Abstract
BackgroundIn The Netherlands, mainly inexperienced physicians work in the ED on all shifts, including the evening and night shifts, when no direct supervision is available. In 2004 a report of the Dutch Health Care Inspectorate revealed that quality of care at Emergency Departments (EDs) was highly variable. Based on this report and international studies showing significant potential for quality improvement, stakeholders felt the need to improve the quality of EM care. Based on the literature, a baseline measurement and a panel of experts, The Netherlands recently developed a nationwide quality requirement framework (QRF) for EM. This article describes the content of and path to this QRF.MethodsTo conduct a baseline measurement, the panel needed to identify measurable entities related to EM care at EDs. This was done by formulating both qualitative and partly quantitative questions related to the following competence areas: triage system, training of personnel (physicians and nurses), facilities and supervision of physicians.27 out of 104 Dutch EDs were sampled via a cross-sectional study design, using an online survey and standardized follow-up interview in which the answers of the survey were reviewed.ResultsIn the QRF, EM care is divided into a basic level of EM care and six competence certification areas (CCAs): (acute) abdominal aortic aneurysm, acute coronary syndrome, acute psychiatric behavioral disorder, cerebral vascular accident, pediatric critical care and infants with low birth weight. For the basic level of EM care and for every CCA minimum prerequisites for medical devices and training of personnel are established. The factors selected for the QRF can be regarded as minimum quality standards for EM care. A major finding of this study was that in The Netherlands, none of the 27 sampled EDs demonstrated compliance with these factors.ConclusionOur study shows that Dutch EDs fall short of what the expert consensus panelists considered minimum prerequisites for adequate EM care. The process of systematic enquiry allowed this information to come to light for the first time, which resulted in the implementation of a QRF for Dutch ED personnel, that is intended improve quality of EM care over time. This is an important development for the worldwide EM community as the QRF shows a way to generate interim standards to improve the chances of appropriate delivery of EM care when the gold standard of providing fully qualified EPs is not initially achievable.
Highlights
In The Netherlands, mainly inexperienced physicians work in the Emergency Departments (EDs) on all shifts, including the evening and night shifts, when no direct supervision is available
The Ministry of Health first assembled a panel of 20 experts that consisted of stakeholders that could formulate a quality requirement framework (QRF).b The panel began by conducting a literature search for existing QRFs related to the basic level of emergency medicine (EM) care that might be useful for addressing the Dutch situation
The factors selected for the QRF can be regarded as minimum quality standards for EM care
Summary
In The Netherlands, mainly inexperienced physicians work in the ED on all shifts, including the evening and night shifts, when no direct supervision is available. Since the founding of The Netherlands Society of Emergency Physicians (NVSHA) in 1999, the need for improving the quality of Dutch EM care has received more attention [5]. This growing attention led to preliminary recognition of emergency physicians (EPs) in 2008, with the possibility of recognition as a medical specialty in the future. There is currently a consensus in The Netherlands that emergency departments (EDs) should be staffed 24/ 7 with EPs. the shortage of EPs has prevented most EDs from being fully staffed with EPs; instead, EDs are mostly staffed by physicians who recently graduated from medical school and/or medical residents who work under the supervision of medical specialists or EPs. In the Dutch system, the choice to seek supervision or advice is up to the (junior) physician who is seeing the patient. Relatively inexperienced physicians working at Dutch EDs have substantial responsibilities for patient care [5,6]
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