185 Making the mandatory meaningful – leveraging regulatory requirements to achieve system improvement
Notice bibliographique
Résumé
Background Mandatory regulatory/College obligations can seem burdensome and feel like they pull you away from meaningful work. The College of Physicians and Surgeons Ontario (CPSO) in Canada has a QI partnership program for hospital-based physicians. This program makes QI activities a mandatory requirement of the regulatory college. One must complete a project to maintain their licensure. Hospital departments can sign up for a group QI project which is often less burdensome to physicians than an individual project. This also allows the hospital to align a project with a larger quality goal. In Ontario, Canada, three separate hospitals undertook this College program to improve psychiatric care.Case Studies Improving Communication at DischargeWaypoint Centre for Mental Health Care is a 315 bed psychiatric hospital located in Central Ontario. Transitions in care and the discharge summary were identified as the priority focus based on incident reviews. Twenty-five physicians participated in completing 5–10 self-directed chart reviews with peer feedback, auditing more than 100 records and identifying areas for improvement related to timeliness, distribution and formatting of discharge summaries. The results of this work informed the development of a dashboard to track discharge summary completion and display timely feedback to physicians. The work supported the business case for the redevelopment of the discharge summary in alignment with feedback from the QI program and our community providers. This discharge summary format has been adopted at two additional mental health facilities.Suicide Risk AssessmentMount Sinai Hospital is a general hospital with 400 beds in Toronto, Canada. Chart reviews demonstrated wide variation in the documentation of suicide risk assessment and intervention across psychiatric inpatient and outpatient programs. Leveraging the CPSO partnership program, we introduced the Columbia Suicide Severity Rating Scale (CSSRS) to standardize suicide risk assessment and recruited 25 physicians to participate. A pilot implementation undertaken on one inpatient service between October 2023 to October 2024 yielded an increase in use of the CSSRS Screener from 43/268 (16.0%, pre-intervention) to 180/497 (36.2%, post-intervention). To spread from this pilot, in September 2024, an electronic version of the CSSRS was incorporated into the electronic patient record for outpatients. Between September and December 2024, the CSSRS Screener was completed for 321/448 (71.6%) of newly referred patients. Individualized audit and feedback to physicians will be used to sustain these gains and further enhance standardization to improve patient safety.Measurement Based CareThe Department of Psychiatry at Sunnybrook Health Sciences Centre, a 1325-bed general hospital in Toronto, Canada, aimed to address low utilization of Measurement-Based Care (MBC) among psychiatrists. At baseline, only 18% used scales to inform treatment decisions. The Department launched several iterative interventions including use of personalized monthly audit-feedback reports, individual coaching sessions, and opportunities for self-reflection. After 1 year, results demonstrated an increase in sustained MBC adherence from 25% to 57.5%. Some early-adopters maintained adherence above 70%. Barriers to adoption included practitioner skepticism regarding accuracy and utility of measures compared to clinical judgment, administrative workflow challenges and lack of an integrated EMR. Enablers included administrative support and offering patients the opportunity to discuss their improvements. This project highlights the need for stakeholder engagement, ongoing audit and feedback, and addressing administrative burden to sustain MBC implementation and inform future scale and spread of MBC in mental health settings more broadly.Conclusion Participation in the regulatory college’s quality improvement partnership has been an effective lever to enhance physician engagement in adopting best practices in psychiatry including: improving the timeliness and quality of discharge communications, adopting a standardized approach to suicide risk assessment, and using measurement based care. Each project highlights the need for stakeholder engagement, audit and feedback, and addressing system level issues to facilitate clinician behaviour change.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,024 | 0,090 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,002 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,014 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».