Quality indicators for the practice of emergency medicine in Europe (EUSEM-QI-V1): results of a European-wide expanded Delphi consensus process.

Emergency medicine in the highly advanced world is traditionally performed in two different ways. The first is the well-known Anglo-American system with skilled EDs, and a pre-hospital emergency medical service utilizing paramedics. The second is the so-called Franco-German system, with a highly developed pre-hospital emergency physician service, but only a basic organization of hospital-based emergency medicine. This gap is now closing fast because of the rapid advancement of hospital-based emergency medicine in Europe. Four criteria might be used to measure this: the recognition as a specialty, the specialist training programme, the professional organization of emergency physicians and the presence of academic centres in Europe. Eleven of the 27 European countries recognize hospital-based emergency medicine as a specialty already. These include Belgium, Czech Republic, Estonia, Hungary, Ireland, Italy, Malta, Poland, Romania, Slovenia and the United Kingdom. Other nations are striving to do so, for example Sweden, France, Germany and Greece. There is no doubt that emergency medicine is gaining momentum and other countries will follow. Training for the specialty of emergency medicine is advanced already. Several curricula presently exist in the respective European countries. A task force, governed by the European Society for Emergency Medicine has been working hard to create a model curriculum for all of Europe, which is expected to be published in 2007. This comprises a 5-year specialty training, with three of them spent in an ED. The curriculum follows a symptom-oriented approach to emergency medicine, and includes a skilled description of the key competencies of the future trained emergency physicians. Given the century-long history of the pre-hospital emergency physician service in some European countries, a number of professional bodies exist representing pre-hospital emergency doctors. Within the last few years, ED physicians followed suit forming organizations of their own. In some countries, the next step of amalgamation has occurred, with the merger of EMS and ED emergency physician organizations, although no country has abolished the pre-hospital emergency physician service. The last milestone, the development of academic emergency centres, has only just started. This process will take some time. The present paper describes the present and future of emergency medicine in some European countries using these criteria.

Emergency Medicine (EM) in Europe has evolved from a fragmented service into a mature, stand-alone specialty with structured postgraduate training. Despite progress, significant disparities remain in specialty recognition, training duration and structure, subspecialty exposure, educational methods, and assessment across European countries. To address these gaps, the European Society for Emergency Medicine (EUSEM) and the Union Europeenne des Medecins Specialistes (UEMS) Section and Board for EM developed the European Training Requirements (ETR) for EM, first adopted in 2018 and updated in 2024. The ETR defines minimum standards for training content, duration, organisation, and assessment. It is endorsed by all EUSEM national societies and UEMS specialties, a major milestone in recognising EM as essential to Europe's frontline healthcare. The European Board Examination in Emergency Medicine (EBEEM) was established as a competency-based pan-European assessment aligned with the ETR, providing an objective measurement of trainee readiness for independent specialist practice. In this perspective, we review literature, policy documents, and survey data to describe advances and persisting disparities in EM training. We highlight programmes exemplifying alignment with outcome-based models and the ETR framework, illustrating harmonisation pathways while respecting national contexts. We argue that the ETR and EBEEM, supported by longstanding national frameworks and guidance from the International Federation for Emergency Medicine (IFEM), can drive genuine harmonisation of EM training across Europe. Finally, we describe these developments within global EM evolution, where strengthening of emergency care systems particularly in low- and middle-income countries, offer significant potential to reduce morbidity and mortality.

Reply EDITOR: The authors of the Working Party on Emergency Medicine of the European Board of Anaesthesiology (European Union of Medical Specialists, EUMS/UEMS) want to thank Dr Raed and colleagues for their correspondence. However, we are afraid that Dr Raed and colleagues have misunderstood the intention of our paper. Our paper, in fact, describes the part of the core curriculum in Anaesthesiology dedicated to Emergency Medicine, as is desirable and as is required for any resident who is trained as an Anaesthesiologist in Europe. In contrast to what Dr Raed and colleagues suggest, our paper does in no way promote exclusivity. Emergency Medicine in Europe is diverse, has different contents and different positions in different countries in association with varying organizations of medical care, varying geography and varying resources. With the exception of nine European Countries, Emergency Medicine is not an independent speciality in most European Member States. The European Directive on recognition of professional qualifications (Directive 2005/36/CE of the European Parliament) does not identify Emergency Medicine as a primary medical speciality. The European Union requires that, to become a speciality it must be recognized in at least two-fifths of the Member States and at the same time, by a particular majority (a weighted vote that is determined by the population of each country and other factors and giving what is called a ‘qualified majority') in a committee on Qualification of the European Commission (not only for medical professions but generally also for all protected professions). Furthermore, to create a Specialist Section for Emergency Medicine within the UEMS, Emergency Medicine has to be recognized as an independent speciality by more than one-third of the EU Member States and must be registered in the official Journal of the European Commission (Medical Directives). All these requirements for a primary medical speciality are not fulfilled for Emergency Medicine. The European Board of Anaesthesiology (and not the European Society of Anaesthesiology, which unfortunately was misquoted in the correspondence) has no ambition to be involved in the crusade of the European Society of Emergency Medicine to have Emergency Medicine recognized as a separate medical specialty. Emergency Medicine has many definitions in many regions and countries in Europe. In our opinion it would definitely be preferable first to agree on the definitions of Emergency Medicine in Europe and then to agree on the competencies that are required to achieve high-quality care in Emergency Medicine throughout Europe. It is also important to identify general quality indicators for Emergency Medicine, applicable to all countries and health care systems. It then remains to be seen whether the institution of Emergency Medicine as a separate medical specialty is the way to go to achieve the aforementioned goals. This may be the case for some countries in Europe, but not for others, depending on many factors. Like for Intensive Care Medicine, the multidisciplinary input from various specialties is considered essential to achieve high-quality care in Emergency Medicine. This multidisciplinary input threatens to be lost by the institution of a separate specialty. We do agree with the authors of the correspondence: let us not forget the history of medicine. Too widespread a specialization in medicine has created barriers in the past, which have not served well for the quality of care for our patients. However, mutual stimulation, mutual respect, communication and cooperation are characteristics which we do have!

The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as "the care health professionals would want to receive if they got sick." The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition-specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.

The findings are presented of a consensus committee created to address the measuring and improving of quality in emergency medicine. The objective of the committee was to critically evaluate how quality in emergency medicine can be measured and how quality improvement projects can positively affect the care of emergency patients. Medical quality is defined as “the care health professionals would want to receive if they got sick.” The literature of quality improvement in emergency medicine is reviewed and analyzed. A summary list of measures of quality is included with four categories: condition‐specific diseases, diagnostic syndromes, tasks/procedures, and department efficiency/efficacy. Methods and tools for quantifying these measures are examined as well as their accuracy in assessing quality and adjusting for differences in environment, and patient populations. Successful strategies for changing physician behavior are detailed as well as barriers to change. Examples are given of successful quality improvement efforts. Also examined is how to address the emergency care needs of vulnerable populations such as older persons, women, those without health insurance, and ethnic minorities.

The lack of cross-border patient health data exchange in Europe is an obstacle in many ways and can negatively affect patient care and health. When clinicians have incomplete information about patients traveling or residing abroad, for example, continuity of care cannot be assured, potentially leading to poorer health outcomes. The European Electronic Health Record Exchange Format (EEHRxF) is a system being established in Europe to permit the interoperability of different healthcare systems, such as electronic health records (EHRs) and medical devices, so that they can share data to support patient care and research. The system is currently being introduced for electronic prescriptions and dispensations, patient summaries, which are part of the larger collection of health data known as the electronic health record, laboratory results and medical imaging studies and their reports, and hospital discharge reports. In emergency medicine, where research is challenging due to time and resource constraints, the EHR should no longer be seen solely as a tool to support clinical practice; it is also a source of valuable information to fuel research and improve patient care. The use of data for research, one of the stated secondary goals of the EEHRxF, thus becomes paramount here and deserves to be properly developed. It is in this context that the eCREAM (enabling Clinical Research in Emergency and Acute care Medicine through automated data extraction) project, a 5-year Horizon Europe project, was established. eCREAM will develop a system to exploit EHRs to enable research and improve decision-making, resource allocation and patient outcomes. It will address this target in two ways. First, by creating a new EHR that simultaneously meets clinical and research needs, collecting reliable, structured data that facilitate the clinical process and are readily usable for research purposes. Second, by developing an advanced natural language processing tool tailored to the specific needs of emergency medicine to automatically extract accurate, structured data from the free texts contained in EHRs. The project's innovative approach addresses current challenges in data extraction and utilization and sets a new standard for emergency medicine in Europe in the digital age. This article provides a general overview of the eCREAM project.

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.

This paper reports the proceedings of the discussion panel assigned to look at clinical aspects of quality in emergency medicine. One of the seven stated objectives of the Academic Emergency Medicine consensus conference on quality in emergency medicine was to educate emergency physicians regarding quality measures and quality improvement as essential aspects of the practice of emergency medicine. Another topic of interest was a discussion of the value of information technology in facilitating quality care in the clinical practice of emergency medicine. It is important to note that this is not intended to be a comprehensive review of this extensive topic, but instead is designed to report the discussion that occurred at this session of the consensus conference.

In order to get an update on prehospital emergency medicine practice all over Europe we submitted questionnaires with a total of 61 questions concerning prehospital emergency medicine in Europe, to 123 European members of the World Association of Emergency and Disaster Medicine (WAEDM). Sixty (49%) questionnaires were returned. One up to seven questionnaires from 22 European countries were analysed: 37 (62%) from urban and 23 (38%) suburban or rural areas; 12 being from former Eastern European countries. Sixteen of the questions--those concerning rescue systems and equipment--are analysed and presented in this paper. A fleet of ambulance cars staffed with paramedics/nurses based at the emergency organization is the most frequently used system in 59% (10/17) of the countries. The same percentage claims to have a ground-based coverage of its area of 80-100%. Airborne coverage between 80-100% and below 60% of the areas is given in the same percentage of 35% (6/17). Physicians are frequently involved in prehospital emergency care in the Eastern European Countries, France, Germany, Italy, Belgium and Turkey, rarely in Switzerland, Denmark, the United Kingdom, Greece, Ireland and Finland, never in the Netherlands and Sweden. In more than 50%, a combination of national, regional and local organizations provide emergency care, which results in large differences of standards. We discovered remarkable differences which could be overcome by enhanced co-ordination and information exchange provided by the European Society for Emergency Medicine, WAEDM, the European Red Cross or the European Academy of Anaesthesiologists.

Health research is fundamental for clinical excellence, a fact that applies equally to emergency medicine (EM). Although European scientific publication rates in EM have traditionally been lower than those of other medical specialties, from 1995 steady progress has been made. To increase the scientific output in EM it is necessary to resolve issues that hinder this progress, including the fact that EM is a new specialty, or even nonexistent in many European countries. This has resulted in a relative lack of scientific culture and training in research methodology of emergency physicians, of explicit recognition of scientific work, or of emergency physician competitiveness to apply to national and European grants for research projects. In addition, it is necessary to improve representation of European journals indexed in the category of EM and to receive a firm boost to EM research from the European Society for Emergency Medicine as well as from all European national societies. This study reviews these aspects and offers a personal perspective on where European EM research should be going.

Emergency medicine (EM) is emerging worldwide. Its development as a recognized specialty is proceeding at difference rates in different countries. Europe is a region with complex political affiliations and is composed of countries both within and outside the European Union (EU). Europe is seeking greater standardization (harmonization) for mutually improved economic development. Medicine in general, and EM in particular, is no exception. In Europe, as in other regions, EM is struggling for acceptance as a valid field of specialization. The European Union of Medical Specialists requires that once two-fifths of countries acknowledge a specialty, all EU countries must address the question. EM had achieved the needed majority by 2011. This article briefly describes the European road to specialty acceptance.

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine

The United Kingdom and the United States first recognised the need for a hospital-based specialty of Emergency Medicine in the early 1970s and were closely followed by Canada and Australia. However, similar developments were not seen on mainland Europe until 1994, when the European Society for Emergency Medicine (EuSEM) was established. Its main aims were to promote the establishment of Emergency Medicine as a primary specialty in individual countries and to develop common standards of specialty training across Europe by agreeing a core curriculum and a 5-year programme of specialty training. This article traces the development of Emergency Medicine as a hospital-based specialty in Europe over the last 20 years. Emergency Medicine is now established as a primary specialty in 17 of the 28 member countries of the European Union as well as Turkey. Moreover, in October 2014, the EuSEM celebrated its twentieth anniversary during a congress in Amsterdam attended by more than 2400 delegates.

ABSTRACTConstruct: We investigated the quality of emergency medicine (EM) blogs as educational resources. Purpose: Online medical education resources such as blogs are increasingly used by EM trainees and clinicians. However, quality evaluations of these resources using gestalt are unreliable. We investigated the reliability of two previously derived quality evaluation instruments for blogs. Approach: Sixty English-language EM websites that published clinically oriented blog posts between January 1 and February 24, 2016, were identified. A random number generator selected 10 websites, and the 2 most recent clinically oriented blog posts from each site were evaluated using gestalt, the Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) score, and the Medical Education Translational Resources: Impact and Quality (METRIQ-8) score, by a sample of medical students, EM residents, and EM attendings. Each rater evaluated all 20 blog posts with gestalt and 15 of the 20 blog posts with the ALiEM AIR and METRIQ-8 scores. Pearson's correlations were calculated between the average scores for each metric. Single-measure intraclass correlation coefficients (ICCs) evaluated the reliability of each instrument. Results: Our study included 121 medical students, 88 EM residents, and 100 EM attendings who completed ratings. The average gestalt rating of each blog post correlated strongly with the average scores for ALiEM AIR (r = .94) and METRIQ-8 (r = .91). Single-measure ICCs were fair for gestalt (0.37, IQR 0.25–0.56), ALiEM AIR (0.41, IQR 0.29–0.60) and METRIQ-8 (0.40, IQR 0.28–0.59). Conclusion: The average scores of each blog post correlated strongly with gestalt ratings. However, neither ALiEM AIR nor METRIQ-8 showed higher reliability than gestalt. Improved reliability may be possible through rater training and instrument refinement.

Editor-in-Chief, European Journal of Emergency Medicine. Chinese University of Hong Kong Correspondence to Colin A. Graham, Editor-in-Chief, Professor of Emergency Medicine, Chinese University of Hong Kong E-mail: [email protected]