Abstract
BackgroundMusculoskeletal injuries are a common presentation to the Emergency Department (ED). The quality of care provided is important to the patients, clinicians, organisations and purchasers of care. In the context of the increasing burden of musculoskeletal disease, quality of care needs to occur despite financial impacts, variations in care, and pressure to reach time-based performance measures. This study aims to develop a suite of evidence-based quality indicators (QI) which will provide a measure of the quality of care for patients with musculoskeletal injuries in the ED.MethodsThis study will utilise a multi-phase mixed methods protocol, commencing with a systematic review of the literature to identify and critically appraise existing QIs for musculoskeletal injuries in the ED. The study will then build on the gaps identified in the review to develop a suite of preliminary QIs, in accordance with established research methodology under the governance of an expert panel. The developed QI set will then be field-tested for feasibility and validity in selected EDs. After field-testing, the suite will be refined in consultation with the expert panel and finalised using a formal voting process.DiscussionThe assessment of performance against QIs provides a quantitative measure for the quality of care provided to patients, to identify and target quality improvement activities. The QIs developed through this study will be evidence-based and balanced across the areas of structures, processes and outcomes. The rigorous methodology used to develop and test the QIs will result in QIs that are meaningful, valid, feasible to collect and efficiently measurable, amenable to improvement, and selected by experts in the emergency medicine field. The final QI suite will have applications across EDs that affords comparison, benchmarking and optimisation of emergency care for patients.
Highlights
Musculoskeletal injuries are a common presentation to the Emergency Department (ED)
In the United States of America (USA), the focus in health care is on developing payment and delivery models that incentivise and support the provision of high quality, cost-efficient care [14]
The United Kingdom (UK) and Australasian systems focus on quantifying health care performance using time-based
Summary
The quality of care provided is important to the patients, clinicians, organisations and purchasers of care. This study aims to develop a suite of evidence-based quality indicators (QI) which will provide a measure of the quality of care for patients with musculoskeletal injuries in the ED. Given the rising burden of musculoskeletal disease, improved quality of care for musculoskeletal injuries has become increasingly important to patients, clinicians, organisations, policy-makers and purchasers of care. Strudwick et al BMC Emergency Medicine (2017) 17:14 process measures that do not necessarily address patient outcomes [15,16,17] These time-based performance measures, while effective at streamlining ED care, have not been universally associated with better outcomes for patients. A strong reliance on time-based performance measures does not necessarily correspond to high levels of quality across all aspects of ED care, and other important measures of quality, such as unplanned return visits and resource allocation to non-emergency activities, can be overlooked [18, 19]
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