Quality indicators for the practice of emergency medicine in Europe (EUSEM-QI-V1): results of a European-wide expanded Delphi consensus process

Abstract

Background and importance: Consensus on quality in emergency medicine in Europe is urgently needed. This study tackles the problem with a novel approach.

Objective: Define an initial set of 20 indicators of quality for emergency medicine in Europe.

Design setting and participants: This process received 259 responses from stakeholders in 41 countries. Panellists included doctors, nurses, managers, and patient representatives.

Results: A novel protocol was developed to combine consensus with evidence by expanding a classic three-round Delphi by novel two-tiered rating and ranking as well as current practice comparison, thus enhancing validity and laying the groundwork for quality indicator implementation. A total of 120 quality indicator suggestions were received and consolidated to 39, which underwent two-tiered evaluation using 'smart ballots' to obtain the 20 of highest priority. Selected quality indicators include the monitoring of vital signs, triage, the use of standard operating procedures for critical clinical syndromes, staffing ratios, disaster, trauma, and dispatch planning, as well as the recording of patient-centred parameters. When tested against current practice in a substantial fourth round (in four phases), consistency was found as to importance, but significant variability was found as to practice: ranging from 97% (triage in place) to 14% (emergent paediatric processes). Average application across all 20 indicators was 50.2%. However, for each quality indicator, examples of best practice were found in individual emergency departments throughout Europe.

Conclusion: Despite the well-documented complexity of agreeing what constitutes quality in emergency medicine, this European-wide study establishes a novel process by which indicators of quality can be agreed and acted upon. The spectrum of the initial 20 indicators (European Society for Emergency Medicine Quality Indicators Version 1) is broad, reflecting the reality of emergency medicine practice. This study found that currently low rates of measurement exist despite ranking highly as an indication of quality. This establishes a baseline of current practice and defines clear priorities for further work to address the 'evidence gap' regarding quality in emergency medicine.

Keywords: benchmarking; consensus; quality improvement; quality indicators; quality measures; smart ballot.