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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 ,
Astrid Guttmann ,
Chad A. Leaver ,
Marian Vermeulen ,
Caroline M. Hatcher ,
Brian H. Rowe ,
Merrick Zwarenstein  and
Geoffrey M. Anderson
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.

Keywords

emergency departmenthealth policyindicatorspatient safetyquality of care

Information

Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 5 , September 2011 , pp. 300 - 309
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Pitts, SR, Niska, RW, Xu, J,et al. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary, National Health Statistics Reports; no 7. Hyattsville, MD: National Center for Health Statistics; 2008.Google ScholarPubMed
2.Carriere, G. Use of hospital emergency room. Statistics Canada Health Reports 2004;16(1).Google Scholar
3.McCaig, LF, Stussman, BJ. National Hospital Ambulatory Medical Care Survey: 1996 emergency department summary. Adv Data 1997;(293):1–20.Google ScholarPubMed
4.Committee on the Future of Emergency Care in the United States Health System. Hospital-based emergency care: at the breaking point. Washington (DC): The National Academies Press; 2006.Google Scholar
5.Bond, K, Ospina, MB, Blitz, S, et al. Frequency, determinants and impact of overcrowding in emergency departments in Canada: a national survery. Healthc Q 2007;10:32–40.CrossRefGoogle Scholar
6.Fatovich, DM, Nagree, Y, Sprivulis, P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 2005;22:351–4, doi:10.1136/emj.2004.018002.CrossRefGoogle ScholarPubMed
7.Locker, T, Mason, S, Wardrope, J, et al. Targets and moving goal posts: changes in waiting times in a UK emergency department. Emerg Med J 2005;22:710–4, doi:10.1136/ emj.2004.019042.CrossRefGoogle Scholar
8.Schoen, C, Doty, MM. Inequities in access to medical care in five countries: findings from the 2001 Commonwealth Fund International Health Policy Survey. Health Policy 2004;67: 309–22, doi:10.1016/j.healthpol.2003.09.006.CrossRefGoogle ScholarPubMed
9.Schoen, C, Osborn, R, Huynh, PT, et al. Primary care and health system performance: adults’ experiences in five countries health affairs, no. 2004. doi:10.1377/hlthaff .w4.487.Google Scholar
10.Vancouver Coastal Health. Innovation reduces ER congestion in lower mainland (March, 2009). Available at: http://www.vch. ca/about_us/news/media_contacts/news_releases/irmovation_ reduces_er_congestion_in_lower_mainland (accessed January 4, 2010).Google Scholar
11.Alberta Health Services. Edmonton EMS, Capital Health hopeful changes will improve ambulance access (April 12, 2007). Available at: http://www.capitalhealth.ca/NewsAndEvents/ NewsReleases/2007/Ambulance_access.htm (accessed January 4, 2010).Google Scholar
12.Ontario Ministry of Health and Long-term Care. Ontario wait times. Available at: http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html (accessed January 4, 2010).Google Scholar
13.Alberti, G. Transforming emergency care in England. London: National Health Service; 2005. p. 1–44.Google Scholar
14.Brimelow, A, British Broadcasting Corporation News. A&E target “risks patient safety.” Available at: http://news.bbc.co.uk/ 2/low/health/8580761.stm (accessed March 24, 2010).Google Scholar
15.Institute of Medicine. Pathways to quality health care: performance measurement, accelerating improvement. Washington (DC): The National Academies Press; 2006.Google Scholar
16.McGlynn, EA. Introduction and overview of the conceptual framework for a national quality measurement and reporting system. Med Care 2003;41:11–7, doi:10.1097/00005650-200301000-00001.Google ScholarPubMed
17.McGlynn, EA. An evidence-based national quality measurement and reporting system. Med Care 2003;41:18–15, doi:10.1097/00005650-200301000-00003.Google Scholar
18.Galvin, RS, McGlynn, EA. Using performance measurement to drive improvement: a road map for change. Med Care 2003;41:148–60, doi:10.1097/00005650-200301001-00006.CrossRefGoogle ScholarPubMed
19.Marshall, MN, Shekelle, PG, Leatherman, S, et al. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA 2000;283:1866–74, doi:10.1001/jama.283.14.1866.CrossRefGoogle Scholar
20.Cain, EF. Improving emergency medical services for children through outcomes research: an interdisciplinary approach. Proceedings of a conference. Ambbul Pediatr 2002;2:285–348, doi:10.1367/1539-4409(2002)002<0285:IEMSFC>2.0. CO;2.Google Scholar
21.Lindsay, P, Schull, M, Bronskill, S, et al. The development of indicators to measure the quality of clinical care in emergency departments following a modified-Delphi approach. Acad Emerg Med 2002;9:1131–9, doi:10.1111/ j.1553-2712.2002.tb01567.x.Google Scholar
22.Guttmann, A, Razzaq, A, Lindsay, P, et al. Development of measures of the quality of emergency department care for children using a structured panel process. Pediatrics 2006; 118:114–23, doi 10.1542/peds.2005-3029.Google Scholar
23.Rowe, BH, Bond, K, Ospina, MB, et al. Data collection on patients in emergency departments in Canada. CJEM 2006;8: 417–24.CrossRefGoogle ScholarPubMed
24.Welker, JA, Huston, M, McCue, JD. Antibiotic timing and errors in diagnosing pneumonia. Arch Intern Med 2008;168: 351–6, doi:10.1001/archinternmed.2007.84.CrossRefGoogle ScholarPubMed
25.Health Quality Council of Alberta. Alberta Quality Matrix for Health. Available at: http://www.hqca.ca/index.php?id=%2035 (accessed Feb 1, 2008).Google Scholar
26.Hospital Report Research Collaborative. Hospital performance results 2008: emergency department care. Available at: http:// www.hospitalreport.ca/downloads/2008/edc_2008.html (accessed Nov 20, 2009).Google Scholar