Treat & Release: Quality of Documentation Tori, Sahand, Jackie & Lindsay

The Problem Variable documentation practices among health care providers in the emergency department. Preliminary chart audits: Assessment: 82% complete Plan of Care: 60% complete Follow-up Plan: 68% complete

Goal Aim is to improve the quality of documentation for Treat & Release (T&R) patients in the Emergency Department to 90% in 6 months time. Have the initial visit chart available 100% of the time to the follow up visit.

Measures Assessed quality of documentation: Assessment Plan of Care Follow up Plan Utilization of new T&R tool Availability of initial visit chart How we went about out chart audits. Took a validated tool called QNOTE that is used to assess quality of healthcare documentation (both electronic and paper) and modified to look at 3 specific areas we felt impacts T&R patients: Assessment, Plan of Care and Follow-up Information. Tracked when patients returned as T&R if the form was being filled out completely and if the initial visit chart was available TWH>TGH for chart availability

Same for TWH (with TWH info) New Treat & Release Document Old Document New Document The old and the new T&R document Tick boxes to cue providers on various aspects of treat & release patients. New check boxes to remind HCPs to include all documented plan of care, and associated documents (Rx, CCAC referral) Same for TWH (with TWH info)

Overall Baseline Median 69% Goal 90% Overall Baseline Median 69% 16 week retrospective chart audits to create run chart. At week 10 we implemented our intervention- Education at the Business meeting in February, and new T&R document was implemented Our practices overall varied (Education & New Form) Intervention

Looked specifically at Assessment, Plan of Care and Follow-up Plan Goal 90% Baseline Median Assessment 85% Baseline Median Follow-up Plan 65% Baseline Median Plan of Care 59% Used a modified version of a validated tool called QNOTE that evaluates the quality of documentation for health care providers. Looked specifically at Assessment, Plan of Care and Follow-up Plan At baseline we’re doing a good job with documenting Assessments- but can do better Vast improvement has been noted in all areas, especially Follow-up plan and Plan of Care- hovering right around the goal of 90% February 9, 2017: Introduction education on use of new Treat & Release tool. February 14, 2017: New Treat & Release tool implemented at both sites. June 2017: Change to TGH T&R chart holding location (Education & New Form) Intervention

Evaluation Baseline Overall Median 69%, rose to 89% post intervention Assessment: 81% to 92% Plan of Care: 59% to 88% Follow-up Plan of Care: 64% to 89% Treat & Release Document is being completed 100% of the time Overall 60% of the time the initial chart is available on follow up visit, this is more of an issue at TGH vs TWH. PDSA cycles are ongoing to improve this metric

Dissemination Accepted as a presentation at the International Conference for Residency Education (ICRE) in October 2017. Submitted abstract to Health Quality Transformation (HQT) conference in October 2017.

Thank you Questions?