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Prioritizing performance measurement for emergency department care: consensus on evidencebased quality of care indicators

Published online by Cambridge University Press:  11 May 2015

Michael J. Schull*
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Medicine, University of Toronto, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
Astrid Guttmann
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Divisions of Pediatrics and Emergency Medicine, The Hospital for Sick Children, Toronto, ON Department of Pediatrics, University of Toronto, Toronto, ON
Chad A. Leaver
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Marian Vermeulen
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Caroline M. Hatcher
Affiliation:
Foothills Medical Centre, Alberta Health Services, Calgary, AB
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, AB
Merrick Zwarenstein
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Centre for Health Services Sciences, Sunnybrook Research Institute, Toronto, ON
Geoffrey M. Anderson
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
*
Institute for Clinical Evaluative Sciences, G-147, 2075 Bayview Avenue, Toronto, ON M4N 3M5; mjs@ices.on.ca

Abstract:

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Background:

The evaluation of emergency department (ED) quality of care is hampered by the absence of consensus on appropriate measures. We sought to develop a consensus on a prioritized and parsimonious set of evidence-based quality of care indicators for EDs.

Methods:

The process was led by a nationally representative steering committee and expert panel (representatives from hospital administration, emergency medicine, health information, government, and provincial quality councils). A comprehensive review of the scientific literature was conducted to identify candidate indicators. The expert panel reviewed candidate indicators in a modified Delphi panel process using electronic surveys; final decisions on inclusion of indicators were made by the steering committee in a guided nominal group process with facilitated discussion. Indicators in the final set were ranked based on their priority for measurement. A gap analysis identified areas where future indicator development is needed. A feasibility study of measuring the final set of indicators using current Canadian administrative databases was conducted.

Results:

A total of 170 candidate indicators were generated from the literature; these were assessed based on scientific soundness and their relevance or importance. Using predefined scoring criteria in two rounds of surveys, indicators were coded as “retained” (53), “discarded” (78), or “borderline” (39). A final set of 48 retained indicators was selected and grouped in nine categories (patient satisfaction, ED operations, patient safety, pain management, pediatrics, cardiac conditions, respiratory conditions, stroke, and sepsis or infection). Gap analysis suggested the need for new indicators in patient satisfaction, a healthy workplace, mental health and addiction, elder care, and community-hospital integration. Feasibility analysis found that 13 of 48 indicators (27%) can be measured using existing national administrative databases.

Discussion:

A broadly representative modified Delphi panel process resulted in a consensus on a set of 48 evidencebased quality of care indicators for EDs. Future work is required to generate technical definitions to enable the uptake of these indicators to support benchmarking, quality improvement, and accountability efforts.

Type
Original Research • Recherche originale
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

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