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International Journal of Emergency Medicine
Published in: International Journal of Emergency Medicine 1/2015

Open Access 01-12-2015 | Original Research

Emergency department quality and safety indicators in resource-limited settings: an environmental survey

Authors: Emily L. Aaronson, Regan H. Marsh, Moytrayee Guha, Jeremiah D. Schuur, Shada A. Rouhani

Published in: International Journal of Emergency Medicine | Issue 1/2015

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Abstract

Background

As global emergency care grows, practical and effective performance measures are needed to ensure high quality care. Our objective was to systematically catalog and classify metrics that have been used to measure the quality of emergency care in resource-limited settings.

Methods

We searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references of included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was then reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into one of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered) and one of three of Donabedian’s structure/process/outcome categories. A fourth expert reviewer blinded to the initial classifications re-classified all indicators, with a weighted kappa of 0.89.

Results

A total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One hundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 % of metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care, with few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of care.

Conclusions

The published quality metrics in emergency care in resource-limited settings primarily focus on the effectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures and those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve quality of care and resource utilization.
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Metadata
Title
Emergency department quality and safety indicators in resource-limited settings: an environmental survey
Authors
Emily L. Aaronson
Regan H. Marsh
Moytrayee Guha
Jeremiah D. Schuur
Shada A. Rouhani
Publication date
01-12-2015
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 1/2015
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1186/s12245-015-0088-x

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