Limits...
Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

Sørup CM, Jacobsen P, Forberg JL - Scand J Trauma Resusc Emerg Med (2013)

Bottom Line: A total of 55 ED performance measures were identified.ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures.The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.

View Article: PubMed Central - HTML - PubMed

Affiliation: DTU Management Engineering, Technical University of Denmark, Produktionstorvet, building 424, 2800, Kongens Lyngby, Denmark. cmiso@dtu.dk

ABSTRACT

Background: Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability.

Aim: To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance.

Methods: Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level.

Results: A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles.

Conclusions: A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.

Show MeSH

Related in: MedlinePlus

Top 25% of highlighted performance measures in included literature.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3750595&req=5

Figure 2: Top 25% of highlighted performance measures in included literature.

Mentions: The main ED tasks are fast recognition and treatment of time-dependent critical conditions plus fast disposition to adequate level of care. Therefore, the great focus on time intervals is not a surprising result. LOS is far the most used time interval. LOS is an indirect overall measure of the efficiency of the whole ED stay. Keeping LOS short also means reducing crowding and keeping an efficient patient flow. Despite that timely treatment is one of the main performance goals for an ED, it is notable that time to treatment is only the ninth most highlighted performance measure (see Figure 2). LOS is often an easy parameter to retrieve from the ED computer system and is relatively easy to define. Time to treatment is more difficult to define and often not as easy to register in a standardised manner. In addition one could argue that time to treatment should be divided into treatment time related to triage category. Thus, data availability and easily defined measures could influence the choice of measures. Indeed, other stakeholders than clinicians contribute to the focus of timely treatment, especially in the wake of crowding. Such stakeholders are patient associations, politicians, and the media.


Evaluation of emergency department performance - a systematic review on recommended performance and quality-in-care measures.

Sørup CM, Jacobsen P, Forberg JL - Scand J Trauma Resusc Emerg Med (2013)

Top 25% of highlighted performance measures in included literature.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750595&req=5

Figure 2: Top 25% of highlighted performance measures in included literature.
Mentions: The main ED tasks are fast recognition and treatment of time-dependent critical conditions plus fast disposition to adequate level of care. Therefore, the great focus on time intervals is not a surprising result. LOS is far the most used time interval. LOS is an indirect overall measure of the efficiency of the whole ED stay. Keeping LOS short also means reducing crowding and keeping an efficient patient flow. Despite that timely treatment is one of the main performance goals for an ED, it is notable that time to treatment is only the ninth most highlighted performance measure (see Figure 2). LOS is often an easy parameter to retrieve from the ED computer system and is relatively easy to define. Time to treatment is more difficult to define and often not as easy to register in a standardised manner. In addition one could argue that time to treatment should be divided into treatment time related to triage category. Thus, data availability and easily defined measures could influence the choice of measures. Indeed, other stakeholders than clinicians contribute to the focus of timely treatment, especially in the wake of crowding. Such stakeholders are patient associations, politicians, and the media.

Bottom Line: A total of 55 ED performance measures were identified.ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures.The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.

View Article: PubMed Central - HTML - PubMed

Affiliation: DTU Management Engineering, Technical University of Denmark, Produktionstorvet, building 424, 2800, Kongens Lyngby, Denmark. cmiso@dtu.dk

ABSTRACT

Background: Evaluation of emergency department (ED) performance remains a difficult task due to the lack of consensus on performance measures that reflects high quality, efficiency, and sustainability.

Aim: To describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance.

Methods: Following the PRISMA guidelines, a systematic literature review of review articles reporting accentuated ED performance measures was conducted in the databases of PubMed, Cochrane Library, and Web of Science. Study eligibility criteria includes: 1) the main purpose was to discuss, analyse, or promote performance measures best reflecting ED performance, 2) the article was a review article, and 3) the article reported macro-level performance measures, thus reflecting an overall departmental performance level.

Results: A number of articles addresses this study's objective (n = 14 of 46 unique hits). Time intervals and patient-related measures were dominant in the identified performance measures in review articles from US, UK, Sweden and Canada. Length of stay (LOS), time between patient arrival to initial clinical assessment, and time between patient arrivals to admission were highlighted by the majority of articles. Concurrently, "patients left without being seen" (LWBS), unplanned re-attendance within a maximum of 72 hours, mortality/morbidity, and number of unintended incidents were the most highlighted performance measures that related directly to the patient. Performance measures related to employees were only stated in two of the 14 included articles.

Conclusions: A total of 55 ED performance measures were identified. ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures. ED employee related performance measures were rarely mentioned in the investigated literature. The study's results allow for advancement towards improved performance measurement and standardised assessment across EDs.

Show MeSH
Related in: MedlinePlus