Information on outcomes in the care of emergency department (ED) patients has been sparse, limiting the ability to focus quality improvement and research on patient-valued outcomes. In a previous qualitative study, we defined four main patient-valued outcomes for emergency department patients who are not admitted to hospital: (1) Symptom relief, (2) Understanding the health concern; (3) Reassurance; (4) Having a plan. (Samuel Vaillancourt et al., 2017) We subsequently developed and validated a 20-question patient-reported outcome measure to assess these four outcomes identified (PROM-ED). (S. Vaillancourt et al., 2018) Prior study of ED physicians have identified significant challenges in the possible implementation of such data collection. (Dainty, Seaton, Laupacis, Schull, & Vaillancourt, 2017)
Our objective in this study is to look at the feasibility and implementation challenges of collecting patient-reported outcome information with PROM-ED from patients after ED care in a routine clinical setting.
We have worked with St. Michael’s Hospital on a policy to gather email addresses as part of registration. In this study, we will collect PROM-ED information over a 4-week period. All ED patients age 18 years or older and with email address will be included. Patients who are admitted or who had primarily a substance use or mental health reason for ED visit will be excluded.
Contact information including name, email address and visit number will be extracted from internal data system, exported to a third-party vendor who will send the PROM-ED questionnaire 2-5 days after initial ED visits with reminders 2 days, 4, and 5 days later. PROM-ED data will then be merged with clinical and administrative information through St. Michael’s Hospital’s enterprise data warehouse (LKS-CHART).
Our primary outcome will be percentage of patients who answer the questionnaire. Secondary outcomes will include patients who click on the link sent by email, issues reported
We will use the Consolidated Framework for Implementation Research (CFIR) for evaluating different aspects of the study (Intervention characteristics, inner setting, characteristics of individuals and process).
Impact on emergency medicine:
PROM-ED could make possible the collection of patient-centred outcome information for patients without a specifics medical diagnosis, which is the majority of patients discharged after ED care. This study will examine the feasibility of data collection in one care setting, preparing PROM-ED for measurement in the research setting or for quality improvement at the level of health system, ED or physicians.
Dainty, K. N., Seaton, B., Laupacis, A., Schull, M., & Vaillancourt, S. (2017). A qualitative study of emergency physicians’ perspectives on PROMS in the emergency department. BMJ Qual Saf, 26(9), 714–721. https://doi.org/10.1136/bmjqs-2016-006012
Vaillancourt, S., Cullen, J., Linton, D., Fahmy, A. C., Dainty, K., Hofstetter, C., … Beaton, D. (2018). LO08: PROM-ED: the development and testing of a patient-reported outcome measure for use with emergency department patients who are discharged home. Canadian Journal of Emergency Medicine, 20(S1), S9–S9. https://doi.org/10.1017/cem.2018.70
Vaillancourt, Samuel, Seaton, M. B., Schull, M. J., Cheng, A. H. Y., Beaton, D. E., Laupacis, A., & Dainty, K. N. (2017). Patients’ Perspectives on Outcomes of Care After Discharge From the Emergency Department: A Qualitative Study. Annals of Emergency Medicine, 70(5), 648-658.e2. https://doi.org/10.1016/j.annemergmed.2017.05.034
 Visits primarily for mental health or substance use were excluded.