Thursday, March 31, 2011

Where's my real-time data?

"Your exit - 10 miles back"

How would you like to see this sign on your next road trip?  What a ridiculous idea - telling drivers that they should have turned off 10 miles ago!  Imagine the confusion and wasted time and gas.  We wouldn't stand for it.  We'd be on the phone to the Department of Highways demanding that the signage be improved.

Yet, in healthcare, we put up with this every day.

Timely feedback is essential for change to progress efficiently and steadily.  PDSA (plan-do-study-act) cycles often involve very small tests of change (e.g. one patient, one time) followed by analysis and then implementation of another change.  Without prompt feedback, we don't know what direction to take for our next cycle.

HQC's Quality Insight provincial dashboard is an ambitious effort to track results ranging from surgical wait times to patient experience in healthcare.  Many of the results are only 4 months old.   While 4 months could barely be considered real-time data, it shines when compared with the 3-year-old data on prostatectomy readmission rates.

This data is from CIHI and indicates how many men are readmitted to hospital after undergoing prostate surgery.  It's a quality indicator (albeit, a rough one) in urology.  Several years ago, Saskatoon's prostatectomy readmission rate was quite high, prompting our department to review our practices.  Since the "latest" data was available, we have adopted a different technology for prostate surgery.  Yet, we don't have any current road signs to guide us.

You may quite rightly point out that our department could do a chart review and make our own calculations of readmission rates.  And, if I griped that it would take time - likely in the evening or weekend - to conduct that review, you would again be right in noting that quality review is part of our professional responsibility for quality improvement.

But, there are many quality indicators for which we would like regular information: wound infection, admission length of stay, pulmonary embolism, perioperative mortality.  Urologists could spend hours combing through charts to collect this data.  And there are many other specialties interested in their own quality indicator reports.  Our health region doesn't have the resources to make all these measurements.

Or, perhaps it's more accurate to say that our resources haven't been allocated toward real-time, automated collection and reporting of quality data.  And that sends the message that we settle for learning about our exit 10 miles too late.

No comments:

Post a Comment