| Abstract |
Background:
AHRQ has characterized quality indicators as appropriate tools to identify
potential suboptimal clinical care. A quality indicator is a retrospectively measurable
element of practical performance for which there is evidence or consensus that it can be
used to assess the quality of care provided. It is necessary to understand variability in the
quality of healthcare provided, which can only be achieved by collecting data. The search
for a reliable and transparent way to measure this volatility led to using specific quality
indicators. Implementing a well organized set of quality indicators, rather than a single
indicator in an ED, determines the improvement of control and management of
procedures, patient safety, and quality of care.
Objective: The main purpose of this study was to determine the ability of Greek EDs to
reliably measure modern quality indicators.
Methods: This was a cross sectional study of all hospitals in the country with autonomous
EDs from September 2023 to January 2024. A form was sent electronically to 40 autonomous
EDs with clear instructions to be answered by the ED directors. The questionnaire asked
about the ability to measure modern quality indicators reliably. We initially recorded general
information such as the number of annual ED visits, the on call system, health district, and
staff status. The study then focused on the indicators proposed by the European Society of
Emergency Medicine (EuSEM) and well established internationally accepted indicators of ED
operation as described by other scientific societies and organizations (American College of
Emergency Physicians, UK NICE). One hundred forty four quality indicators were divided into
three categories according to the DONABEDIAN method. Thus, in the form, there were 57
quality indicators related to structure (STRUCTURE), 73 quality indicators related to
processes (PROCESS), and 14 indicators related to outcome (OUTCOME). Qualitative and
quantitative indicators existed in all three categories. Quality indicators were ranked
according to the percentage of positive responses received. In addition, correlations were
made between quality indicators and the number of visits per year to the Emergency
Department and the health regions of the country.
Results: Out of 40 EDs, 32 replied to our questionnaire. Of the 32 hospitals we analyzed,
most (37.50%) reported receiving 20,000 50,000 patients yearly. In ranking quality
indicators according to the percentage of positive responses received, 19 indicators emerged, with >80%, which were all structure and process indicators. There were no
outcome indicators in a high percentage of positive responses. The top ten indicators that
emerged from the ranking are: 1) Daily census (96.80%) 2) Annual volume of visits (93.70%)
3) How many nurses are present in the ED area at any given time (93.70%) 4) How many
doctors specializing in Emergency Medicine work in the ED (93.70%) 5) The time of ordering
examinations (93.70%) 6) How many specialists without specialization in Emergency
Medicine work in the ED are in the ED at any given time (90.30%) 7) Ability to provide
bedside diagnostics services within the Emergency Department (90.30%) 8) Maximum
number of beds/stretchers that can be used in the ED area (87.10%) 9) How many doctors
specializing in Emergency Medicine are in the ED at any given time (87.10%) 10) How many
trainees employed in cases of pathology are in the ED at any given time (87.10%). When we
ranked quality indicators according to the percentage of positive responses received, 11
indicators emerged, with <20%. The last 5 with the lowest percentage that emerged from the
ranking are: 1) Detection and treatment of infectious diseases (10.70%), 2) Recording of
patients' pain intensity (9.70%) 3) Ability to manage end of life care in the ED (9.70%) 4)
Ability to measure and demonstrate ED response to complications, adverse events and risk
management issues (9.70%) 5) Availability of comprehensive geriatric assessment or
multidisciplinary assessment for patients who are recognized in the ED as vulnerable
(
Conclusion: The Greek EDs that participated in the study stated a limited ability to record
reliable and modern quality indicators. It is possible to record mainly structural indicators,
but there is minimal ability to record outcome indicators, which are the most important.
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