FMUP
CLASS 10
INTRODUCTION TO MEDICINE II
ADVISER: ALBERTO FREITAS, PhD
EMERGENCY CARE UNIT
INDICATORS
2 7 th M a y 2 0 1 1
SUMMARY
• 1. Central Aims
• 2. Introduction
• 3. Methods
• 4. Results
• 5. Discussion
• 6. Conclusion
• 7. Complete Reference
1. CENTRAL AIMS
WHY?
Main Question
Which are the most
relevant quality indicators
for emergency care units
and how important are
they for their
management?
Why?
Central aims
∙ Determine which indicators are more
widely used in order to evaluate the
quality
of
services
provided
by
emergency care units;
∙ Understand the relevance of particular
quality indicators, from emergency care
units managers’ point of view, for the
improvement of health care provided.
2.INTRODUCTION
WHAT?
Emergency medicine is characterized by high stress,
increasing number of patients and rapid decision-
making with incomplete information.
Quality of care is the degree to which health services
for
individuals
and
populations
increase
the
likelihood of desired health outcomes, and are
consistent with current professional knowledge.
SANDERS AB. Quality in emergency medicine: an introduction. Acad Emerg Med. 2002; 9:1064–6.
LOHR KN, SCHROEDER SA. Following a Modified-Delphi Approach.
ECU quality indicators
were created to analyse
patient’s satisfaction
and ECU’s evolution, as
well as health
providers’ performance
and success.
HSIEH, M.; KAGLE, J.: Understanding patient satisfaction and insatisfaction with health care. Health Soc Work, 1991 Nov.
Definition of Indicators
Basic tools for the management of an
organizational system
Simple or compound
Self-explaining
Synthetic
MAINZ J, et al. Defining and classifying clinical indicators for quality improvements. Int J Qual Health Care. 2003;15(6):523-530
Quality Indicators
Quality indicators are being developed in order to:
Assess
Study
Inform
DE VOS M, et al. Using quality indicators to improve hospital care: a review of the literature. J Qual Health Care. 2009; 21(2): 119–129.
Quality Indicators
An useful indicator has to:
Be relevant,
Allow decisions,
Set priorities in solving problems,
Be composed by independent and easily
identifiable parts,
Be sensitive to variations and be prepared
with easy collection data.
O Serviço de Urgências, Recomendações para a organização dos cuidados urgentes e emergentes, Indicadores para o serviço de urgência,
pg. 60-63.
3. METHODS
HOW?
How?
Methods
Our final document is a systematic review,
consisting in an:
∙ observational,
∙ retrospective and
∙ descriptive study,
based on the analysis of articles on ECU Quality
Indicators.
Methods
How?
Databases
•Pubmed
•ISI Web of Knowledge
•Google Scholar
•Scopus
Methods
How?
Articles were selected
in order to
obtain a wide perspective about the application of
emergency care unit quality indicators
and
to select a list of specific indicators which appeared to be
more relevant.
Methods
How?
Criteria
Exclusion criteria
• Articles were too specific and concerned particular
situations in local management events;
• Articles written before 1990.
Including criteria
• Articles mentioning a wide range of indicators;
• Articles focusing on the general importance of indicators;
• Articles intended for healthcare emergency unit
management.
How?
Three
categories
were created:
Methods
∙ Information specific for each individual
indicator;
∙ General information on the importance of
indicators for healthcare emergency units
management;
∙ General information on possible
applications of indicators, worldwide.
How?
3. Methods
Queries initially used:
("emergency medicine"[MeSH Terms] AND
("quality indicators, health care"[MeSH
Terms]);
("emergencies"[MeSH Terms] AND
department [All Fields] AND ("quality
indicators, health care"[MeSH Terms]);
("emergency medical services"[MeSH
Terms] AND ("quality indicators, health
care"[MeSH Terms]);
• retrieved 20 articles,
• 10 were selected;
• retrieved 10 articles,
• 5 were selected;
• retrieved 267 articles,
• 19 were selected.
How?
Methods
A research on "Emergency Medicine" category was performed in Isi Web
of Knowledge, and the top 19 journals were selected. The queries used
were as follows:
("ann. emerg. med."[Journal]
AND indicator[Text Word])
("resuscitation"[Journal] AND
indicator[Text Word])
("acad. emerg. med."[Journal]
AND indicator[Text Word])
•46 articles were found and all of them were
excluded:
•21 because they were published before 1990;
•25 because they were too specific for certain
diseases or situations.
•We found 37 articles, but all of them were
excluded:
•8 because they were published before 1990;
•29 because they were too specific for certain
diseases or situations.
•We found 25 articles and 10 of them were
selected. The others were excluded because
they were too specific for certain diseases or
situations.
Methods
How?
("injury"[Journal] AND
indicator[Text Word])
•We found 35, but all of them were excluded:
•4 because they were published before 1990;
•31 because they were too specific for certain diseases or
situations.
• We found 33 articles:
("am j emerg med"[Journal]
AND indicator[Text Word])
• 4 of them were excluded because they were published before 1990;
• 27 were excluded because they were too specific for certain
diseases or situations;
• 2 articles were also excluded because no full text was available.
("emerg med j"[Journal]
AND indicator[Text Word])
•We found 17 articles;
•12 were excluded because they were too specific for certain
diseases or situations
•3 was selected
("Prehosp. Emerg.
Care"[Journal] AND
indicator[Text Word])
•We found 4 articles
•They all were excluded because they were too specific for certain
diseases or situations.
Methods
How?
•We found 15 articles
("J. Emerg. Med."[Journal] AND
indicator[Text Word])
("Emergency Medicine Clinics Of
North America"[Journal] AND
indicator[Text Word])
("Pediatric Emergency
Care"[Journal] AND indicator[Text
Word])
•All of them were excluded: 2 because they were published
before 1990; 13 because they were too specific for certain
diseases or situations.
•We found 6 articles and all of them were excluded:
•2 because they were published before 1990;
•4 because they were too specific for certain diseases or
situations
•We found 17, but all of them were excluded:
•3 because they were published before 1990;
•14 because they were too specific for certain diseases or
situations.
•We found 6 articles and selected 1 of them.
("Emerg. Med. Australas."[Journal]
•The others were not included because they were too specific
AND indicator[Text Word])
for certain diseases or situations.
Methods
How?
("Eur J Emerg Med"[Journal]
AND indicator[Text Word])
• We found 10 articles and they were not included
because they were too specific for certain diseases
or situations.
("Unfallchirurg"[Journal]
AND indicator[Text Word])
• We found 9 articles and they were not included
because they were too specific for certain diseases
or situations.
("Notfall
Rettungsmed"[Journal] AND
indicator[Text Word])
("J. Emerg. Nurs."[Journal]
AND indicator[Text Word])
• No articles were found.
•We found 5 articles and 4 of them were excluded because
they were too specific for certain diseases or situations. The
other article seemed to be useful but it had no full.
Methods
How?
("Ulus. Travma Acil Cerrahi
Derg."[Journal] AND
indicator[Text Word])
• We found 3 articles and they were not
included because they were too specific for
certain diseases or situations
("Eur. J. Trauma Emerg.
Surg."[Journal] AND
indicator[Text Word])
• No articles were found.
Signa Vitae"[Journal] AND
indicator[Text Word])
• No articles were found.
("Notarzt"[Journal] AND
indicator[Text Word])
• No articles were found
How?
Methods
Google Scholar
(emergency "quality
indicators")
• We found 20 articles but 11 were not
included because they were too specific for
certain diseases or situations
Scopus
(“emergency” [AND]
"quality indicators")
• We found 874 articles but 870 were not
included because they were too specific for
certain diseases or situations
How?
Methods
∙ Initially, the project was intended to include a
statistical approach, based on surveys sent to several
hospitals in Europe, in order to assess professional’s
opinions on the subject;
∙ A questionnaire was elaborated and sent, through
MedQuest, to 150 contacts (e-mails), selected from
European public hospitals websites and from articles
whose articles on the area were published in high
ranked magazines from Isi Web of Knowledge;
∙ Nevertheless, the number of answers
significant for conducting this type of study.
wasn't
4. RESULTS
is referred in read articles
Number of times each indicator
INDICATOR
# OF ARTICLES
Daily Admissions
1
ED Visitors
1
Number of Complaints
1
Medical Treatment
1
Nurse Treatment
1
Staff Organization
2
Left without beeing seen
2
Satisfaction of the Accompanying Person
2
Occupancy Rate
3
Total Time in ECU
7
Patient Satisfaction
12
Readmission Rate
13
Mortality Rate
14
Waiting Time (including Time to Treage and Time
to Treatment)
18
5. DISCUSSION
Waiting time until observation
Mortality rate in ECU
Readmission rate
ECU Occupancy rate
Cost per treated patient
Patient’s Satisfaction
Waiting time until observation
•Comprises the Waiting time from
arrival to triage, the time for triaging
patients, the time from triage to
emergency care unit physician and
the time from assessment to
disposition.
LYONS M, BROWN R, WEARS R. Factors that affect the flow of patients through triage. Emerg Med J. 2007 Feb; 24(2): 78-85.
Mortality Rate in ECU
• Number of deaths occurring in a given
population at risk during a specified
time period (also known as the recall
period).
• In emergencies, usually expressed as
deaths/10.000 persons/day;
alternatively, as deaths per 1000
persons per month or per year.
MARTINS HM, CUÑA LM, FREITAS P. Is Manchester (MTS) more than a triage system? A study of its association with mortality and
admission to a large Portuguese hospital. Emerg Med J. 2009 Mar; 26(3):183-186
BITTAR O J N V, et al. Indicadores de qualidade e quantidade em saúde. RAS . 2001 Jul-Set;3(12):21-29.
Readmission Rate
• Considers any emergency
admission entailing an identical
major diagnosis within a definable
amount of days following the
release of the patient from the
hospital.
GARCÍA OC, ALMENARA BJ, GARCÍA OJJ. Readmission rate at a regional hospital. Rev Esp Salud Publica. 1998 Mar-Apr;72(2):103-110
LENG GC,et al. Is the emergency readmission rate a valid outcome indicator?. Qual Health Care. 1999 Dec;8(4):234-238
ECU Occupancy Rate
•Ratio of the total number of
patients to the total number
of ECU treatment bays per
hour.
BITTAR O J N V, et al. Indicadores de qualidade e quantidade em saúde. RAS . 2001 Jul-Set;3(12):21-29.
Cost per treated patient
•Comprises the average money
spent during patient
attendance in ECU’s, including
material cost and provided
services
WINTER A, HAUX R. A Three-Level Graph-Ba sed Model for the Management of Hospital Information Systems. Methodes of
Information in Medicine. 1995 Sep; 34(4): 378-96.
Patient’s Satisfaction
•Evaluates patient’s
perspective on emergency
care units service quality
and professionals attitude.
SOUFI, G., BELAYACHI, J., HIMMICH, S., AHID, S., SOUFI, M., ZEKRAOUI, A., ABOUQAL, R. Patient satisfaction in an acute medicine
department in Morocco. 2010 BMC Health Services Research 10, art. no. 149
Limitations
• Very low number of responses to questionnaires sent;
• Difficulties in encountering general information, which
didn’t concern specific cases;
• Communicating with European experts in the field;
• Few results which effectively could be useful, in the
most representative medical search motors;
• Identifying the most important indicators while reading
the articles.
6. CONCLUSION
Conclusion
∙ Quality indicators are very important for a precise management
of an ECU.
∙ Considering the role of the ECU within a hospital, good ECU
quality
indicators
are
very
important
to
the
hospital’s
management.
∙ Analysis of the most important ECU quality indicators shows us,
that the time healthcare quality relationship is vital to ECU.
∙ Not enough research on emergency unit quality indicators.
7. COMPLETE REFERENCE
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ACKNOWLEDGEMENTS
Professor Altamiro Rodrigues da Costa Pereira
Professor Alberto Freitas
Eng. Jorge Abel Jácomo Gomes
AUTHORSHIP
• Andreia Leal, [email protected];
• Beatriz Silva, [email protected];
• Diogo Leal, [email protected];
• Eduardo Nóbrega, [email protected];
• Inês Falcão, [email protected];
• Inês Silva, [email protected];
• Joana Vieira, [email protected];
• Joana Silva, [email protected];
• José Máximo, [email protected];
• José Rodrigues, [email protected];
• Mafalda Corvacho, [email protected];
• Mª Inês Margarido, [email protected];
• Nuno Almeida, [email protected].
LAST WORD
“The first rule of any technology used in a business is that automation
applied to an efficient operation will magnify the efficiency. The
second is that automation applied to an inefficient operation will
magnify the inefficiency”
Bill Gates