Murphy Adrian, Wakai Abel, Walsh Cathal, Cummins Fergal, O'Sullivan Ronan
Paediatric Emergency Research Unit (PERU), National Children's Research Centre, Dublin, Ireland.
Division of Population Health Sciences, Emergency Care Research Unit (ECRU), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland Department of Emergency Medicine, Beaumont Hospital, Dublin, Ireland.
Emerg Med J. 2016 Apr;33(4):286-92. doi: 10.1136/emermed-2015-204793. Epub 2016 Jan 21.
INTRODUCTION: Key performance indicators (KPIs) are used to monitor and evaluate critical areas of clinical and support functions that influence patient outcome. Traditional prehospital emergency care performance monitoring has focused solely on response time metrics. The landscape of emergency care delivery in Ireland is in the process of significant national reconfiguration. The development of KPIs is therefore considered one of the key priorities in prehospital research. AIMS: The aim of this study was to develop a suite of KPIs for prehospital emergency care in Ireland. METHODS: A systematic literature review of prehospital care performance measurement was undertaken followed by a three-round Delphi consensus process facilitated by a broad-based multidisciplinary group of panellists. The consensus process was conducted between June 2012 and October 2013. Each candidate indicator on the Delphi survey questionnaire was rated using a 5-point Likert-type rating scale. Agreement was defined as at least 70% of responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using descriptive statistics. Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. RESULTS: Of the 78 citations identified by the systematic review, 5 relevant publications were used to select candidate indicators for the Delphi round 1 questionnaire. Response rates in Delphi rounds 1 and 2 were 89% and 83%, respectively. Following the consensus development conference, 101 KPIs reached consensus. Based on the Donabedian framework for quality-of-care indicators, 7 of the KPIs which reached agreement were structure KPIs, 74 were process KPIs and 20 were outcome KPIs. The highest ranked indicator was a process KPI ('Direct transport of ST-elevation myocardial infarction patients to a primary percutaneous intervention (PCI)-capable facility for ECG to PCI time <90 min'). CONCLUSION: Improving the quality of prehospital care requires the development and implementation of performance measurement using scientifically valid and reliable KPIs. Employing a Delphi panel of key multidisciplinary Emergency Medical Service stakeholders, it was feasible to develop a suite of 101 KPIs for performance monitoring of prehospital emergency care in Ireland. This suite of KPIs may contribute to a framework for achieving safer, better care in the prehospital environment.
引言：关键绩效指标（KPI）用于监测和评估影响患者预后的临床及支持功能的关键领域。传统的院前急救绩效监测仅关注响应时间指标。爱尔兰的急救服务格局正在经历重大的全国性重新配置。因此，制定关键绩效指标被视为院前研究的关键优先事项之一。 目的：本研究的目的是为爱尔兰的院前急救制定一套关键绩效指标。 方法：对院前护理绩效评估进行系统的文献综述，随后由一个基础广泛的多学科专家小组进行三轮德尔菲共识达成过程。共识达成过程于2012年6月至2013年10月进行。德尔菲调查问卷上的每个候选指标都使用5点李克特式评分量表进行评分。达成共识的定义为至少70%的受访者在评分量表上对某个指标评为“同意”或“强烈同意”。使用描述性统计分析数据。通过对原始样本进行自抽样来检验评分的敏感性以确保稳健性。 结果：在系统综述确定的78篇文献中，5篇相关出版物被用于为第一轮德尔菲调查问卷选择候选指标。第一轮和第二轮德尔菲的回复率分别为89%和83%。在共识发展会议之后，101个关键绩效指标达成了共识。基于唐纳贝迪安护理质量指标框架，达成一致的关键绩效指标中有7个是结构指标，74个是过程指标，20个是结果指标。排名最高的指标是一个过程指标（“将ST段抬高型心肌梗死患者直接转运至具备初级经皮冠状动脉介入治疗（PCI）能力的机构，心电图至PCI时间<90分钟”）。 结论：提高院前护理质量需要使用科学有效且可靠的关键绩效指标来制定和实施绩效评估。通过组建一个由关键多学科紧急医疗服务利益相关者组成的德尔菲小组，为爱尔兰院前急救的绩效监测制定一套101个关键绩效指标是可行的。这套关键绩效指标可能有助于构建一个在院前环境中实现更安全、更好护理的框架。
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