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Predictive variables of an emergency department quality and performance indicator: a 1-year prospective, observational, cohort study evaluating hospital and emergency census variables and emergency department time interval measurements
  1. Enrique Casalino1,2,3,
  2. Christophe Choquet1,3,
  3. Julien Bernard1,2,3,
  4. Abigael Debit1,2,3,
  5. Benoit Doumenc1,3,
  6. Audrey Berthoumieu1,
  7. Mathias Wargon1,2,3
  1. 1Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Emergency Department, Paris, France
  2. 2Université Paris Diderot, Sorbonne Paris Cité, Paris, France
  3. 3Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France
  1. Correspondence to Professor Enrique Casalino, Service d'Accueil des Urgences, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France; enrique.casalino{at}


Objective Emergency department (ED) crowding impacts negatively on quality of care. The aim was to determine the association between ED quality and input, throughput and output-associated variables.

Methods This 1-year, prospective, observational, cohort study determined the daily percentage of patients leaving the ED in <4 h (ED quality and performance indicator; EDQPI). According to the median EDQPI two groups were defined: best-days and bad-days. Hospital and ED variables and time interval metrics were evaluated as predictors.

Results Data were obtained for 67 307 patients over 364 days. Differences were observed between the two groups in unadjusted analysis: number of daily visits, number of patients as a function of final disposition, number boarding in the ED, and time interval metrics including wait time to triage nurse and ED provider, time from ED admission to decision, time from decision to departure and length of stay (LOS) as a function of final disposition. Five variables remained significant predictors for bad-days in multivariate analysis: wait time to triage nurse (OR 2.36; 95% CI 1.36 to 4.11; p=0.002), wait time to ED provider (OR 1.93; 95% CI 1.05 to 3.54; p=0.03), number of patients admitted to hospital (OR 1.86; 95% CI 1.09 to 3.19; p=0.02), LOS of non-admitted patients (OR 9.5; 95% CI 5.17 to 17.48; p<0.000001) and LOS of patients admitted to hospital (OR 2.46; 95% CI 1.44 to 4.2; p=0.0009).

Conclusions Throughput is the major determinant of EDQPI, notably time interval reflecting the work dynamics of medical and nursing teams and the efficacy of fast-track routes for low-complexity patients. Output also significantly impacted on EDQPI, particularly the capacity to reduce the LOS of admitted patients.

  • Acute coronary syndrome
  • bacterial
  • cardiac care
  • efficiency
  • emergency care systems
  • emergency department management
  • HIV
  • infectious diseases
  • neurology
  • stroke

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.