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BMC Emergency Medicine
Published in: BMC Emergency Medicine 1/2017

Open Access 01-12-2016 | Study protocol

Developing quality indicators for the care of patients with musculoskeletal injuries in the Emergency Department: study protocol

Authors: Kirsten Strudwick, Anthony Bell, Trevor Russell, Melinda Martin-Khan

Published in: BMC Emergency Medicine | Issue 1/2017

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Abstract

Background

Musculoskeletal injuries are a common presentation to the Emergency Department (ED). The quality of care provided is important to the patients, clinicians, organisations and purchasers of care. In the context of the increasing burden of musculoskeletal disease, quality of care needs to occur despite financial impacts, variations in care, and pressure to reach time-based performance measures. This study aims to develop a suite of evidence-based quality indicators (QI) which will provide a measure of the quality of care for patients with musculoskeletal injuries in the ED.

Methods

This study will utilise a multi-phase mixed methods protocol, commencing with a systematic review of the literature to identify and critically appraise existing QIs for musculoskeletal injuries in the ED. The study will then build on the gaps identified in the review to develop a suite of preliminary QIs, in accordance with established research methodology under the governance of an expert panel. The developed QI set will then be field-tested for feasibility and validity in selected EDs. After field-testing, the suite will be refined in consultation with the expert panel and finalised using a formal voting process.

Discussion

The assessment of performance against QIs provides a quantitative measure for the quality of care provided to patients, to identify and target quality improvement activities. The QIs developed through this study will be evidence-based and balanced across the areas of structures, processes and outcomes. The rigorous methodology used to develop and test the QIs will result in QIs that are meaningful, valid, feasible to collect and efficiently measurable, amenable to improvement, and selected by experts in the emergency medicine field. The final QI suite will have applications across EDs that affords comparison, benchmarking and optimisation of emergency care for patients.
Literature
1.
Australian Institute of Health and Welfare. Emergency department care 2015-16: Australian hospital statistics. In: Health services series no 72 Cat no HSE 182. Canberra: AIHW; 2016.
2.
Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015;10(2):171–5.CrossRefPubMed
3.
Lowthian JA, Curtis AJ, Cameron PA, et al. Systematic review of trends in emergency department attendances: an Australian perspective Emergency Medicine Journal Published Online First: 20 October 2010. doi: 10.​1136/​emj.​2010.​099226.
4.
Toloo S, FitzGerald G, Aitken P, Ting J, Tippett V, Chu K. Emergency health services: demand and service delivery models. Monograph 1: literature review and activity trends. 2011.
5.
6.
7.
8.
9.
Gaieski DF, Mehta S, Hollander JE, Joseph Bernstein MD M. Low-severity musculoskeletal complaints evaluated in the Emergency Department. Clin Orthop Relat Res. 2008;466(8):1987–95.CrossRefPubMedPubMedCentral
10.
Unwin M, Kinsman L, Rigby S. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints. Int Emerg Nurs. 2016;29:3–8.CrossRefPubMed
11.
Briggs AM, Cross MJ, Hoy DG, Sànchez-Riera L, Blyth FM, Woolf AD, March L. Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 World Health Organization World Report on ageing and health. Gerontologist. 2016;56 Suppl 2:S243–55.CrossRefPubMed
12.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013;380(9859):2197–223.CrossRef
13.
14.
15.
Sprivulis PC, Da Silva J, Jacobs IG, Frazer AR, Jelinek GA. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184(5):208.PubMed
16.
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184(5):213.PubMed
17.
Bernstein SL, Aronsky D, Duseja R, Epstein S, Handel D, Hwang U, McCarthy M, John McConnell K, Pines JM, Rathlev N. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med. 2009;16(1):1–10.CrossRefPubMed
18.
Jones P, Schimanski K. The four hour target to reduce emergency department ‘waiting time’: a systematic review of clinical outcomes. Emerg Med Australas. 2010;22(5):391–8.CrossRefPubMed
19.
Sørup CM, Jacobsen P, Forberg JL. Evaluation of emergency department performance–a systematic review on recommended performance and quality-in-care measures. Scand J Trauma Resusc Emerg Med. 2013;21(1):62.CrossRefPubMedPubMedCentral
20.
Stokes B: Four Hour Rule Program Progress and Issues Review. In.: Government of Western Australia, Department of Health; 2011.
21.
The Australian Health Minister’s Advisory Council. Emergency Department qualitative indicator development - a review of current trends. In: AHMAC CEO’s strategic discussion - attachment 1. 2012.
22.
Australasian College for Emergency Medicine, The College for Emergency Nursing Australasia: Quality Standards for Emergency Departments and other Hospital-Based Emergency Care Services. In. Melbourne; 2015.
23.
Australasian College for Emergency Medicine. Statement on national time-based acute hospital access targets in Australia and New Zealand. 2016. https://​acem.​org.​au/​getattachment/​9171fb05-9f66-4278-8c3f-d5123888c472/​Statement-on-National-Time-Based-Emergency-Access.​aspx.​
24.
Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361(2):109–12.CrossRefPubMed
25.
Australasian College for Emergency Medicine. Policy on a quality framework for Emergency Departments. 2012.
26.
Anderson G, Brown A, Green B, et al. Clinical utilization and outcomes. In: Baker GR, Anderson GM, Brown AD, editors. Hospital report ’99 - a technical report. Toronto: Ontario Hospital Assocation; 1999.
27.
Lindsay M, Bronskill S, Schull M, Chan B, Anderson G, et al. Clinical utilization and outcomes. In: Baker GR, Anderson GM, Brown AD, editors. Hospital report 2001 - Emergency Department care. Toronto: Joint Initiative of the Ontario Hospital Association and the Government of Ontario; 2011.
28.
National Quality Forum. Musculoskeletal measures. 2013. http://​www.​qualityforum.​org/​Musculoskeletal_​Measures.​aspx.​
29.
Hospitals Principal Committee. Emergency Department outcome indicators. In: Consultation report (attachment 1). 2014.
30.
Ball ST, Walton K, Hawes S. Do emergency department physiotherapy Practitioner’s, emergency nurse practitioners and doctors investigate, treat and refer patients with closed musculoskeletal injuries differently? Emerg Med J. 2007;24(3):185–8.CrossRefPubMedPubMedCentral
31.
Hoskins R. Evaluating new roles within emergency care: a literature review. Int Emerg Nurs. 2011;19(3):125–40.CrossRefPubMed
32.
Mo-Yee Lau P, Hung-Kay Chow D, Henry Pope M. Early physiotherapy intervention in an accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial. Aust J Physiother. 2008;54(4):243–9.CrossRefPubMed
33.
Kilner E. What evidence is there that a physiotherapy service in the emergency department improves health outcomes? A systematic review. J Health Serv Res Policy. 2011;16(1):51–8.CrossRefPubMed
34.
Gordon J, Sheppard LA, Anaf S. The patient experience in the emergency department: a systematic synthesis of qualitative research. Int Emerg Nurs. 2010;18(2):80–8.CrossRefPubMed
35.
Heins JK, Heins A, Grammas M, Costello M, Huang K, Mishra S. Disparities in analgesia and opioid prescribing practices for patients with musculoskeletal pain in the emergency department. J Emerg Nurs. 2006;32(3):219–24.CrossRefPubMed
36.
Desmeules F, Roy J-S, MacDermid JC, Champagne F, Hinse O, Woodhouse LJ. Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review. BMC Musculoskelet Disord. 2012;13(1):107.CrossRefPubMedPubMedCentral
37.
Jennings N, Clifford S, Fox AR, O’Connell J, Gardner G. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review. Int J Nurs Stud. 2015;52(1):421–35.CrossRefPubMed
38.
Brand C, Martin-Khan M, Wright O, Jones R, Morris J, Travers C, Tropea J, Gray L. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: study protocol. BMC Health Serv Res. 2011;11(1):281.CrossRefPubMedPubMedCentral
39.
Martin-Khan M, Burkett E, Schnitker L, Jones RN, Gray LC. Methodology for developing quality indicators for the care of older people in the Emergency Department. BMC Emerg Med. 2013;13(1):23.CrossRefPubMedPubMedCentral
40.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.CrossRefPubMed
41.
de Koning J, Burgers J, Klazinga N: Appraisal of Indicators through Research and Evaluation (AIRE). In.: Department of Social Medicine, Academic Medical Center, University of Amsterdam; 2007.
42.
43.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C: National Academy Press; 2001.
44.
Rubin HR, Pronovost P, Diette GB. Methodology matters. From a process of care to a measure: the development and testing of a quality indicator. Int J Qual Health Care. 2001;13(6):489–96.CrossRefPubMed
45.
Strudwick K, Nelson M, Martin‐Khan M, Bourke M, Bell A, Russell T. Quality indicators for musculoskeletal injury management in the Emergency Department: a systematic review. Acad Emerg Med. 2015;22(2):127–41.CrossRefPubMed
46.
National Health and Medical Research Council. NHMRC guidelines and publications. 1999. http://​www.​nhmrc.​gov.​au/​guidelines-publications.​
47.
National Health and Medical Research Council. NHMRC levels of evidence and grades for recommendations for guideline developers. Canberra: National Health and Medical Research Council; 2009. https://​www.​nhmrc.​gov.​au/​_​files_​nhmrc/​file/​guidelines/​developers/​nhmrc_​levels_​grades_​evidence_​120423.​pdf.​
48.
Maitland GD. Maitland’s vertebral manipulation. In: Butterworth-Heinemann. 6th ed. 2000.
49.
Maitland GD. Peripheral Manipulation. In: Butterworth-Heinemann. 3rd ed. 1991.
50.
Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR. The RAND/UCLA appropriateness method user’s manual. Santa Monica: Rand Corp; 2001.
51.
Brook RH, Chassin MR, Fink A, Solomon DH, Kosecoff J, Park R. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63.CrossRefPubMed
52.
Kaplan RS, Norton DP. Putting the balanced scorecard to work. In: The performance measurement, management and appraisal sourcebook. 1995. p. 66–79.
53.
Kötter T, Blozik E, Scherer M. Methods for the guideline-based development of quality indicators--a systematic review. Implement Sci. 2012;7(1):1–22.CrossRef
54.
Australasian College for Emergency Medicine. ACEM accredited emergency departments. 2015. https://​acem.​org.​au/​getmedia/​dbdaa33b-406f-4a17-a207-f8232cf19791/​Accredited_​ED.​aspx.​
55.
Metadata
Title
Developing quality indicators for the care of patients with musculoskeletal injuries in the Emergency Department: study protocol
Authors
Kirsten Strudwick
Anthony Bell
Trevor Russell
Melinda Martin-Khan
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Emergency Medicine / Issue 1/2017
Electronic ISSN: 1471-227X
DOI
https://doi.org/10.1186/s12873-017-0124-7

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