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

被引：28
作者：
Aaronson E.L. [1 ,2 ,3 ,5 ]
Marsh R.H. [1 ,3 ]
Guha M. [4 ]
Schuur J.D. [1 ,3 ]
Rouhani S.A. [1 ,3 ]
机构：
[1] Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, 02115, MA
[2] Harvard Affiliated Emergency Medicine Residency, Brigham and Women’s Hospital/Massachusetts General Hospital, Boston, MA
[3] Department of Emergency Medicine, Harvard Medical School, Boston, MA
[4] Center for Clinical Excellence, Brigham and Women’s Hospital, Boston, MA
[5] Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA
来源：
International Journal of Emergency Medicine | 2015年 / 8卷 / 1期
关键词：
Quality Indicator; Emergency Care; Quality Metrics; Full Text Review; Included Article;
D O I：
10.1186/s12245-015-0088-x
中图分类号：
学科分类号：
摘要：
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. © 2015, Aaronson et al.
引用
收藏
页数：7
相关论文
共 56 条
[41]  
Tamburini G., Di Mario S., Maggi R.S., Vilariam J.N., Grove S., Evaluation of guidelines for emergency triage assessment and treatment in developing countries, Arch Dis Child, 81, 6, pp. 478-482, (1999)
[42]  
Waxman M.H., Kimaiyo S., Ongaro N., Wools-Kaloustian K.K., Fanigan T.P., Carter E.J., Initial outcomes of an emergency department rapid HIV testing program in western Kenya, AIDS Patient Care STDS, 21, 12, pp. 981-986, (2007)
[43]  
Ye L., Zhou G., He X., Shen W., Gan J., Zhang M., Prolonged length of stay in the emergency department in high-acuity patients at a Chinese tertiary hospital, Emerg Med Australasia, 24, pp. 634-640, (2012)
[44]  
Aboutanos M.B., Mora F., Rodas E., Salamea J., Parra M.O., Salgado E., Et al., Ratification of IATSIC/WHO’s guidelines for essential trauma care assessment in the South American region, World J Surg, 34, 11, pp. 2735-2744, (2010)
[45]  
Arreola-Risa C., Mock C., Vega Rivera F., Romero Hicks E., Guzman Solana F., Porras Ramirez G., Et al., Evaluating trauma care capabilities in Mexico with the World Health Organization’s Guidelines for Essential Trauma Care publication, Rev Panam Salud Publica, 19, 2, pp. 94-103, (2006)
[46]  
Hanche-Olsen T.P., Alemu L., Viste A., Wisborg T., Hansen K.S., Trauma care in Africa: a status report from Botswana, guided by the World Health Organization’s “Guidelines for Essential Trauma Care, World J Surg, 36, 10, pp. 2371-2383, (2012)
[47]  
Mock C., Nguyen S., Quansah R., Arreola-Risa C., Viradia R., Joshipura M., Evaluation of trauma care capabilities in four countries using the WHO-IATSIC guidelines for essential trauma care, World J Surg, 30, pp. 946-956, (2006)
[48]  
Son N.T., Mock C., Improvements in trauma care capabilities in Vietnam through use of the WHO-IATSIC guidelines for essential trauma care, Int J Inj Contr Saf Promot, 13, 2, pp. 125-127, (2006)
[49]  
Tachfouti N., Bhatti J.A., Nejjari C., Kanjaa N., Salmi L.R., Emergency trauma care for severe injuries in a Moroccan Region: conformance to French and World Health Organization Standards, J Healthc Qual, 33, 1, pp. 30-38, (2011)
[50]  
Molyneux E., Ahmad S., Robertson A., Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting, Bull World Health Organ, 84, 4, pp. 314-319, (2006)
123456