Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators

Abstract

Measuring quality in Emergency Medical Services (EMSs) systems is challenging. This paper reviews the current approaches to measuring quality in health care and EMS with a focus on currently used clinical performance indicators in EMS systems (US and international systems). The different types of performance indicators, the advantages and limitations of each type, and the evidence-based prehospital clinical bundles are discussed. This paper aims at introducing emergency physicians and health care providers to quality initiatives in EMS and serves as a reference for tools that EMS medical directors can use to launch new or modify existing quality control programs in their systems.

Non-conveyance of patients: Challenges to decision-making in emergency care

“…[1,3] The term out-of-hospital emergency care used in this article refers to the care of acutely ill patients in a pre-hospital setting. [4] Emergency care consists of rapidly changing, chal-lenging situations, which create a sense of urgency and induce stress in care providers. [3] Developing out-of-hospital emergency care is of great importance in order to decrease patient mortality and disability.…”

“…Effective care delivered in the patient's home or other pre-hospital setting also improves the overall quality of patient care and potentially cuts care costs. [4][5][6] In Finland, emergency medical services have been organized on a regional basis as a part of the health care system, [7] regulated by the Health Care Act and Decree on Emergency Medical Services. The way of organizing services is defined by each regional hospital district, which means that the contents of the services can vary from one district to another.…”

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

“…Existent operating A&E systems have largely evolved in response to emergent health care services' needs, namely trauma, traffic accidents and non-traumatic cardiac arrest, rather than pre-planned A&E infrastructures (El Sayed, 2012). Therefore, adopting an integrated framework that identifies quality issues and provides improvement plans that benefit A&E settings.…”

“…The A&E unit is characterised by complexities in health care delivery that warrant a coordinated approach to quality assurance (Shah, 2006;El Sayed, 2012). These complexities include life threatening presenting conditions (e.g., trauma and cardiac arrest); high patient attendances and turnover; fluctuations in work demands and workload particularly when faced with not so common major disasters; shift rotations that cover full twenty four hours a day for whole week; and variations in A&E staff expertise (Oberklaid et al, 1991).…”

“…In particular at A&E, key performance indicators as part of quality improvement programmes enable management to continuously monitor, measure and evaluate emergency rooms' overall performance and effectiveness (El Sayed, 2012). Healthcare systems can use several valid quality measures that assess processes, (diagnostic or therapeutic interventions), or outcomes (Chassin, 1998).…”