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

Christian Michel Sørup,Peter Jacobsen,Jakob Lundager Forberg

doi:10.1186/1757-7241-21-62

Abstract

BackgroundEvaluation 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.AimTo describe, map, and critically evaluate which performance measures that the published literature regard as being most relevant in assessing overall ED performance.MethodsFollowing 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.ResultsA 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.ConclusionsA 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.

Highlights

IntroductionIn Europe, many emergency department (ED) have undergone organisational changes [1,2]
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
ED time intervals were the most recommended performance measures followed by patient centeredness and safety performance measures

Summary

Introduction

In Europe, many EDs have undergone organisational changes [1,2]. Hospitals receiving acute patients are increasingly merged to larger organizations. The rationale for re-structuring is first and foremost to cope with an increased amount of patients while securing delivery of high quality and efficiency, concurrently with decreased overall hospital capacity [3]. Promotion of interdisciplinary teamwork and earlier senior physician involvement are examples of means to deliver timely and high quality treatment to patients within the EDs, which is essential for early diagnosis and provision of effective treatment of the increasing number of patients with comorbidities [4,5]. Many different ways of organising the ED is evolving and the costs and effects are being debated [8]. A way of assessing the effect on the re-organisation and the many local initiatives is highly warranted

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Conclusion