Evaluation of Performance Indexes of Emergency Department
AbstractIntroduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016). In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004). While, the percentage of patients who were decided upon in 6 hours (p=0.2), unsuccessful CPR percentage (p=0.34) and patients discharged against medical advice (p=0.42) showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.
Trzeciak S, Rivers E. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20(5):402-5.
Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184(5):213-6.
Geelhoed GC, de Klerk NH. Emergency department overcrowding, mortality and the 4-hour rule in Western Australia. Med J Aust. 2012;196(2):122-6.
Saadat S, Yousefifard M, Asady H, Jafari AM, Fayaz M, Hosseini M. The Most Important Causes of Death in Iranian Population; a Retrospective Cohort Study. Emergency. 2014;3(1):16-21.
Goroll AH, Mulley AG. Primary care medicine: office evaluation and management of the adult patient: Wolters Kluwer Health; 2012. p. 33-8.
Nordstrom K, Zun LS, Wilson MP, et al. Medical evaluation and triage of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA Medical Evaluation Workgroup. West J Emerg Med. 2012;13(1):3-7.
Casalino E, Choquet C, Julien B, et al. 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. Emerg Med J. 2012;30(8):638-45.
Dixon A, Ham C. Setting objectives for the NHS Commissioning Board. BMJ. 2012;345:e5893.
Guidotti TL. What key performance indicators can be used in occupational health? J Occup Environ Med. 2012;54(8):1042-3.
Heydaranlou E, Khaghani Zadeh M, Ebadi A, Sirati Nir M, Aghdasi Mehr Abad N. A survey on implementation of FOCUS-PDCA on performance of Tabriz Shahid Mahalati emergency department. J Militar Med. 2008;10(4):5-9. [Persian].
Forster AJ, Stiell I, Wells G, Lee AJ, Van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med. 2003;10(2):127-33.
Han JH, Zhou C, France DJ, et al. The effect of emergency department expansion on emergency department overcrowding. Acad Emerg Med. 2007;14(4):338-43.
Bagust A, Place M, Posnett JW. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ. 1999;319(7203):155.
Kiwi M, Soto M, Thraves C. Adversarial queuing theory with setups. Theor Comput Sci. 2009;410(8):670-87.
Ferreira MAM, Andrade M, Filipe JA, Coelho MP. Statistical queuing theory with some applications. Int J Latest Trend Finance Econom Sci. 2012;1(4):190-4.
Heydari G, Ramezankhani A, Hosseini M, Yousefifard M, Masjedi M. Evaluation of knowledge, attitude and practice about smoking among male teachers in Tehran. Iran Payesh. 2010;9(4):355-61. [Persian].
Bowker L, Stewart K. Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores. Resuscitation. 1999;40(2):89-95.
Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58(3):297-308.
Rahmani H, Arab M, Akbari F, Zeraati H. Structure, process and performance of the emergency unit of teaching hospitals of Tehran University of Medical Sciences. J School Public Health. 2006;4(4):13-22. [Persian].
Movahednia S, Partovishayan Z, Bastanitehrani M. A survey of timing indicators of emergency department at Firoozgar hospital: 2012. J Health Admin. 2013;16(51):95-102.
Zohoor A, Pilevar Zadeh M. Study of speed of offering services in emergency department at Kerman Bahonar hospital in 2000. Razi J Med Sci. 2003;10(35):413-9. [Persian].
Tabibi1 SJ, Najafi2 B, Shoaie3 S. Waiting time in the emergency department in selected hospitals of Iran University of Medical Sciences in 2007. Pejouhesh. 2009;33(2):117-22. [Persian].
Hashemi B, Baratloo A, Rahmati F, et al. Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine. Emergency. 2013;1(1):20-3.
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