Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators.

Maria Søe Mattsson,Nick Mattsson,Hanne B Jørsboe

doi:10.1186/s13049-014-0060-4

Abstract

BackgroundThe Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of this study was to investigate the quality of acute care in a re-organized ED based on national indicator project data in a pre and post reorganizational setting.MethodsQuasi experimental design was used to examine the effect of the health care quality in relation to the reorganization of an ED. Patients admitted at Nykøbing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbæk Hospital works as a control hospital.Chi-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P < 0.05 was considered statistically significant.ResultsWe assessed 4584 patient cases from RKKP. A significant positive change was seen in all of the additional eight indicators related to stroke at NFS (P < 0.001); however, COPD indicators were unchanged in both hospitals. In NFS two of eight heart failure indicators were significantly improved after the reorganization (p < 0.01). In patients admitted with a bleeding ulcer 2 of 5 indicators were significantly improved after the reorganization in NFS and HOL (p < 0.01). Both compared hospitals showed significant improvements in the two indicators concerning hip fracture (p < 0.001). Significant reductions in the 30 day-mortality in patients admitted with stroke were seen when the pre- and the post-intervention data were compared for both NFS and HOL (p = 0.024).ConclusionsDuring the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark is recommended.

Highlights

The Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files
The aim of this study is to investigate the impact of reorganization of the acute care in a new Emergency Department with observation units on the quality of health care, including mortality rate, as monitored by five selective acute conditions; stroke, acute gastrointestinal bleeding and perforation, heart failure, COPD, COPD with pneumonia and hip fractures
Heart failure In Nykøbing Falster (NFS) two of eight heart failure indicators were significantly improved after the reorganization: “echocardiography” (88.97% vs. 97.55%, p = 0.001) and “exercise by physiotherapist” (11.32% vs. 41.42%, p < 0.0001) while data demonstrate a significant decrease in to 2 out of 8 indicators; “NYHA classification” (96.32% vs. 90.69%, p = 0.05) and “initiated a structured training program” (92.59% vs. 84.62%, p = 0.05)

Summary

Introduction

The Emergency Departments (EDs) reorganization process in Denmark began in 2007 and includes creating a single entrance for all emergency patients, establishing triage, having a specialist in the front and introducing the use of electronic overview boards and electronic patient files. The aim of the new EDs was to improve the quality of the diagnostic process and allow for an earlier diagnosis and treatment of all types of acute patients based on international experience [1]. A few clinical databases related to Emergency Medicine were under development in 2013 [11,12] the usual quality measurements of choice have been to monitor different time intervals, e.g. door to treatment, which are easy accessible data for administrative use. These intervals, does not differentiate properly between the different acute care needs of patients

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