Health System Integration and Sustainability Improving emergency department care using patient perspectives on outcomes

Samuel Vaillancourt, St. Michael’s Hospital
Samuel Vaillancourt, St. Michael’s Hospital

Developing a Patient-Reported Outcome Measure (PROM) for patients visiting the EmergencyDepartment:  The PROM-ED project.

Issue

  • Efforts to assess Emergency Department (ED) care from a patient’s perspective have focused mostly on patient experience and/or satisfaction measures. Only in specific disease-focused areas (strokes, heart attacks and sepsis) has there been efforts to assess the outcome of care from the patient’s perspective.
  • It is important to remember that patients don’t seek ED care for the experience, rather they have a specific health issue that needs to be resolved. 
  • Patient-Reported Outcome Measures (PROMS) measure how the patient is doing after ED care in terms of symptoms, function, distress and health-related quality of life.

Project

  • In this project, researchers seek to develop a Patient-Reported Outcomes measure tool for the Emergency Department (PROM-ED).
  • The research team sought to develop and validate the first PROM for adult patients without a primary mental health or addictions presentation receiving emergency department (ED) care and who were not hospitalized.
  • With the help of patient partners, the team developed a conceptual framework through qualitative interviews with ED patients post-discharge to identify key areas (domains) of importance to patients.
  • From this framework, candidate survey questions were developed for each area of importance to include in the tool. These questions were further tested and refined through a multi-stakeholder Delphi process involving ED clinicians, researchers, patients and system administrators.

Patient Engagement

  • Eight patient partners worked closely with emergency physicians, qualitative scientist and the PROM researcher to develop the PROM-ED tool.
  • Patient partner perspectives were critical in each phase of our research (i.e., defining key concepts, developing instruments and validating results) and helped to differentiate the roles of the patient partner in a research project with the role of patient participants in research.

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