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      Describing key performance indicators for waiting times in emergency centres in the Western Cape Province, South Africa, between 2013 and 2014

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      SAMJ: South African Medical Journal
      Health and Medical Publishing Group

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          Abstract

          BACKGROUND. Data measured as key performance indicators (KPIs) are used internationally in emergency medicine to measure and monitor quality of care. The Department of Health in the Western Cape Province, South Africa, introduced time-based KPIs for emergency centres (ECs) in 2012. OBJECTIVES. To describe the most recently processed results of the audits conducted in Western Cape ECs between 2013 and 2014. METHODS. A retrospective, descriptive study was conducted on data collected in the 6-monthly Western Cape EC triage and waiting time audits for 2013 - 2014. Time variables were analysed overall and per triage category. ECs in hospitals were compared with ECs in community health centres (CHCs). A descriptive analysis of the sample was undertaken. Proportions for categorical data are presented throughout. The continuous variable time was described using means and standard deviations. The χ² test and Fisher's exact test were used to describe associations. The level of significance was p<0.05, with the 95% confidence interval where appropriate. RESULTS. There was no significant difference in triage acuity proportions between hospital and CHC ECs. Waiting times were longer than recommended for the South African Triage Scale, but higher-acuity patients were seen faster than lower-acuity patients. Waiting times were significantly longer at hospitals than at CHCs. A red priority patient presenting to a CHC would take 6.1 times longer to reach definitive care than if the patient had presented to a hospital EC. CONCLUSIONS. The triage process appears to improve waiting times for the sickest patients, although it is protracted throughout. Acutely ill patient journeys starting at CHC ECs suggested significant delays in care. Models need to be explored that allow appropriate care at the first point of contact and rapid transfer if needed. To improve waiting times, resource allocation in the emergency care system will need to be reconsidered.

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          The development of indicators to measure the quality of clinical care in emergency departments following a modified-delphi approach.

          To develop and apply a systematic approach to identify and define valid, relevant, and feasible measures of emergency department (ED) clinical performance. An extensive literature review was conducted to identify clinical conditions frequently treated in most EDs, and clinically relevant outcomes to evaluate these conditions. Based on this review, a set of condition-outcome pairs was defined. An expert panel was convened and a Modified-Delphi process was used to identify specific condition-outcome pairs where the panel felt there was a link between quality of care for the condition and a specific outcome. Next, for highly rated condition-outcome pairs, specific measurable indicators were identified in the literature. The panelists rated these indicators on their relevance to ED performance and need for risk adjustment. The feasibility of calculating these indicators was determined by applying them to a routinely collected data set. Thirteen clinical conditions and eight quality-of-care outcomes (mortality, morbidity, admissions, recurrent visits, follow-up with primary care, length of stay, diagnostics, and resource use) were identified from the literature (104 pairs). The panel selected 21 condition-outcome pairs, representing eight of 13 clinical conditions. Then, the panel selected 29 specific clinical indicators, representing the condition-outcome pairs, to measure ED performance. It was possible to calculate eight of these indicators, covering five clinical conditions, using a routinely collected data set. Using a Modified-Delphi process, it was possible to identify a series of condition-outcome pairs that panelists felt were potentially related to ED quality of care, then define specific indicators for many of these condition-outcome pairs. Some indicators could be measured using an existing data set. The development of sound clinical performance indicators for the ED is possible, but the feasibility of measuring them will be dependent on the availability and accessibility of high-quality data.
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            Crossing the Quality Chasm: A New Health System for the 21st Century

            A. Baker (2001)
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              Part 9: Acute Coronary Syndromes: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                samj
                SAMJ: South African Medical Journal
                SAMJ, S. Afr. med. j.
                Health and Medical Publishing Group (Cape Town, Western Cape Province, South Africa )
                0256-9574
                2078-5135
                July 2018
                : 108
                : 7
                : 579-584
                Affiliations
                [01] orgnameUniversity of Cape Town orgdiv1Faculty of Health Sciences orgdiv2Division of Emergency Medicine South Africa
                Article
                S0256-95742018000700018
                10.7196/samj.2018.v108i7.12969
                30004346
                bab14314-0fbc-4a93-aeca-f7b57043a1d2

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 6
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                SciELO South Africa


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