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Defining quality indicators for emergency care delivery: findings of an expert consensus process by emergency care practitioners in Africa
  1. Morgan C Broccoli1,
  2. Rachel Moresky2,
  3. Julia Dixon3,
  4. Ivy Muya4,
  5. Cara Taubman2,5,
  6. Lee A Wallis6,
  7. Emilie J Calvello Hynes3
  8. on behalf of the AFEM Scientific Committee
    1. 1 Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA
    2. 2 sidHARTe Program, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA
    3. 3 Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
    4. 4 Nursing Committee Chair and Executive Committee Secretary, African Federation for Emergency Medicine, Cape Town, South Africa
    5. 5 Department of Emergency Medicine, Harlem Hospital, New York, USA
    6. 6 Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
    1. Correspondence to Dr Emilie J Calvello Hynes; emiliejbc{at}gmail.com

    Abstract

    Facility-based emergency care delivery in low-income and middle- income countries is expanding rapidly, particularly in Africa. Unfortunately, these efforts rarely include measurement of the quality or the impact of care provided, which is essential for improvement of care provision. Our aim was to determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. We undertook a multiphase expert consensus process to identify, rank and refine quality indicators. A comprehensive review of the literature identified existing indicators; those associated with a substantial burden of disease in Africa were categorised and presented to consensus conference delegates. Participants selected indicators based on inclusion criteria and priority clinical conditions. The indicators were then presented to a group of expert clinicians via on-line survey; all meeting agreements were refined in-person by a separate panel and ranked according to validity, feasibility and value. The consensus working group selected seven conditions addressing nearly 75% of mortality in the African region to prioritise during indicator development, and the final product at the end of the multiphase study was a list of 76 indicators. This comprehensive process produced a robust set of quality indicators for emergency care that are appropriate for use in the African setting. The adaptation of a standardised set of indicators will enhance the quality of care provided and allow for comparison of system strengthening efforts and resource distribution.

    • health systems
    • health systems evaluation
    • health services research

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/bmjgh-2017-000479

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      Footnotes

      • Contributors MCB, LAW and EJCH conceived and designed the study. All authors contributed substantially to indicator inputs and the indicator selection process. MCB, LAW and EJCH drafted the manuscript. All the authors contributed to the article’s revision.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement No additional data are available.

      • Collaborators Abuagla, Qais; Azaz, Akliilu; Becker, Joe; Bizanso, Mark; Brewer, Tom; Brysiewicz, Petra; Cameron, Peter; Castren, Maaret; Cattermole, Giles; Chang, Cindy; Corder, Robert; Cox, Megan; De Vries, Shaheem; DeVos, Elizabeth; Diango, Ken; Dunlop, Steve; Fraser Doh, Kiesha; Fruhan, Scott; Geduld, Heike; George, Upendo; Hangula, Rachel; Hankin-Wei, Abigail; Hardcastle, Timothy; Harrison, Hooi-Ling; Helmy, Sanna; Hollong, Bonaventure; Jaiganesh, Thiagarajan; Kalanzi, Joseph; Krym, Valerie; Lin, Janet; Loganathan, Deb; Mabula, Peter; Mbanjumucyo, Gabin; Mfinanga, Juma; Mould-Millman, Nee-Kofi; Mukuddem, Nurenesa; Muldoon, Lily; Muller, Mudenga Mutendi; Murray, Brittany; Norgang, Kathryn; Nwauwa, Nnamdi; Nyrienda, Mulinda; Ogunjumo, Daniel; O’Reilly, Gerard; Osama, Muhammed-Ali; Osei-Ampofo, Maxwell; Pakeerathan, Sivarasasingham; Phillips, Georgina; Rahman, Najeeb; Richards, David; Sawe, Hendry; Taubman, Cara; Teklu, Sisay; Tenner, Andi; Tyndall, J Adrian; Wachira, Benjamin; Walter, Darren; Walton, Lisa Moreno; Zaki, Hany. The following countries (number of participants) were represented throughout the process, some participated in more than one phase: Australia (3), Botswana (1), Cameroon (1), Canada (1), DR Congo (3), Egypt (2), Ethiopia (2), Finland (1), Ghana (2), Kenya (1), Malawi (1), Mozambique (1), Namibia (1), Nigeria (2), Rwanda (3), Somalia (1), Sierra Leone (1), South Africa (5), Sudan (2), Tanzania (4), UAE (2), Uganda (1), UK (4), USA (14).