: English
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2023.02.247

1. Utilizing an audit and feedback system, participants will be able to describe the importance of creating sustainable systems in place to evaluate palliative care health system changes. 2. Upon completion, participants will be able to critically analyze quality improvement strategies such as the implementation of a best practice alert in the emergency department. Audit and feedback (A&F) is a quality improvement strategy to encourage and improve physicians’ clinical practice. Best practice alerts (BPAs) and A&F systems were implemented in the Primary Palliative Care for Emergency Medicine (PRIM-ER) trial, focusing on sustaining health system change and improving care for patients with serious illness that visit the emergency department (ED). To summarize the implementation, use, and feedback of BPAs implemented at the PRIM-ER sites Eighteen health systems participating in PRIM-ER implemented ED supportive care BPAs across 33 EDs. Each site collected information on the BPAs and their A&F review process and details (eg, sensitivity and specificity of the alert, improvements needed). Of the potential BPAs, 27 sites implemented a hospice alert, 23 sites implemented the advance care planning (ACP) alert, and 14 sites implemented a goals-of-care alert for patients with serious, life-limiting illness but no ACP. None of the 33 sites had a previous existing ED supportive care BPA. Between BPA launch and the first A&F data review, sites waited an average of 10 days. Out of 33 EDs, 22 sites reported the BPA(s) firing appropriately, three reported firing too frequently, three reported not firing enough, and four reported firing incorrectly. Sites recorded trends reflecting the frequency for firing BPAs, times ACPs were accessed, patient disposition, and involvement of providers. In their feedback, some sites reported changes that were made as a result of the BPA (eg, “Palliative care team now rounds in the ED once a day”), or suggested changes (eg, “Fire separately for attendings and residents”). Most sites indicated that they would review the data monthly moving forward. A&F is crucial in continuously monitoring, sustaining, and optimizing BPAs. This ensures adaptions are data driven and focused on improving outcomes in patients identified with life-limited illness in the ED.