Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project

Abstract

Objective: Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated. Methods: A literature review was used to identify potential indicators. A reference group of 25 key stakeholders from across the health system was convened, with the aims of validating the suggested indicators and to ensure that other candidate indicators were not overlooked. A thematic analysis using a general inductive approach was used to analyse focus group discussions. Results: The major themes were communication, access, timeliness, appropriateness and satisfaction. The 12 indicators selected after literature review were confirmed and two further indicators added after the thematic analysis. The indicators are: hospital and ED length of stay; re‐presentation within 48 h; mortality; times to reperfusion, antibiotics, asthma treatment, analgesia, CT for head injury and to theatre (appendicitis and fractured neck of femur); triage time compliance; proportion who left without being seen; quality of discharge information; and ED overcrowding/access block. Conclusion: Through literature review and consultation with stakeholders, an evidence‐based and clinically relevant set of indicators was compiled with which to measure the effect of the SSED target. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs.

Review article: Components of a good quality discharge summary: A systematic review

“…Prior research suggests that the quality of discharge information (from both ED and inpatient wards) is not always adequate and contains errors that might negatively affect patient outcomes, such as readmission to hospital, representation to ED and failure to complete the recommended follow‐up . It is therefore not surprising that a healthcare systems reference group in New Zealand identified the communication between ED and primary care as an important quality indicator with respect to the recent adoption of national emergency access targets . It is plausible that undue pressure to discharge patients from ED might lead to shortcuts with respect to communication.…”

Review article: What makes a good healthcare quality indicator? A systematic review and validation study

“…Confounding factors, such as having more time to think about this process and increased alertness to evidence around the particular indicators selected in the intervening time might have led to changes in choice regardless of whether QICA was used or not. When ranking a set of candidate indicators in the SSED study, all indicators had high face validity to the users and participants in both pilots knew their own prior assessments. Both factors are likely to bias against a difference using the QICA tool.…”

“…The first pilot was completed by two authors independently who appraised and ranked eight indicators (PJ and JLF). The indicators had previously been shortlisted for inclusion as process or outcome measures for a study assessing the impact of a national emergency access target in New Zealand …”

Quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania: learning from mothers' experiences

“…Health care is regarded as better when there is a good outcome and a higher patient satisfaction [24,25], which includes establishing a sense of trust, covering the patient’s need, and promoting dialogue and follow up of patients or sick neonates through parents [15,26,27]. These are important indicators for improving the quality of care [28].…”