Emergency department quality and safety indicators in resource-limited settings: an environmental survey

Abstract

BackgroundAs global emergency care grows, practical and effective performance measures are needed to ensure high quality care. Our objective was to systematically catalog and classify metrics that have been used to measure the quality of emergency care in resource-limited settings.MethodsWe searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references of included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was then reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into one of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered) and one of three of Donabedian’s structure/process/outcome categories. A fourth expert reviewer blinded to the initial classifications re-classified all indicators, with a weighted kappa of 0.89.ResultsA total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One hundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 % of metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care, with few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of care.ConclusionsThe published quality metrics in emergency care in resource-limited settings primarily focus on the effectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures and those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve quality of care and resource utilization.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0088-x) contains supplementary material, which is available to authorized users.

Identifying priorities for quality improvement at an emergency Department in Ghana

“…In a Donabedian framework, these are all structural measures. The implication is that staff may be unable to offer the intended level of care, and as a result, standard ED performance indicators focused on more upstream processes and outcomes may need careful consideration and adaptation for meaningful use in this setting [ 11 – 13 ].…”

Defining quality indicators for emergency care delivery: findings of an expert consensus process by emergency care practitioners in Africa

“… 8 9 There is no formalised minimum set of clinical quality indicators established and agreed on by providers and policy makers in LMICs. 10 National health systems seeking to monitor performance of newly established emergency care service delivery are left without context-appropriate indicators. The lack of standardisation impedes evaluation of the impact of emergency care service delivery initiatives and comparison within and between regions.…”

“… 9 15 In addition, the vast majority of quality indicators for emergency care are process indicators (activities and outputs), and are not proximally linked with improved clinical outcomes. 10 12 16–19 …”

“…A recent systematic review identified 34 articles using indicators to measure the quality of emergency care in resource-limited settings. 10 These publications generally describe indicators assessing care delivered for one specific disease process such as asthma or trauma, rather than addressing the emergency care system as a whole. South Africa has identified performance indicators for its emergency units (EUs), however, the uptake and feasibility of these performance indicators has been extremely limited.…”

Harnessing Inter-disciplinary Collaboration to Improve Emergency Care in Low- and Middle-income Countries (LMICS): Results of Research Prioritisation Setting Exercise

“…[29] A consensus-based set of 76 quality indicators for emergency care in LMICs was produced at the 2016 AFEM, including indicators on mortality outcomes [16]. More recently, International Federation of Emergency Medicine developed a framework for quality and safety , setting out global expectations for emergency care.…”