Madsen Michael, Kiuru Sampsa, Castrèn Maaret, Kurland Lisa
aSilkeborg Hospital and University of Copenhagen, Denmark bAshburton Hospital, Canterbury DHB, New Zealand cUniversity of Turku, Finland dDepartment of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Finland eDepartment of Clinical Science and Education, Karolinska Institutet fDepartment of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
Eur J Emerg Med. 2015 Oct;22(5):298-305. doi: 10.1097/MEJ.0000000000000279.
The aim of this study was to perform a comprehensive systematic review of emergency department performance indicators in relation to evidence. A systematic search was performed through PUBMED, EMBASE, CINAHL and COCHRANE databases with (and including synonyms of) the search words: [emergency medicine OR emergency department] AND [quality indicator(s) OR performance indicator(s) OR performance measure(s)]. Articles were included according to the inclusion/exclusion criteria using the PRISMA protocol. The level of evidence was rated according to the evidence levels by the Oxford Centre for Evidence-Based Medicine. Performance indicators were extracted and organized into five categories; outcome, process, satisfaction, equity and structural/organizational measures. Six thousand four hundred and forty articles were initially identified; 127 provided evidence for/against a minimum of one performance indicator: these were included for further study. Of the 127 articles included, 113 (92%) were primary research studies and only nine (8%) were systematic reviews. Within the 127 articles, we found evidence for 202 individual indicators. Approximately half (n=104) of all this evidence (n=202) studied process-type indicators. Only seven articles (6%) qualified for high quality (level 1b). Sixty-six articles (51%) were good retrospective quality (level 2b or better), whereas the remaining articles were either intermediate quality (25% level 3a or 3b) or poor quality (17% level 4 or 5). We found limited evidence for most emergency department performance indicators, with the majority presenting a low level of evidence. Thus, a core group of evidence-based performance indicators cannot currently be recommended on the basis of this broad review of the literature.
本研究的目的是对急诊科与证据相关的绩效指标进行全面的系统评价。通过PUBMED、EMBASE、CINAHL和COCHRANE数据库，使用检索词[急诊医学或急诊科]和[质量指标或绩效指标或绩效衡量指标]（包括其同义词）进行系统检索。根据纳入/排除标准，使用PRISMA协议纳入文章。证据水平根据牛津循证医学中心的证据等级进行评定。提取绩效指标并将其分为五类：结果、过程、满意度、公平性和结构/组织措施。最初识别出6440篇文章；127篇文章为至少一项绩效指标提供了支持或反对的证据：这些文章被纳入进一步研究。在纳入的127篇文章中，113篇（92%）为原发性研究，只有9篇（8%）为系统评价。在这127篇文章中，我们发现了202个个体指标的证据。所有这些证据（n=202）中约一半（n=104）研究的是过程类型指标。只有7篇文章（6%）符合高质量（1b级）标准。66篇文章（51%）具有良好的回顾性质量（2b级或更高），而其余文章要么是中等质量（25%为3a级或3b级），要么是低质量（17%为4级或5级）。我们发现大多数急诊科绩效指标的证据有限，大多数证据水平较低。因此，基于对文献的广泛综述，目前无法推荐一组基于证据的核心绩效指标。
