Testing quality indicators and proposing benchmarks for physician-staffed emergency medical services: a prospective Nordic multicentre study

Objectives A consensus study from 2017 developed 15 response-specific quality indicators (QIs) for physician-staffed emergency medical services (P-EMS). The aim of this study was to test these OIs for important characteristics in a real clinical setting. These characteristics were feasibility, rankability, variability, actionability and documentation. We further aimed to propose benchmarks for future quality measurements in P-EMS. Design In this prospective observational study, physician-staffed helicopter emergency services registered data for the 15 QIs. The feasibility of the QIs was assessed based on the comments of the recording physicians. The other four OI characteristics were assessed by the authors. Benchmarks were proposed based on the quartiles in the dataset. Setting Nordic physician-staffed helicopter emergency medical services. Participants 16 physician-staffed helicopter emergency services in Finland, Sweden, Denmark and Norway. Results The dataset consists of 5638 requests to the participating P-EMSs. There were 2814 requests resulting in completed responses with patient contact. All OIs were feasible to obtain. The variability of 14 out of 15 OIs was adequate. Rankability was adequate for all Us. Actionability was assessed as being adequate for 10 OIs. Documentation was adequate for 14 OIs. Benchmarks for all OIs were proposed. Conclusions All 15 OIs seem possible to use in everyday quality measurement and improvement. However, it seems reasonable to not analyse the QI 'Adverse Events' with a strictly quantitative approach because of a low rate of adverse events. Rather, this QI should be used to identify adverse events so that they can be analysed as sentinel events. The actionability of the QIs 'Able to respond immediately when alarmed', 'Time to arrival of P-EMS', 'Time to preferred destination', 'Provision of advanced treatment' and 'Significant logistical contribution' was assessed as being poor. Benchmarks for the OIs and a total quality score are proposed for future quality measurements.