爱尔兰急诊科关键绩效指标的制定：采用电子改良德尔菲共识法。

Development of key performance indicators for emergency departments in Ireland using an electronic modified-Delphi consensus approach.

机构信息

Emergency Care Research Unit, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.

出版信息

Eur J Emerg Med. 2013 Apr;20(2):109-14. doi: 10.1097/MEJ.0b013e328351e5d8.

DOI:10.1097/MEJ.0b013e328351e5d8

PMID:22382650

Abstract

OBJECTIVE

The objective of this study was to develop a consensus among emergency medicine (EM) specialists working in Ireland for emergency department (ED) key performance indicators (KPIs).

METHODS

The method employed was a three-round electronic modified-Delphi process. An online questionnaire with 54 potential KPIs was set up for round 1 of the Delphi process. The Delphi panel consisted of all registered EM specialists in Ireland. Each indicator on the questionnaire was rated using a five-point Likert-type rating scale. Agreement was defined as at least 70% of the responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using standard descriptive statistics. Data were also analysed as the mean of the Likert rating with 95% confidence intervals (95% CIs). Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. Statistical analyses were carried out using SPSS version 16.0.

RESULTS

The response rates in rounds 1, 2 and 3 were 86, 88 and 88%, respectively. Ninety-seven potential indicators reached agreement after the three rounds. In the context of the Donabedian structure-process-outcome framework of performance indicators, 41 (42%) of the agreed indicators were structure indicators, 52 (54%) were process indicators and four (4%) were outcome indicators. Overall, the top-three highest rated indicators were: presence of a dedicated ED clinical information system (4.7; 95% CI 4.6-4.9), ED compliance with minimum design standards (4.7; 95% CI 4.5-4.8) and time from ED arrival to first ECG in suspected cardiac chest pain (4.7; 95% CI 4.5-4.9). The top-three highest rated indicators specific to clinical care of children in EDs were: time to administration of antibiotics in children with suspected bacterial meningitis (4.6; 95% CI 4.5-4.8), separate area available within EDs (seeing both adults and children) to assess children (4.4; 95% CI 4.2-4.6) and time to administration of analgesia in children with forearm fractures (4.4; 95% CI 4.2-4.7).

CONCLUSION

Employing a Delphi consensus process, it was possible to reach a consensus among EM specialists in Ireland on a suite of 97 KPIs for EDs.

摘要

目的

本研究旨在爱尔兰从事急诊医学的专家之间达成共识，确定急诊科关键绩效指标（KPI）。

方法

采用三轮电子改良 Delphi 法。第一轮 Delphi 流程建立了一份包含 54 个潜在 KPI 的在线问卷。德尔菲小组由爱尔兰所有注册的急诊医学专家组成。问卷上的每个指标均采用 5 分李克特量表进行评分。共识定义为至少 70%的应答者对量表上的指标评为“同意”或“强烈同意”。使用标准描述性统计数据对数据进行分析。还使用 95%置信区间（95%CI）的李克特评分平均值对数据进行分析。通过对原始样本进行自举法来检查评分的敏感性，以验证其稳健性。使用 SPSS 版本 16.0 进行统计分析。

结果

第一轮、第二轮和第三轮的回复率分别为 86%、88%和 88%。三轮后，97 个潜在指标达成一致。根据绩效指标的 Donabedian 结构-过程-结果框架，41 项（42%）指标为结构性指标，52 项（54%）为过程性指标，4 项（4%）为结果性指标。总体而言，评分最高的前三个指标为：配备专门的急诊临床信息系统（4.7；95%CI 4.6-4.9）、急诊符合最低设计标准（4.7；95%CI 4.5-4.8）和疑似心前胸痛患者从急诊到达至首次心电图的时间（4.7；95%CI 4.5-4.9）。特定于急诊科儿童临床护理的评分最高的前三个指标为：疑似细菌性脑膜炎儿童使用抗生素的时间（4.6；95%CI 4.5-4.8）、急诊科内用于评估儿童的单独区域（同时评估成人和儿童）（4.4；95%CI 4.2-4.6）和儿童前臂骨折时使用镇痛剂的时间（4.4；95%CI 4.2-4.7）。