Abstract
Objectives: To develop a set of performance indicators to monitor the performance of emergency and urgent care systems in the Republic of Ireland. Design: This study comprised of an update of a previously performed systematic review and a formal consensus development exercise. Results: Initial literature searches yielded 2339 article titles. After further searches, sixty items were identified for full-text review. Following this review, fifty-seven were excluded. Three articles were identified for inclusion in the systematic review. These papers produced 42 unique indicators for consideration during the consensus development exercise. In total, 17 indicators had a median of greater than 7 following the meeting and met our pre-specified criterion for acceptable consensus. Discussion: Using this systematic review and nominal group consensus development exercise, we have identified a set of 17 indicators, which a consensus of different experts regard as potentially good measures of the performance of urgent and emergency care systems in Ireland.
Highlights
Emergency and urgent care consists of all the services which contribute to the management of people when immediate care is sought for a health condition
Articles were excluded after review of the full text version if the indicators that they contained were already listed by the previous systematic review or if they focused on individual components of the urgent and emergency care system such as emergency department waiting times or ambulance response times
Fifty-seven were excluded for the following reasons: forty-four of the articles excluded at the full text stage were focused on service based indicators, seven reported on indicators that had been described by the previous systematic review and six were of a descriptive nature and not focused on specific indicators (Figure 1)
Summary
Emergency and urgent care consists of all the services which contribute to the management of people when immediate care is sought for a health condition. When patients need immediate care they can enter the health system through a range of services and will often use more than one This can lead to a duplication of services, confusion about the most appropriate access point for individual patients and the danger of poorly co-ordinated care, especially at the point where patients transfer from one service to another. Policy makers have a variety of tools at their disposal when attempting to engineer a systems approach to urgent and emergency care These include the centralisation of care for high risk cases at high volume hospital units and the use of referral pathways and new facilities such as minor injury units to direct low-risk cases to settings that are appropriate for their condition[2]. Other elements include the use of telemedicine to provide support to smaller facilities and the development of community services for patients with conditions that are sensitive to the quality of ambulatory care[3]
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