Methodology for developing quality indicators for the care of older people in the Emergency Department

Abstract

BackgroundCompared with younger people, older people have a higher risk of adverse health outcomes when presenting to emergency departments. As the population ages, older people will make up an increasing proportion of the emergency department population. Therefore it is timely that consideration be given to the quality of care received by older persons in emergency departments, and to consideration of those older people with special needs. Particular attention will be focused on important groups of older people, such as patients with cognitive impairment, residents of long term care and patients with palliative care needs. This project will develop a suite of quality indicators focused on the care of older persons in the emergency department.Methods/designFollowing input from an expert panel, an initial set of structural, process, and outcome indicators will be developed based on thorough systematic search in the scientific literature. All initial indicators will be tested in eight emergency departments for their validity and feasibility. Results of the data from the field studies will be presented to the expert panel at a second meeting. A suite of Quality Indicators for the older emergency department population will be finalised following a formal voting process.DiscussionThe predicted burgeoning in the number of older persons presenting to emergency departments combined with the recognised quality deficiencies in emergency department care delivery to this population, highlight the need for a quality framework for the care of older persons in emergency departments. Additionally, high quality of care is associated with improved survival & health outcomes of elderly patients. The development of well-selected, validated and economical quality indicators will allow appropriate targeting of resources (financial, education or quality management) to improve quality in areas with maximum potential for improvement.

Structural Quality Indicators to Support Quality of Care for Older People With Cognitive Impairment in Emergency Departments

“…If quality indicators are effective in stimulating change in practice, then they have a limited life span; after a period of implementation, existing indicators should be reevaluated to ensure that the point of difference in quality across hospitals is still being targeted. Figure 1 gives an overview of process 28,31,32 and outcome quality indicators for the care of older ED patients with cognitive impairment. This study (a subset of the primary study) focused on the development of SQIs targeting the special needs of the older ED population with cognitive impairment.…”

“…A quality appraisal of methodology was performed and consideration given to grades of research evidence according to the A project developing quality indicators for all older people presenting to EDs was carried out in eight hospitals across Australia. 28 In addition to these indicators, an additional suite of indicators was developed for persons with cognitive impairment. In addition to the SQIs described in this paper, process and outcome quality indicators were also proposed.…”

“…28 In summary, a structured research approach was taken for the development of the SQIs for the care of older people with cognitive impairment in the ED, including combining available evidence with expert opinion (phase 1), a field study (phase 2), and consensus voting (phase 3). This methodology was chosen based on previous quality indicator development experience, 29,30 and the recognition that field data included at the time of development results in quality indicators that more effectively differentiate between hospitals.…”

“…First, the draft set of SQIs was applied in a convenience sample, consisting of eight Australian EDs located in three states, including four teaching hospitals (54,920 to 117,737 ED presentations between 2011 and 2012) and four major community hospitals (46,690 to 66,013 ED presentations between 2011 and 2012). 36 A study for the development of process and outcome quality indicators for the care of older persons in EDs was implemented in these eight hospitals (May 2012 through February 2013) with 580 patients consecutively recruited during weekdays from 8 a.m. to 5 p.m. 28 Additionally, this study involved collection of data in relation to the drafted SQIs in the eight participating EDs. This study was approved by the relevant hospital research ethics committees and the University of Queensland.…”

Process Quality Indicators Targeting Cognitive Impairment to Support Quality of Care for Older People with Cognitive Impairment in Emergency Departments

“…Improved outcomes may be the result of many factors including, but not limited to, improved processes. Therefore, patient outcomes should also be measured in their own right ( Figure 1 [18][19][20] ).…”