Objectives and Background Despite the spread of time targets for Emergency Department (ED) lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in ED (SSED) National Research Project in New Zealand seeks to address this by assessing the impact of the SSED target in NZ on a range of quality indicators. The purpose of this paper was to identify the indicators for the SSED project and to describe the process used to select and validate these.
Method A structured literature review was used to identify potential indicators. A reference group of 32 key stakeholders representing the whole health system was convened with the aims of validating the suggested indicators and to ensure that other significant indicators were not overlooked. A thematic analysis using a general inductive approach was used to analyse focus group discussions. Validation of the analysis was subsequently sought from the reference group attendees.
Results The major themes to emerge were communication, access, timeliness, appropriateness and satisfaction. The 12 indicators selected after literature review were confirmed and two further indicators selected as a result of the thematic analysis. The primary outcomes for the SSED study are hospital and ED lengths of stay and re-presentation to hospital <48 h. The secondary outcomes are: mortality, times to reperfusion, antibiotics, asthma treatment, analgesia, CT for head injury, and theatre (appendicitis and fractured neck of femur), triage time compliance, left without being seen rate, quality of discharge information and ED overcrowding/access block.
Conclusion We have a balanced set of evidence based and clinically relevant indicators that encompass all domains of quality of care with which to measure the effect of the SSED target. This indicator set is consistent with recent international recommendations for measuring quality of care in EDs.
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