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Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review

Published online by Cambridge University Press:  10 December 2017

Ian Howard ,
Peter Cameron ,
Lee Wallis ,
Maaret Castren  and
Veronica Lindstrom
Ian Howard*
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
Peter Cameron
Affiliation:
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Lee Wallis
Affiliation:
Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
Maaret Castren
Affiliation:
Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki University, Helsinki, Finland
Veronica Lindstrom
Affiliation:
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden Academic EMS, Stockholm, Sweden
*
Correspondence: Ian Howard, BEMC, MPhil Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm, Sweden E-mail: ianhoward@outlook.com
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Abstract

Introduction

Historically, the quality and performance of prehospital emergency care (PEC) has been assessed largely based on surrogate, non-clinical endpoints such as response time intervals or other crude measures of care (eg, stakeholder satisfaction). However, advances in Emergency Medical Services (EMS) systems and services world-wide have seen their scope and reach continue to expand. This has dictated that novel measures of performance be implemented to compliment this growth. Significant progress has been made in this area, largely in the form of the development of evidence-informed quality indicators (QIs) of PEC.

Problem

Quality indicators represent an increasingly popular component of health care quality and performance measurement. However, little is known about the development of QIs in the PEC environment. The purpose of this study was to assess the development and characteristics of PEC-specific QIs in the literature.

Methods

A scoping review was conducted through a search of PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA); EMBase (Elsevier; Amsterdam, Netherlands); CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA); Web of Science (Thomson Reuters; New York, New York USA); and the Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). To increase the sensitivity of the literature, a search of the grey literature and review of select websites was additionally conducted. Articles were selected that proposed at least one PEC QI and whose aim was to discuss, analyze, or promote quality measurement in the PEC environment.

Results

The majority of research (n=25 articles) was published within the last decade (68.0%) and largely originated within the USA (68.0%). Delphi and observational methodologies were the most commonly employed for QI development (28.0%). A total of 331 QIs were identified via the article review, with an additional 15 QIs identified via the website review. Of all, 42.8% were categorized as primarily Clinical, with Out-of-Hospital Cardiac Arrest contributing the highest number within this domain (30.4%). Of the QIs categorized as Non-Clinical (57.2%), Time-Based Intervals contributed the greatest number (28.8%). Population on Whom the Data Collection was Constructed made up the most commonly reported QI component (79.8%), followed by a Descriptive Statement (63.6%). Least reported were Timing of Data Collection (12.1%) and Timing of Reporting (12.1%). Pilot testing of the QIs was reported on 34.7% of QIs identified in the review.

Conclusion

Overall, there is considerable interest in the understanding and development of PEC quality measurement. However, closer attention to the details and reporting of QIs is required for research of this type to be more easily extrapolated and generalized.

HowardI, CameronP, WallisL, CastrenM, LindstromV. Quality Indicators for Evaluating Prehospital Emergency Care: A Scoping Review. Prehosp Disaster Med. 2018;33(1):43–52.

Keywords

Emergency Medical Serviceshealth care quality assessmentpatient safetyquality indicators
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 43 - 52
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: none

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