Physician and departmental performance metrics in pediatric emergency care: Secondary use of patient visit data

Objectives: To develop, implement, and validate a physician and departmental performance metric feedback process based on secondary use of patient visit data using the level of electronic health record implementation available in most Canadian pediatric emergency departments (PEDs). Methods: Patient visit data for the IWK Health Centre PED in Halifax, Canada were used to create individual physician and departmental performance metrics including: physician dwell time, 24 and 72 hour return-rates, admission rates, sign-over rates. Visit acuity was measured using the Canadian Triage and Acuity Scale (CTAS). Feedback directly to physicians was contextual, anonymous, non-proscriptive and non-threatening. Relationships between various performance metrics were analyzed to explore the rational trade-off hypothesis. This data acquisition and analysis has become an annual part of the departmental review process. Results: Wide practice variation was found. Exposure to personal performance feedback was associated with positive change in physician behaviour. Analysis failed to find a rational trade-off between increased resource utilization and holistically better care. Physician buy in was excellent. Conclusions: At this preliminary stage, surveillance of physician and departmental metrics derived from secondary use of patient visit data shows promise in improving care, dissecting clinical decision making, and (possibly) directing professional development processes. Secondary data analysis, even in small centres and in the absence of sophisticated electronic health records management, can provide clinically and administratively useful data. Further studies, at a multi-centred scale, are planned.