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

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.

Performance Improvement Priorities From the Perspective of Emergency Department Staff in Iran’s Hospitals

“…can be lack of patient admission, disorder in the performance of emergency department staff, decreased quality of services provided, increased stress, decreased employee morale, reduced service quality, reduced efficiency and inappropriate effects on the performance of this ward (6).…”

Qualitative analysis of perceptions and experiences of emergency department staff in relation to implementation and outcomes of the Four‐Hour Rule/National Emergency Access Target in Australia

“…Using grounded theory to capture perceptions and attitudes around the implementation of the policy allows a degree of measurability . For example, even though there is currently no validated direct way of measuring ED environmental dysfunction, staff perceptions and other parameters could be used to attempt its detection and scale this dysfunction . It is suggested that the complex interplay between clinical and resource factors and the policy is perceived by staff in a gestalt fashion.…”

Assessment of Performance Index of Emergency Department in a Hospital in Tehran, Iran

“…15 In other studies around the world, several indicators such as the duration of wait time of the patient from entrance until admission at ED, patient wait time until doctor's visit, patient wait time from admission at ED since doctor's order, the duration of changing the patients' condition, duration of physical exit of patients discharged from the ED, duration from order until referral of patient, duration of obtaining admission from the target hospital, duration of the referred or admitted patient leaving the hospital's ED, and duration of performance and result preparation of lab tests and x-ray since the doctor's orders. 8,[18][19][20] Therefore, further studies are required in this area to clarify the strengths and weaknesses of the ED and define the road ahead to promote improvement. …”