27th May 2011

EMERGENCY CARE UNIT EMERGENCY CARE UNIT INDICATORSINDICATORS

FMUP

CLASS 10

INTRODUCTION TO MEDICINE II

ADVISER: ALBERTO FREITAS, PhD

SUMMARY

• 1. Central Aims

• 2. Introduction

• 3. Methods

• 4. Results

• 5. Discussion

• 6. Conclusion

• 7. Complete Reference

1. CENTRAL AIMSWHY?

Central aimsWhy?

2.INTRODUCTIONWHAT?

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.: HSIEH, M.; KAGLE, J.: Understanding patient satisfaction and insatisfaction with health careUnderstanding patient satisfaction and insatisfaction with health care. Health Soc Work, 1991 . Health Soc Work, 1991

Nov.Nov.

Definition of Indicators

MAINZ J, et al. Defining and classifying clinical indicators for quality improvements. Int J Qual Health Care. 2003;15(6):523-530

Quality Indicators

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 are being developed in order to:

Quality Indicators

O Serviço de Urgências, Recomendações para a organização dos cuidados urgentes e emergentes, Indicadores para o serviço de

urgência, pg. 60-63.

An useful indicator has to:

3. METHODSHOW?

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.

How?

MethodsHow?

Methods

in order to

and

How?

Methods

Criteria

How?

MethodsHow?

3. Methods

Queries initially used: 

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:

How?

MethodsHow?

MethodsHow?

MethodsHow?

MethodsHow?

MethodsHow?

Google Scholar

(“emergency” [AND] "quality indicators")

• We found 874 articles but 870 were not included because they were too specific for certain diseases or situations

Scopus

∙ 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 wasn't significant for conducting this type of study.  

MethodsHow?

4. RESULTS

Num

ber

of

tim

es

each

indic

ato

r is

refe

rred in r

ead a

rtic

les

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

LYONS M, BROWN R, WEARS R. Factors that affect the flow of patients through triage. Emerg Med J. 2007 Feb; 24(2): 78-85.

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.

GARCÍA OC, ALMENARA BJ, GARCÍA OJJ. Readmission rate at a regional hospital. Rev Esp Salud Publica. 1998 Mar-Apr;72(2):103-110LENG GC,et al. Is the emergency readmission rate a valid outcome indicator?. Qual Health Care. 1999 Dec;8(4):234-238

BITTAR O J N V, et al. Indicadores de qualidade e quantidade em saúde. RAS . 2001 Jul-Set;3(12):21-29.

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.

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

Complete Reference

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Complete Reference

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Complete Reference

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ACKNOWLEDGEMENTS

Professor Altamiro Rodrigues da Costa Pereira

Professor Alberto Freitas

Eng. Jorge Abel Jácomo Gomes

AUTHORSHIP

• Andreia Leal, mimed10212@med.up.pt;

• Beatriz Silva, mimed10245@med.up.pt;

• Diogo Leal, mimed10109@med.up.pt;

• Eduardo Nóbrega, mimed10025@med.up.pt;

• Inês Falcão, mimed10118@med.up.pt;

• Inês Silva, mimed10207@med.up.pt;

• Joana Vieira, mimed10191@med.up.pt;

• Joana Silva, mimed10140@med.up.pt;

• Jose Máximo, mimed10124@med.up.pt;

• Jose Rodrigues, mimed10026@med.up.pt;

• Mafalda Corvacho, mimed10215@med.up.pt;

• Mª Inês Margarido, mimed10166@med.up.pt;

• Nuno Almeida, mimed10132@med.up.pt.

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